The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

NORTH FLORIDA REGIONAL MEDICAL CENTER 6500 NEWBERRY RD GAINESVILLE, FL 32605 Feb. 13, 2014
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on interview(s), reviews of medical records and policy and procedures the hospital failed to provide a medical screening examination and evaluation for one (#1) of 34 patients presenting to the hospital to determine if an emergency medical condition existed. Refer to finding in Tag A-2406.

Based on interview(s), reviews of medical records and policy and procedures the hospital failed to provide stabilizing treatment that was within the capability of the hospital as required for one (#1) of 34 patients presenting to the hospital to emergency department. Refer to findings in tag A-2407.

Based on review of policy and procedures, and staff interview the facility failed to ensure that their policy and procedures regarding transfers was followed by failing to appropriately transfer an individual by not ensuring that medical treatment was first provided that was within the capability and capacity of the hospital to minimize risks to the individuals health; and failed to ensure the receiving hospital was contacted, and had agreed to accept the patient and had space and qualified personnel available to for treatment of 1 (#1) of 34 sampled patients. Refer to findings in Tag A-2409
VIOLATION: HOSPITAL MUST MAINTAIN RECORDS Tag No: A2403
Based on interviews and medical record reviews the hospital failed to maintain records for one (#1) of 34 patients sampled presenting to the hospital emergency department.

Findings are:

Review of the patient's medical record from the transferring hospital for patient #1 revealed she was transferred via EMS to North Florida Regional Medical Center on 01/22/2014.

Review of the Physicians Certification of Medical Necessity for Ambulance Transportation dated 01/22/2014 revealed: Destination: North Florida Regional Medical Center ER. Patient's physical condition and/or medical interventions that make transportation by ambulance medically necessary: Large gastric ulcer - weakness. Family wants transfer North Florida Regional. The transfer form was signed by the physician. The physician noted an accepting physician.

Review of the transferring hospital nurses notes on 01/22/2014 revealed:
15:34 Report called to RN (Registered Nurse) at NFRMC ER. Transferred by EMS ground to North Florida Regional Medical Center.
15:36 ER care complete, transfer ordered by MD
16:22 Patient left the ED

On 02/07/2014 at 3:45 PM a call to the Emergency Department Charge Nurse revealed she was in charge on January 22, 2014 when the patient was transferred to North Florida Regional Medical Center. She received a phone call from the nurse at the transferring hospital to give report. She determined the Emergency Department physicians had not accepted this patient. She told the transferring hospital to call the transport center and tell them which hospital they were to send the patient to. She and the ED physician went out to the ambulance when it arrived. The patient was then transported to another facility. The patient was not examined by the physician.

On 02/07/2014 at 11:45 AM interview with the Emergency Department physician revealed the female patient was transferred to the facility via EMS from another hospital. She stated she called the transport center and determined the patient was to go to a different facility. The physician spoke with the ambulance driver and informed her patient was going to the other hospital. The physician stated patient never got out of the ambulance and was not examined.

The hospital was unable to provide the surveyor with patient records at the facility on the date the patient#1 arrived via ambulance.
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
Based on interview and reviews of medical record(s), Central Logs and policies and procedures, review the hospital failed to maintain records for one (#1) of 34 patients sampled presenting to the hospital emergency department.

Findings are:

A review of the policy and procedures 900-1.307.400 EMTALA - Florida Central Log Policy effective 04/12 revealed: The hospital will maintain a Central Log containing information on each individual who comes on the hospital campus requesting assistance or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment, whether he or she was refused treatment, or whether he or she was transferred or discharged . The Central log of individuals who have come to the hospital seeking medical attention or who appeared to need medical attention will be available within a reasonable amount of time for surveyor review and must be retained for a minimum of five years from the date of disposition of the individual.


Review of the patient's (#1) medical record from the transferring hospital for patient #1 revealed she was transferred via EMS to North Florida Regional Medical Center (NFRMC) on 01/22/2014.


On 02/07/2014 at 3:45 PM a call to the Emergency Department Charge Nurse revealed she was in charge on January 22, 2014 when the patient (#1) was transferred to North Florida Regional Medical Center. On 02/07/2014 at 11:45 AM interview with the Emergency Department physician verified the female patient (#1) was transferred to the facility via EMS from another hospital. She stated she called the transport center and determined the patient was to go to a different facility.


The hospital failed to ensure that their policy and procedure on central log was followed as evidenced by failing to maintain central log information on patient #1 on 1/22/2014 when she presented to North Florida Regional Medical Center via ambulance.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on interviews, reviews of medical records, policies and procedures the hospital failed to provide a medical screening, examination and evaluation for one (#1) of 34 patients presenting to the hospital's emergency department to determine if an emergency medical condition existed.

Findings are:

Review of the medical record for patient #1 revealed she was transferred via EMS to North Florida Regional Medical Center on 01/22/2014.

Review of the Physicians Certification of Medical Necessity for Ambulance Transportation dated 01/22/2014 revealed: Destination: North Florida Regional Medical Center ER. Patient's physical condition and/or medical interventions that make transportation by ambulance medically necessary: Large gastric ulcer - weakness. Family wants transfer North Florida Regional. The transfer form was signed by the physician. The physician noted an accepting physician.

Review of the transferring hospital nurses notes on 01/22/2014 revealed:
15:34 Report called to RN (Registered Nurse) at NFRMC ER. Transferred by EMS ground to North Florida Regional Medical Center.
15:36 ER care complete, transfer ordered by MD
16:22 Patient left the ED

On 02/07/2014 at 3:45 PM a call to the Emergency Department Charge Nurse revealed she was in charge on January 22, 2014 when the patient was transferred to North Florida Regional Medical Center. She received a phone call from the nurse at the transferring hospital to give report. She determined the Emergency Department physicians had not accepted this patient. She told the transferring hospital to call the transport center and tell them which hospital they were to send the patient to. She and the ED physician went out to the ambulance when it arrived. The patient was then transported to another facility. The patient was not examined by the physician.

On 02/07/2014 at 11:45 AM interview with the Emergency Department physician revealed the female patient was transferred to the facility via EMS from another hospital. She stated she called the transport center and determined the patient was to go to a different facility. The physician spoke with the ambulance driver and informed her the patient was going to the other hospital. The physician stated patient never got out of the ambulance and was not examined. She said she has since learned she had to get the patient out of ambulance and medically screen them once they arrive on the property.

A review of the facility policy and procedures for the Florida Medical Screening Examination and Stabilization Policy #900-1.307 Effective 03/13 revealed:

An MSE is required when:

a. ii. The individual arrives as a transfer from another hospital or health care facility. Upon arrival of a transfer, a physician or qualified medical person (QMP) must perform an appropriate MSE. The Physician or QMP shall provide any additional screening and treatment required to stabilize the EMC. The MSE of the individual must be documented. This type of screening cannot be performed by the triage nurse.

d. An individual is in a ground or air ambulance for purposes of examination and treatment for a medical condition at a hospital's DED, and the ambulance is either: owned and operated by the hospital, even if the ambulance is not on hospital grounds, or neither owned nor operated by the hospital, but on hospital property.

The facility failed to ensure that their policy and procedure was followed as evidenced by failing to perform a medical screening examination upon arrival of a transfer by a Physician or Qualified Medical Professional for patient#1 on 1/22/2014.
VIOLATION: STABILIZING TREATMENT Tag No: A2407
Based on interviews, reviews of medical records and policy and procedures the hospital failed to provide stabilizing treatment that was within the capability of the hospital as required for one (#1) of 34 patients presenting to the hospital to emergency department. Refer to findings in tag A-2407.
Findings are:


A review of the facility policy and procedures for the Florida Medical Screening Examination and Stabilization Policy #900-1.307 Effective 03/13 revealed:


8. Stabilizing treatment within hospital capability and transfer.
Once the hospital has provided an appropriate MSE and stabilizing treatment within its capability, an appropriate transfer may be affected by following the appropriate transfer provisions


Review of the medical record for patient #1 revealed she was transferred via EMS to North Florida Regional Medical Center on 01/22/2014. Review of the Physicians Certification of Medical Necessity for Ambulance Transportation dated 01/22/2014 revealed: Destination: North Florida Regional Medical Center ER. Patient's physical condition and/or medical interventions that make transportation by ambulance medically necessary: Large gastric ulcer - weakness. Family wants transfer North Florida Regional. The transfer form was signed by the physician. The physician noted an accepting physician.


On 02/07/2014 at 11:45 AM interview with the Emergency Department physician revealed the female patient was transferred to the facility via EMS from another hospital. She stated she called the transport center and determined the patient was to go to a different facility. The physician spoke with the ambulance driver and informed her patient was going to the other hospital. The physician stated patient never got out of the ambulance and was not examined. The facility failed to ensure that their policy and procedure was followed as evidenced by failing to provide stabilizing treatment as required that was within the capability and capacity of the hospital for patient #1 on 1/22/2014.
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
Based on review of policy and procedures, and staff interview the facility failed to ensure that their policy and procedures regarding transfers was followed by failing to appropriately transfer an individual by not ensuring that medical treatment was first provided that was within the capability and capacity of the hospital to minimize risks to the individual's health; and failed to ensure the receiving hospital was contacted, and had agreed to accept the patient and had space and qualified personnel available to for treatment of 1 (#1) of 34 sampled patients

Findings are:

Review of the Florida Transfer Policy effective 03/13
EMTALA obligations regarding the appropriate transfer of an individual determined to have an EMC (emergency medical condition) apply to any dedicated emergency department (DED) of a hospital whether located on or off the hospital campus and all other departments of the hospital located on hospital property.


Transfer of individuals who are not medically stable
Requirements prior to transfer:
The following requirements must be met for any transfer of an individual with an EMC that has not been stabilized.

i. Minimize the risk. Before any transfer may occur, the transferring hospital must first provide, within its capacity and capability, medical treatment to minimize the risks to the health of the individual or unborn child.

ii. Any transfer to another medical facility of an individual with an EMC must be in
initiated either by written request for transfer from the individual or the legally responsible person acting on the individual ' s behalf or by a physician order with the appropriate physician or QMP and Physician certification as required under EMTALA.

iii. Medically necessary transfers shall be to the geographically closest hospital with service capability unless a prior arrangement is in place or the geographically closest hospital lacks capacity or refuses to consent to the transfer.

iv. The transferring hospital must call the receiving hospital or the Transfer Center if the facility is part of a Transfer Center network, to verify the receiving hospital has available space and qualified personnel for the treatment of the individual. The receiving hospital must agree to accept the transfer and provide appropriate treatment. The transferring physician shall ensure that a receiving hospital and physician that are appropriate to the medical needs of the individual have accepted responsibility for the individual ' s medical treatment and hospital care.

v. The transferring hospital must document its communication with the receiving hospital, including the request date and time and the name of the person accepting the transfer.

vi. The transferring hospital must sent to the receiving hospital copies of all medical records available at the time of transfer related to the EMC and continuing care of the individual.

vii. A physician must sign an express written certification that, based on the information available at the time of transfer, the medical benefits reasonable expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual or, in the case of a woman in labor, to the unborn child, from being transferred.

viii. If a physician is not physically present at the time of the transfer a QMP may sign the certification, after consultation with a physician. A physician shall countersign it within 24 hours

ix. Memorandum of transfer must be completed for every patient who is transferred to another separately licensed hospital.
A copy of the memorandum of transfer shall be retained by the transferring and receiving hospitals.



On 02/07/2014 at 3:45 PM a call to the Emergency Department Charge Nurse revealed she was in charge on January 22, 2014 when the patient was transferred to North Florida Regional Medical Center. She received a phone call from the nurse at the transferring hospital to give report. She determined the Emergency Department physicians had not accepted this patient. She told the transferring hospital to call the transport center and tell them the hospital they were to send the patient to. She and the ED physician went out to the ambulance when it arrived. The patient was then transported to another facility. The patient was not examined by the physician. The facility failed to ensure that their policy an procedure regarding the appropriate transfer of an individual was followed as evidenced by there was no medical record of treatments offered for patient #1. The patient was transported to another acute care facility without even getting out of the ambulance upon arrival to North Florida Regional Medical Center. The facility failed to contact the receiving hospital to obtain verbal confirmation that the receiving hospital had agreed to accept Patient #1 on 1/22/2014.