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.

UNITED HEALTH SERVICES HOSPITALS, INC 10-42 MITCHELL AVENUE BINGHAMTON, NY 13903 Sept. 28, 2017
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on findings from document review and interview, the facility did not follow its policies and procedures (P&P) to ensure compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) requirements. The hospital did not accept patients with emergency medical conditions when the hospital had capacity and capability. The hospital did not provide adequate EMTALA education to its staff and the hospital lacked a comprehensive EMTALA P&P. These lapses could lead to untoward patient outcomes.

Findings include:

-- Review of the hospital's P&P titled "Transfer Center," dated 3/2017, indicated the hospital needs to accept appropriate transfers of individuals with emergency medical conditions if the hospital has specialized capabilities or facilities and has the capacity to treat those individuals.

-- Review of Patient #1, #2 and #3's "Regional Transfer Center Intake Forms," dated 9/18/17, 5/13/17, 4/29/17 respectively, indicated the hospital refused to accept the appropriate patient transfers. (See additional findings in Tag 2411)

-- Review of the EMTALA education provided to new staff during orientation titled "Patient Transfers," undated, indicated that every patient should be treated regardless of their ability to pay and it discussed transfer of patients to a higher level of care. There was no education pertaining to other EMTALA regulations (e.g., recipient hospital responsibilities, on-call physicians, appropriate medical screening exam, etc.)

-- During interview of Staff A (Manager of Nursing Education) on 9/28/17 at 9:40 am, he/she indicated nursing staff only receive EMTALA education at orientation and there are no mandatory yearly updates.

-- During interview of Staff B (Emergency Department [ED] Medical Director) on 9/27/17 at 10:00 am, he/she indicated ED providers receive EMTALA education through their malpractice insurance when they first apply. There is no formal hospital training done, however if there is a change in EMTALA regulations staff would be notified.

-- Review of the hospital's P&P revealed no evidence of an EMTALA P&P that addressed all the regulations (e.g., Recipient Hospital Responsibilities, On-call Physicians, appropriate medical screening exam, etc.)

-- During interview of Staff C (Director of Quality Management) on 9/27/17 at 11:30 am, he/she acknowledged the above findings.
VIOLATION: RECIPIENT HOSPITAL RESPONSIBILITIES Tag No: A2411
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on findings from document review and interview, in 3 of 8 referral cases reviewed (Patients #1, #2 and #3), the hospital failed to accept patients, with emergency medical conditions, who required inpatient care despite having specialized services and the capacity to treat the patient. These lapses could lead to untoward patient outcomes.

Findings include:

-- Review of the hospital's policy and procedure (P&P) titled "Transfer Center," date of origin 3/2017, indicated the hospital needs to accept the appropriate transfer of individuals with an emergency medical condition if the hospital has specialized capabilities or facilities and has the capacity to treat those individuals. The Transfer Center is responsible for coordinating all transfers and expediting appropriate physician contact. The call process is initiated after the sending facility has requested a transfer, indicated the level of care needed and the specialty service required. The Transfer Center Registered Nurse (RN) would then facilitate physician to physician contact via a three way call. After the on-call physician responds the physicians should discuss the case to determine placement, level of care and specialty service required. Once agreed upon the patient is given a room assignment. Cases that are considered emergent needing immediate medical attention on arrival should be considered for Emergency Department (ED) to ED transfer. Due to the nature of surgical cases requiring immediate intervention on arrival it is at the surgeon's discretion to send the patient to the ED verses an inpatient unit. The surgeon is responsible to be in the ED on patient arrival to provide evaluation.

-- Review of Patient #1's "Regional Transfer Center Intake Form," indicated on 9/18/17 at 9:34 pm, Hospital A contacted UHS Wilson's Regional Transfer Center regarding the transfer of Patient #1, a [AGE] year old female with an emergency medical condition. Staff D (RN Care Management Transfer Center) documented that Patient #1 had an altered mental status. She was weak, flushed, feverish (Temperature 101.7 degrees fahrenheit), and had a 10 centimeter gluteal abscess. Hospital A had treated Patient #1 with intravenous fluids, Tylenol, and antibiotics.

Staff D discussed the patient with Staff E (Hospitalist) at 9:40 pm.

-- Per review of an email dated 9/18/17, Staff E asked Staff D to contact the on-call surgeon to see if they wanted to admit Patient #1 to their service or if they would see the patient on consult. The on-call surgeon was paged at 9:51 pm and he/she called the Transfer Center back at 10:13 pm, and stated he/she would not accept the patient.

Staff D then contacted Staff F (Director of the Hospitalists), he/she stated Staff E would accept the patient and consult surgery in the morning. Staff D then obtained the bed assignment and notified Hospital A of acceptance.

Staff D then received a call from Staff G (on-call surgeon), when asked about Patient #1, he/she informed Staff G that Patient #1 had been accepted by the Hospitalist for admission. After an unpleasant conversation, Staff G was advised to call the Hospitalists to discuss the case.

Staff D then received a call from Staff F who indicated, the hospital could not accept the patient because Staff G adamantly refused to see the patient during the night if any urgent surgical intervention was needed and that no other surgeon would do so either.

-- Per interview of Staff G, (on-call surgeon) on 9/27/17 at 1:20 pm, he/she received a call from a nurse in the ED around 10:30 pm about a patient transfer request from Hospital A for surgical care of a large abscess. Staff G stated he/she felt the patient would be best treated at another facility. He/she anticipated being busy, as he/she normally is with ED calls, and it would be difficult to care for Patient #1. At the time of the call he did not have any patients to evaluate. Staff G indicated he/she was not aware of EMTALA obligations regarding recipient hospitals and has not received any EMTALA education.

-- Review of Patient #2's "Regional Transfer Center Intake Form," indicated on 5/13/17 at 9:54 pm, Hospital B contacted UHS Wilson's Regional Transfer Center regarding the transfer of Patient #2 with an emergency medical condition (acute appendicitis, confirmed by imaging). The Transfer Center called Staff G (on-call surgeon) at 9:57 pm. Staff G called the Transfer Center back at 10:00 pm and refused the patient transfer. Documentation indicated Staff G stated he was the only surgeon available and he could not be taking call for 7 or more facilities. The form also had documentation regarding an email that was sent to Staff H (President of UHS Physician Group) and Staff I (Chief Medical Officer) for follow-up.

-- Review of Patient #3's "Regional Transfer Center Intake Form," indicated on 4/29/17 at 12:25 pm Hospital A contacted UHS Wilson's Regional Transfer Center regarding the transfer of Patient #3 with an emergency medical condition (acute appendicitis, confirmed by imaging). The Transfer Center called Staff J (on-call surgeon) at 12:30 pm. Staff J called the Transfer Center back at 12:35 pm and refused the patient transfer. Documentation by the Transfer Center staff indicated, "Staff J declined, stated Hospital A is part of Hospital C and the patient can go there."

-- Per interview of Staff H (President of UHS Medical Group) on 9/28/17 at 10:30 am, he/she is informed of transfer refusals and reviews cases when necessary with providers. Staff H spoke with the on-call surgeons involved with Patient #2 and Patient #3. They were informed of the need to accept patients. There was no formal documentation completed regarding the specific conversations with the providers. He/she explained unless it is unsafe, all patients should be accepted for transfer. He/she indicated EMTALA education is needed throughout the entire system of providers.