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Based on a review of facility documents, it was determined that Penn Highlands Tyrone failed to maintain a Control Register of individuals who presented to the their Emergency Department (ED) seeking assistance for two of two patients identified. (PT1, PT2)

Findings include:

Review of Policy "EMTALA - Central Log, Policy Stat ID 7907986, " last approved May 2020 revealed " ... Purpose: To maintain a system for tracking the care provided to each individual who comes to Tyrone Health Network Emergency Department for an emergency medical condition. Procedure: 1. The Central Log will also include those patients transferred from other facilities to the ED, and those patients who present to the ED, then decline to stay and have a medical screening exam (MSE). The Central Log will be located in the Emergency Department Electronic Health Record. A. Patients who leave prior to medical screening exam without providing a name will be registered as outlined in Guidelines for ED Registration policy. This will generate an entry onto the log, and a chart in the electronic health record. B. The ED nurse will then enter into the patient's chart indicating they left without triage or MSE. C. The Registration Clerk or the ED nurse will complete an EMTALA - left without being seen form for any patient that leaves prior to completing the MSE. ... The log must contain: a. the name, age, gender; b. time of arrival; c. complaint and disposition; d. whether the individual: i. refused treatment; ii. Was refused treatment; iii. Left without being seen (LWBS); iv. Stabilized and transferred (include facility name and time of transfer); v. transferred to another facility (include facility name and time of transfer); vi. Admitted and treated; vii. Discharged including date and time. ... ."

1. Review of Ambulance Trip Sheet dated April 12, 2021, relative to PT1 (MR27) revealed "... 17:39 ... initiated transport to Tyrone ED ... alert sent by ... via radio. ALS patient advisory sent to Tyrone ED via Med8. The facility questioned EMS if the facility is appropriate for the patient. The report lasts the duration of transport to Tyrone ED ... 17:44 ... arrived at Tyrone ED. The crew is met at the door by the Emergency Physician. The physician continues to question EMS and EMS advised that diversion to ... is capable as the patient is stable yet slightly confused. The crew diverts to ... 17:47 ... initiated transport to ... 18:10 ... arrived at ... 18:15 ... ."

2. During review of the Log it was noted that the patient associated with the allegations (PT1), was not present on the Log dated April 12, 2021.
3. Review of Ambulance Trip Sheet for PT2 (MR28) ... AMED trip sheet dated November 11, 2020 reveals, "... 16:35 401 on scene. ... 16:36 Patient contact made. ... 16:45 Enroute Tyrone Hospital. Advised by (EMP5) Nurse ... they are unable to accept the patient and are diverting us to Altoona. 16:51 Enroute to ... 17:14 401 arrives ... . Patient taken to ED ... ."

4. During review of the Log, it was noted that the patient associated with the allegations (PT2 (MR28), was not present on the Log dated November 11, 2020.

Based on a review of facility documents, it was determined that Penn Highlands Tyrone failed to ensure that a medical screening examination was provided for two of two patients who presented to the Emergency Department. (PT1, PT2)

Findings include:

Review of policy "EMTALA - Medical Screening Examination and Stabilization Policy, " last approved January 2021 revealed " ... When an individual comes to the Emergency Department (ED) and a request is made on his or her behalf for an examination or treatment for a medical condition, or a prudent layperson observer would believe that the individual presented with an emergency medical condition (EMC), an appropriate medical screening examination (MSE), within the capabilities of the hospital's ED (including ancillary services routinely available and the availability of on-call physicians), shall be performed by an individual qualified to perform such examination to determine where an EMC exists, or with respect to a pregnant woman having contractions whether the woman is in labor and whether the treatment requested is explicitly for an EMC. If an EMC is determined to exist, the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility, or an appropriate transfer as required by EMTALA. Such stabilization treatment shall be applied in a nondiscriminatory manner ... ."


1. Review of Ambulance Trip Sheet dated April 12, 2021, relative to PT1 revealed "... 17:39 ... initiated transport to Tyrone ED ... alert sent by ... via radio. ALS patient advisory sent to Tyrone ED via Med8. The facility questioned EMS if the facility is appropriate for the patient. The report lasts the duration of transport to Tyrone ED ... 17:44 ... arrived at Tyrone ED. The crew is met at the door by the Emergency Physician. The physician continues to question EMS and EMS advised that diversion to ... is capable as the patient is stable yet slightly confused. The crew diverts to ... 17:47 ... initiated transport to ... 18:10 ... arrived at ... 18:15 ... ."

2. Review of Medical Command Record relative to PT1 which stated "... Date: 4/12/2021 1743 ... unresponsive + apneic breathing son performed CPR ... ETA: 5 minutes A&Orient with confusion ... Command: divert to ... 1747 at door assessed on arrival remains altered after unresponsive episode and patient full code ... ."

3. Facility could provide no documentation that a medical screening examination was completed for PT1.

4. Review of Ambulance Trip Sheet for PT2 (MR28) ... AMED trip sheet dated November 11, 2020 reveals, "... 16:35 401 on scene. ... 16:36 Patient contact made. ... 16:45 Enroute Tyrone Hospital. Advised by (EMP5) Nurse ... they are unable to accept the patient and are diverting us to Altoona. 16:51 Enroute to ... 17:14 401 arrives ... . Patient taken to ED ... ."

5. Facility could provide no documentation that a medical screening examination was completed for PT2.

Based on a review of facility documents and medical records (MR), it was determined that Penn Highlands Tyrone failed to ensure an appropriate transfer for two of two patients. (PT1, PT2)

Findings include:

Review of policy "Transfer of Patient to Another Health Care Facility, Policy Stat ID 7676405," last approved February 2020, revealed " Patients must not arbitrarily be transferred to another health care facility. ... Acceptance shall be documented of the Memorandum of Transfer Form, which the patient signs. ... The Memorandum of Transfer Form must be completed by the ED nurse/physician and patient or their representative. ... "
Review of policy "Transfer of Emergency Patients Between Hospitals, Policy Stat ID 7676384, " last approved February 2020, revealed " ... d. The patient and/or guardian (in case of a minor) should be informed and concur with the transfer. The Consent form must be signed by the patient or parent/guardian and the physician in the ED. E. The patient must be stable prior to transfer or documentation by the M.D. that the benefits of the transfer outweigh the risks. ... g. Copies of the Emergency Department record including laboratory and x-ray reports and Memorandum of Transfer form must be sent with the patient or faxed within one hour. ... ."
1. Review of Ambulance Trip Sheet dated April 12, 2021, relative to PT1 revealed "... 17:39 ... initiated transport to Tyrone ED ... alert sent by ... via radio. ALS patient advisory sent to Tyrone ED via ... The facility questioned EMS if the facility is appropriate for the patient. The report lasts the duration of transport to Tyrone ED ... 17:44 ... arrived at Tyrone ED. The crew is met at the door by the Emergency Physician. The physician continues to question EMS and EMS advised that diversion to ... is capable as the patient is stable yet slightly confused. The crew diverts to ... 17:47 ... initiated transport to ... 18:10 ... arrived at ... 18:15 ... ."

2. Review of Tyrone Hospital Medical Command Record relative to PT1 which stated "... Date: 4/12/2021 ... unresponsive + apneic breathing ... performed CPR ... ETA: 5 minutes A&Orient with confusion ... Command: divert to ... 1747 at door assessed on arrival remains altered after unresponsive episode and patient full code ... ."

3. There was no documentation relative to PT1 that appropriate transfer arrangements occurred.

4. Review of Ambulance Trip Sheet for PT2 (MR28) ... AMED trip sheet dated November 11, 2020 reveals, "... 16:35 401 on scene. ... 16:36 Patient contact made. ... 16:45 Enroute Tyrone Hospital. Advised by (EMP5) Nurse ... they are unable to accept the patient and are diverting us to Altoona. 16:51 Enroute to ... 17:14 401 arrives ... . Patient taken to ED ... ."

5. There was no documentation relative to PT2 that appropriate transfer arrangements occurred.