HospitalInspections.org

Based on policy and procedure review, medical record review and interview, the hospital failed to adhere to the provider's agreement that required a hospital to be compliant 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. See 2011 for further details.

Based on policy and procedure review, medical record review, and interview, it was determined the facility failed to accept an appropriate transfer for one of one (#1) patient requiring intensive care unit and surgical services not offered by the transferring facility. By not accepting Patient #1 the facility delayed the treatment needed for Patient #1. The failed practice had the likelihood to affect any patient needing intensive care unit and surgical services provided by the facility. Findings follow:

A. Review of Patient #1's clinical record showed:
1) Patient arrived by Emergency Medical Service (EMS) to Hospital A and was triaged on arrival at 10:21 AM on 6/30/2024.
2) Patient #1's chief complaint on arrival was diarrhea for past two weeks with nausea no pain.
3) Patients medical history showed Irritable Bowel Syndrome (IBS), Alcoholic Cirrhosis, and Chronic Congestive Heart Failure (CHF).
4) At 10:21 AM Blood Pressure (BP) 119/76 Mean Arterial Pressure (MAP) 90 Heart Rate (HR) 110 Respiratory Rate (RR) 20 with Oxygen Saturation (O2) of 94% on Room Air (RA) Temperature 98.4 Fahrenheit (F) 0/10 pain scale Glasgow Coma Scale (GCS) 15/15.
5) At 12:35 PM BP 120/60 MAP 84 HR 106 RR 18 O2 99% Temperature 98. (F) Pain 0/10 GCS 15/15.
6) At 3:21 PM Reassessment to Acuity Level 54 reason: "He (Patient #1) reports no complaints, he is calm and resting quietly and has had no adverse reaction. Overall patient status improved.
7) Computerized Tomography (CT) showed
a) Small bowel obstruction (SBO) with dilated loops ranging to 45.8 millimeter (mm)
b) Acute diverticulitis of the ascending colon extending to the proximal transverse colon with small microperforations. There is no evidence of colonic abscess.
c) Severe hepatomegaly and steatosis of the liver.
d) Nonobstructing left nephrolithiasis.
8) Vitals at time of discharge at 5:25 PM on 6/30/2024 were BP 116/80 Pulse 66 Temp 89.4 RR 20 O2 99
9) Diagnosis SBO, SEPSIS
B. Patient was accepted for transfer to Jefferson Regional Medical Center (JRMC) at 12:33 PM on 6/30/2024.
C. At 1:21 PM JRMC refused patient on grounds that Physician #1 was not advised of patient's hepatic comorbidties.
D. Patient #1 was accepted and transferred to Hospital C at 5:25 PM. Hospital C is 278 miles from Hospital A which is 234 miles farther than if the patient had transferred to JRMC.
E. Review of Diversion Log showed that the facility was not on Intensive Care Unit or Surgical Services diversion on 6/30/2024.
F. Review of on-call roster for 6/30/2024 showed Physician #1 was on-call, was privileged for surgical services by the hospital and carried a Fellowship in American College of Surgeons.
G. Review of facility policy titled EMTALA showed that "Jefferson Regional will accept appropriate transfers of individuals with emergency medical conditions if we have the specialized capabilities not available at the transferring hospital and have the capacity to treat those individuals."