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.

Based on staff interview and clinical record review, it was determined that for 1 of 22 (Pt. #1) patient requests for emergency services, the Hospital failed to accept the transfer of a patient requiring specialized care based on ability to pay (A2411)

Based on staff interview and clinical record review, it was determined that for 1 of 22 (Pt. #1) clinical records reviewed, it was determined that for 1 of 1 (Pt. #1) patient request for transfer acceptance, the Hospital failed to accept the transfer of a patient requiring specialized care.

Findings include:

1. E#4 from the transferring Hospital #2 was contacted by telephone on 6/13/12 at approximately 3:40PM. E#4 stated, "I called Hospital #1 ENT Resident on call by asking the Hospital operator to page ENT on call. I spoke to the ENT Resident. The call was placed on hold and then the ENT Resident returned and said the admission was denied because of no insurance. We had one guy at Hospital #2 and he was off that day. The intent was to have Pt. #1 admitted for an operation. Hospital #3 was good enough to take the Pt."

2. The ENT Resident (E#3) on call at Hospital #1 on 5/27/12 was interviewed by telephone on 6/14/12 at approximately 9:30AM. E#3 stated, "On 5/27/12 I took a call from an ER Attending at (Hospital #2) who stated that they had a patient who required ENT intervention. They (Hospital #2) did not have an ENT physician that weekend. I was told the patient was stable with no airway compromise. The ER Attending stated that they would like to transfer the Pt. for ENT services. I explained that we do not accept transfers directly to ENT services and that the Pt. has to go through the ER, I would then be paged and I would evaluate the Pt. for admission. I then asked if the Pt. had insurance. The ER Attending stated that is an inappropriate question . The ER Attending stated that Pt. #1 had no insurance. I explained that this hospital (Hospital #1) does not treat uninsured patients but Hospital #3 treats uninsured patients and also has ENT services. The caller said goodbye and hung up. "

3. The clinical record for Pt. #1 was reviewed on 6/15/12. Pt. #1, a [AGE] year old male, presented ambulatory to Hospital #2 on 5/27/12 at 7:58PM with complaints of a sore throat and swollen neck. The triage nurse documented on 5/27/12 at 7:58PM, " Patient states sore throat started on Friday from a broken tooth. Pain increased since then with increased salivation and swollen neck." Nursing documentation at 8:00PM included, "Pt states it's like I have a gurgle in my throat with a change of voice noted." Triage vital signs were: Temp 98.6, pulse 103, resp 20, B/P 184/81 and Spo2 (blood oxygenation) 98%. The Medical Screening exam documented on 5/27/12 at 8:50PM included," [AGE] year old male presents with sore throat, difficulty swallowing started one week ago thought related to a cracked tooth, continued to get worse. Able to swallow but with effort, often having to spit out and secretions. Assoc muffled voice, swelling in neck, feels like it is difficult to breath especially when he lies flat." The ED physician's examination also included, "oropharynx without obvious swelling. Floor of mouth hard to touch, no tongue protrusion, neck full firm to touch." While in the ED, Pt. #1 received an antibiotic with IV fluids and laboratory work. The ED history and physical contained documentation that Hospital #1 was contacted on 5/27/12 at 9:00PM for an ENT evaluation and request to transfer. Documentation included, " Consultant (Hospital #1) ENT -no- Pt. has no insurance."

4. According to Pt. #1's clinical record from the receiving Hospital (Hospital #3), Pt #1 presented to Hospital #3 on 5/27/12 at approximately 10:54PM by advanced support ambulance for a higher level of care and surgical intervention. A CT scan obtained on 5/28/12 at 00:30 while at Hospital #3 included, "There is a large abscess in the floor of mouth with extensive subcutaneous emphysema. Airway is preserved but is pushed towards the front." Pt. #1 was admitted directly to the operating room from the ER on 5/28/12 for incision and drainage of the abscess. Pt. #1 required post operative endotracheal intubation and subsequent surgeries that included a tracheostomy. Pt. #1 was discharged on [DATE].

5. The Interim Physician Associate for Health Affairs in charge of admission pre-approval from Hospital #1 was interviewed on 6/14/12 at approximately 10:30AM. The Physician provided a "self pay" policy for admission to the Hospital. The Interim Physician stated that he is on call 24/7 and decides if patients who are uninsured are admitted to the Hospital based on the presenting problem. The self pay policy included, "Elective self-pay patients will only be considered for charity care if: the specialized care required is only available at the Medical Center " The Interim Physician stated that the incident would be investigated and that the Hospital treats all patients in the ER regardless of ability to pay.