HospitalInspections.org

Based on interviews and record reviews, the facility was not in compliance with the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide an appropriate transfer. Refer to Tag 2409.

Based on record review and interview, the facility failed to transfer 1 [P(patient)1 ] of 20 patients reviewed to an outside facility for a condition that was determined to need a higher level of care. This deficient practice is likely to affect all pediatric patients who present with an emergency medical condition and who require a higher level of care.

The findings are:

A. Record review of Facility Policy and Procedure titled "101.08 Emergency Services and Transfer & Discharge," last revised 02/2022 effective 12/2022, stated on page 1 under title "POLICY," number 6: "6. If it is determined that transfer to another facility is necessary, contact will be made by the physician and by the nurse. Physician will speak with ED [Emergency Department] physician or specialty physician and gain acceptance; the nurse will speak with the admissions unit for bed placement and give RN [Registered Nurse] to RN report. A Memorandum of Transfer (see attachment) will be completed and a copy sent with a patient as well as any pertinent documentation for the receiving facility."

B. Record review of P1 "ED [Emergency Department] Note Provider" for Facility (F) 1, dated 11/26/2022 at 9:15 pm, page 2, located under title "Chief Complaint" Pt presents to ED stating testicular pain on the left side...testicular pain, swelling, and redness.

C. Record review of P1 "ED Note Provider" for Facility (F) 1, aged 10 years old, Medical Record, dated 11/26/2022, page 3, located under title "Medical Decision Making" where in consulting Urologist [S(staff)] 12, at [F2] "recommended urgent evaluation in the ED at [F2]."

D. Record review of P1 "ED Note Provider" for F1 Medical Record, dated 11/26/2022, page 3, located under title "Medical Decision Making" stated: "He appears nontoxic (nonseptic-no infection in blood stream) and we will leave the IV (intravenous catheter, a device used to draw blood and give treatments including intravenous fluids, drugs, or blood transfusions) in the hopes that there will be no further delays. Discussed case with (S13) MD (Medical Doctor) in the ED at [Name of Facility 2] to give report."

E. Record review of P1 Medical Record for F1 dated 11/26/2022, page 1 of ED Discharge Information, located under title "Discharge Instructions", revealed: "Go to the ER (emergency room) at (F2) immediately where (S12), MD (Medical Doctor) Urologist, will evaluate him in the ER."

F. Record review of P1 Medical Record form F1 showed no evidence of "Memorandum of Transfer (document containing vital information to be provided to receiving facility)."

G. Record review of Emergency Department Activity Log at F1 dated 11/26/2022 listed P1's disposition on 11/26/2022 at 11:12 pm as "Home or Self Care." P1 was discharged from F1 and not transferred to F2.

H. During an interview with Emergency Department Medical Director S (Staff) 5 on 12/06/2022 at 9:56 am stated, "That Facility F2 and F3 were not accepting transfers at this time. We discuss with patients hospitals that are refusing transfers and if they go to their [another hospital] door they must treat. We have patients who understand and go on their own. We don't admit anyone under 18 at this facility. We don't have specialists for Pediatrics (PEDs) or Obstetric (OB) patients. No resources, equipment, over worked with our hospitals and when we deem there is an emergency, it is a risk to work in this setting."

I. During an interview with Emergency Department Registered Nurse (RN) S9 on 12/06/2022 at 11:32 am, stated that a patient would never be told to transfer or to go themselves to another facility. S9 also stated that "a patient should never leave with an IV in their arm. Potentially could be dangerous if not monitored by a medical professional".

J. During an interview with Clinical Informatics Coordinator S1, on 12/06/2022 at 9:00 am, during medical record review, confirmed that P1 medical record indicated the that there was a need for immediate Urologic evaluation, the IV was left in P1 and confirmed that the patient was discharged and not transferred to another facility. The patient was taken to another facility in a personal vehicle. It was confirmed that P1 was not provided medical records related to the emergency medical condition at the time of discharge.

K. Record review of P1 Emergency Department Record at F2 dated 11/26/2022 page 6, located under "Physician Documentation" at 11:41 pm, "This 10 yrs old White Male presents to ER via Walk In (no prior arrangements were made by F1) with complaints of Urinary Problem... Male brought in from outside facility reported coming in with swollen erythematous testicle (result of increased flow in the blood vessels close to the skin that occurs in the setting of injury, infection or generalized inflammation) scrotal area (the bag of skin that holds and helps to protect the testicles)."

L. Record review of F2 Consult Note dated 11/27/2022 page 9, located under "Assessment" at 12:22 am, "This male child has enough positive findings on history and on physical examination to be concerning for acute testicular torsion on the left...Given that time is of essence, if the testis is compromised and may die, surgical exploration in a case like this is recommended."

M. Record review of F2 Operative Report dated 11/27/2022 page 18, located under "Findings" at 2:53 am, "The left testis was torsed (cutting off blood supply to the testicle)."



























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