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A. Based on medical record review and staff interview it was determined the Hospital failed to ensure certification on the risks and benefits of transfer were completed on all patients transferred (A-2409).

A. Based on medical record review, ambulance run sheet, interviews and staff interview, it was determined in 2 of 20 (Pt #1 and #4) medical records reviewed, the Hospital failed to ensure documentation of certification regarding the benefits and risks associated with the transfer.

Findings include:

1. The medical record of Pt. #1 was reviewed on 8/2/11. Pt. #1 was triaged at 0836 and an EKG was performed and indicated Pt. #1 was suffering an acute myocardial infarction, sinus bradycardia and left axis deviation. Pt. #1 had a Medical Screening examination by E # 1 with documentation indicating the primary impression was Myocardial Infarction acute, condition critical, referral documentation indicated discussed transferring Pt. #1 with receiving hospital. Ground transfer was indicated. The " Authorization for Transfer " form indicated, Pt #1 was stable and that Pt. #1 requested the transfer. The Medical record did not have documentation that Pt. #1 ' s wife or Pt. #1 was made aware of the risk of further deterioration and even death could occur during the transfer or that there was a closer hospital than the accepting hospital . There was no written request for a transfer by Pt. #1 or Pt. #1 ' s wife, nor was there any reasons why the transfer was being requested and a statement that Pt. #1 or Pt. #1 ' s wife was aware of the risks and benefits associated with the transfer found in Pt.#1 ' s medical record.

2. The ambulance run sheet was reviewed on 8/2/11 indicating Pt. #1 left transferring hospital enroute to accepting hospital at 0910 am on 07/19/11 via Advanced Life Support ambulance with transferring Hospital ED RN, Pt. # 1 received pain medication in the ambulance, was nauseated, vomited and suffered ventricular fibrillation , requiring resuscitation in the ambulance. Documentation indicated a full resuscitation effort was in progress in the ambulance. According to ambulance run sheets and interview with the transferring RN, after administering the pain medication in the ambulance and the code, the ambulance diverted to the closest Hospital.

3. Review of the receiving Hospital ED record of Pt. #1 on 8/2/11 by the ambulance indicated that Pt. #1 expired in the ED of the receiving hospital after unsuccessful resuscitation efforts. Pt. #1 was pronounced dead at the receiving Hospital, 4 miles away from the transferring Hospital.

4. The medical record of Pt #4 was reviewed on 8/2/11. Pt #4 presented to the Emergency Department (ED) on 6/7/11 with the Chief Complaint (CC) of Full Arrest. ED documentation indicated Pt #4 was resuscitated, diagnosed with Acute Myocardial Infarction (AMI), and transferred by land to an outlying hospital for cardiac follow up. Documentation on the Physician's "ED Provider Documentation" indicated "Narrative Course - Patient went into a full arrest secondary to an acute MI. I spoke to" physician at receiving hospital "and it was felt the patient could be transferred there under the stat heart protocol and hypothermia. Family was informed and agreeable. Patient left the ER with vital signs and unconscious." Documentation does not include the risks and benefits associated with the transfer or a copy of the Hospitals "Authorization for Transfer" form which identifies if the patient is stable or not and that the risk and benefits of the transfer were discussed and approved by the patient or authorized representative.

5. During a staff interview, conducted with the Executive Director, Critical Care Services on 8/2/11 at 3:00 PM, the above findings were confirmed.