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Based on interview and record review, the hospital failed to abide by the provider's agreement that required a hospital to comply with §42 CFR 489.24, Special responsibilities of Medicare hospitals in emergency cases. The hospital was not in compliance with the EMTALA (Emergency Medical Treatment and Labor Act) requirements, citing 1 of 1 patient (Patient #6) that presented in the emergency department on 10/01/17 and then was transferred to a local facility.

Cross Refer to Tag 2406

Based on interview and record review, the hospital failed to provide an appropriate medical screening examination of 1 of 1 patient (Patient #6) who presented in the emergency room on 10/01/17. A radiologist conducted a "CT scan" of the facial bones, listed multiple findings, and noted that a follow-up ophthalmology consultation was recommended for further evaluation. The ophthalmologist on-call (Physician #5) was notified of the findings and did not examine Patient #6.

Findings included:

Patient #6 presented in the emergency department (ED) on 10/01/17 at 1:31 PM via ambulance. The chief complaint was "The patient was hit in the right eye with a golf ball." Patient #6 was transferred to the facility from their sister hospital. The ED physician saw Patient #6 at 1:32 PM. The physician noted the patient was "hit with his own golf ball around 11:00 AM while playing golf." Patient #6 "complained pressure to the right eye, and had no vision out of the right eye." Patient #6 "reported he could not open his eyelid on his own." The "triage BP (blood pressure) was 161/99." The pain level was "8" of a pain scale of 10. The Physical Examination of the eye included "2 x 1/2 cm laceration of the lower lid, rupture globe, mild bleeding from the globe, globe appears to be deformed, no light perception, hemorrhage from globe." The "Differential Diagnosis: Open globe fracture."

The "CT Facial Bones W/O IV Contrast impression: 1. Fracture of the floor the right orbit. 2. Fracture of the medial floor of the right orbit and lamina papyracea. 3. Right cheek and orbital soft tissue edema. 4. Hemorrhage in the right maxillary sinus and in many of the right ethmoid air cells. 5. Marked deformity of the right globe...the finding is consistent with a ruptured right globe...consistent with hemorrhage in the vitreous and aqueous. Follow-up ophthalmology consultation is recommended for further evaluation."

On 10/01/17 at 2:08 PM the ED physician noted "Discussed patient's case with Physician #5 who is on-call...and wants to transfer patient...At 3:10 PM call with Physician/local hospital who will accept the patient..." The ED disposition was "transfer to acute care hospital."

In an interview with Physician #4 the attending ED physician on 01/16/18 at 11:22 AM and 01/18/18 at 2:05 PM, Physician #5 stated he took care of Patient #6 on 10/01/17. Patient #6 had a ruptured globe and was transferred from their sister hospital. Physician #4 consulted with Physician #5 who was the ophthalmology on-call that day [10/01/17]. Physician #5 was informed of the findings. Physician #5 told Physician #4 that he needed another ophthalmologist to work on Patient #6 and that he was the only ophthalmologist that worked in the hospital. Physician #4 was told by Physician #5 that Patient #6 needed to be transferred to this particular local hospital, but this hospital did not have ophthalmology services. Physician #5 transferred Patient #6 to a different local hospital that had available ophthalmology services. Physician #4 was asked if he requested Physician #5 to come to the ED to physically assess the patient. Physician #4 replied "no." Physician #4 stated he thoroughly explained Patient #6's medical condition to Physician #5.

In an interview with Physician #5 on 01/16/18 at 1:12 PM via telephone he stated he recalled the case. The ED physician told him a detailed description of the patient's injury and reviewed the patient's CT scan which he could access in the computer. Physician #5 stated with all the information he gathered, he told the ED physician that this was beyond his skill sets and could not manage the patient's care. This would require a complicated wound closure that required 2 eye surgeons. The patient's tissue disruption was extensive in the posterior globe. The patient needed a higher level of care..."I knew my limitation; I could not tackle the patient's condition."