HospitalInspections.org

Based on document review and interview, facility failed to report receiving a patient that may have been transferred in violation of the requirements of 489.24(e), for 2 of 20 (patients 1 and 2's) medical records (MR) reviewed.

Findings include:

1. Review of facility policy, Emergency Medical Treatment and Labor Act (EMTALA), 700-119, revised 7/13/2016, indicated, if at any time it is believed that (facility 1) may have received an individual who was transferred in an unstabilized emergency medical condition from another hospital in violation of the requirements of EMTALA, Risk Management should be contacted immediately.

2. Review of E-mail, to N1 (Chief Quality Risk, Regulatory and Patient Safety Officer), from N7 (Medical Doctor, Fellow of the American Psychiatric Association), with a date, April 01, 2019 11:50 am, indicated the following. Today (Facility 2) sent someone to our hospital from their emergency department ostensibly for psychiatric admission. They did not call us to discuss the patient and obviously we did not accept the patient transfer. Attached is the emergency department note with conflicting disposition plan from the resident documentation to the attending documentation. I think this was likely an accident but I believe it may be an EMTALA violation, nevertheless. They (the) patient is currently checked into our emergency department. His MRN (medical record number) (patient 1)...

3. Review of E-mail, to N1 (Chief Quality Risk, Regulatory and Patient Safety Officer), from N6 (Emergency Department Clinical Operations Director), with a date of April 01, 2019 2:08 pm, indicated the following. We had a patient arrive to the ED (Emergency Department) today in a... ambulance from the ED (Emergency Department) at (facility 2)... The nurse then called (facility 2) and spoke with a resident... (He/She) stated the patient had been seen by... (their crisis staff) and they cleared (him/her) for release the night before. The resident called... (their crisis staff) to come see the patient again because he was not comfortable releasing the patient... (Charge Nurse) came to me because (facility 2) transferred us a patient without an accepting physician, concerned it was an EMTALA violation... N8 (Resident, Medical Doctor) stated that (he/she) didn't feel comfortable from a safety standpoint sending the patient via cab so he/she called an ambulance... I asked (N8) if he/she had contacted someone at... (facility 1) to transfer the patient and (he/she) said (he/she) had not...

4. Review of patient 1's MR, Patient Care Timeline, dated 4/1/2019, first time noted 11:20 am, indicated the following. Arrival Complaint SI (Suicidal Ideation) sent from facility 2 ...resident said that (he/she) did not feel comfortable sending patient by car...released the patient and had (him/her) sent by ambulance to facility 1.
Patient discharged (facility 1) at 15:02 pm.

5. Review of E-mail from S2 (Medical Doctor) on April 10, 2019, at 4:20 am, indicated the following. I received a transfer from (facility 3) for cellulitis around the eye. The patient had normal vision, no eye pain, no photophobia. (He/she) failed outpatient antibiotics and was sent there to be admitted and the hospitalist refused admission. I accepted the patient because (he/she) had nowhere to go but I was wondering if this would be an EMTALA violation? (emails indicated patient was patient #2)

6. Review of E-mail from S1 (Medical Director of Emergency Department) to N1, with a date of April 16, 2019 7:07 am, indicated the following. (S2) asked me about this patient. Evidently this was not an ophthalmology problem, the hospitalist at (facility 3) told their ED (emergency department) they would not admit the patient. Could this be a failure to treat a patient that is within their purview to treat?...

7. Review of patient 2's MR indicated admitted 4/10/2019 at 3:19 am and discharged on 4/11/2019 at 3:41 pm. ED (emergency department) Provider Note Signed by S2 on 4/10/2019, 4:55 am, indicated the following. History obtained from patient. 11 days ago (he/she) was doing yard work and was scratched over the left eye. He/she had skin redness, swelling and pain several days after... was placed on Keflex last Sunday. He/she noticed the pain, redness and swelling did not completely go away so he/she went to (facility 3). There he/she was diagnosed with preseptal cellulitis, he was refused admission by the hospitalist at (facility 3) and was transferred here for antibiotics...

8. Interview on 4/16/2019, at approximately 4:11 pm, with N1, confirmed N1 was still investigating patient 1 and 2 about possible EMTALA violation. N1 had not reported a possible violation to CMS or the state survey agency.