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Based on record review and interview, Hospital A failed to comply with 489.24 (e) (1)-(2) for 1 of 10 patients (Patient #1), in that the Emergency Department (ED) personnel did not contact Hospital B to secure an available bed for the transfer of Patient #1 who was needing a higher level of care. Hospital A directly called the 911 EMS System (Emergency Medical Service) for the transfer of Patient #1 on 11/16/14.

Findings included:

Patient #1 presented in the Hospital A Emergency Department located at North Tarrant Parkway, Fort Worth, TX 76177 on 11/16/14 at 6:37 PM for a head injury. From 6:51 PM to 7:00 PM, Physician #8 intubated the patient. Physician #8 noted "Disposition...Primary Impression: intracranial hemorrhage, Secondary Impression: Fall, Scalp laceration, Disposition: Transferred...Yes." On 11/16/14 at 7:45 PM the patient left the facility via ambulance. There was no documentation in Patient #1's medical record for the following information: Hospital A called Hospital B to pre-arrange a transfer, physician to physician report was conducted, medical record was sent, and a memorandum of transfer was completed.

In an interview on 12/2/14 at 3:07 PM in Hospital's A "Houston" conference room via phone, Personnel #6 was asked who called 911 to transfer Patient #1. Personnel #6 replied that she did. Personnel #6 stated this was not the procedure when transferring a patient. Personnel #6 stated the ED protocol was to call the transfer center for transfers of ED patients. Personnel #6 was was asked if a memorandum of transfer was completed. Personnel #6 replied that it was not. This was confirmed by Personnel #4 on 12/2/14 at 8:30 PM via phone.

Hospital A's policy: "EMTALA Texas Transfer (Emergency Medical Treatment and Labor Act)" reviewed 12/2013 pages 1, 6, and 13 required "Any transfer of an individual with an emergency medical condition (EMC) must be initiated by a written request for transfer from the individual...or by a physician order with the appropriate physician certification as required under EMTALA. EMTALA obligations regarding the appropriate transfer of an individual determined to have an EMC apply to any dedicated emergency department of a hospital whether located on or off campus...Any individual who has been medically stabilized may be transferred...pursuant to physician's order via a pre-arranged transfer of treatment plan...and all of the following conditions are met: a. Minimize the Risk...b. Document stable condition...c. Consent...d. Send Medical Records...e. Send Memorandum of Transfer..."

Based on record review and interview, Hospital A failed to provide an appropriate transfer for 1 of 10 patients (Patient #1) on 11/16/14, in that, the Emergency Department (ED) personnel did not contact Hospital B to secure available bed for Patient #1 who was needing a higher level of care. Hospital A directly called 911 EMS System (Emergency Medical Service) to transfer Patient #1 on 11/16/14.

Findings included:

Patient #1 presented in the Hospital A Emergency Department located at North Tarrant Parkway, Fort Worth, TX 76177 on 11/16/14 at 6:37 PM for a head injury. From 6:51 PM to 7:00 PM, Physician #8 intubated the patient. Physician #8 noted "Disposition...Primary Impression: intracranial hemorrhage, Secondary Impression: Fall, Scalp laceration, Disposition: Transferred...Yes." On 11/16/14 at 7:45 PM the patient left the facility via ambulance. There was no documentation in Patient #1's medical record for the following: Hospital A called Hospital B if space and qualified personnel was available for the treatment of Patient #1 and if Hospital B agreed to provide appropriate medical treatment.

In an interview on 12/2/14 at 3:07 PM in Hospital's A "Houston" conference room via phone, Personnel #6 was asked who called 911 to transfer Patient #1. Personnel #6 replied that she did. Personnel #6 stated this was not the procedure when transferring a patient. Personnel #6 stated the ED protocol was to call the transfer center for transfers of ED patients. Personnel #6 was was asked if a memorandum of transfer was completed. Personnel #6 replied that it was not. This was confirmed by Personnel #4 on 12/2/14 at 8:30 PM via phone.

Hospital B's medical record for Patient #1 dated 11/16/14 reflected "HPI - 7:58 PM Patient #1...presents to the ED via EMS as a transfer from Hospital A...Per EMS, patient fell and hit his head...approximately 6:00 PM...While at Hospital A, patient lost consciousness...intubated...Patient did not receive a CT scan." The notation was authored by a physician from Hospital B on 11/16/14 at 7:57 PM.

Hospital A's policy: "EMTALA Texas Transfer (Emergency Medical Treatment and Labor Act)" reviewed 12/2013 pages 1, 6, and 13 required "Any transfer of an individual with an emergency medical condition (EMC) must be initiated by a written request for transfer from the individual...or by a physician order with the appropriate physician certification as required under EMTALA. EMTALA obligations regarding the appropriate transfer of an individual determined to have an EMC apply to any dedicated emergency department of a hospital whether located on or off campus...Any individual who has been medically stabilized may be transferred...pursuant to physician's order via a pre-arranged transfer of treatment plan...and all of the following conditions are met: a. Minimize the Risk...b. Document stable condition...c. Consent...d. Send Medical Records...e. Send Memorandum of Transfer..."

Patient Transfer Agreement dated 9/1/12 between Hospital A and Hospital B indicated both parties "acknowledged, understood and agreed the following...Responsibilities of the Parties...Notify the receiving Party's designated representative prior to transfer to receive confirmation as to availability of appropriate space, services, and staff necessary to provide care to the Patient..."