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.

HILLCREST MEDICAL CENTER 1120 SOUTH UTICA AVENUE TULSA, OK 74104 Nov. 25, 2013
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on review of hospital documents, the emergency room (ER) department central log, policies and procedures and medical records and interviews with hospital staff, the hospital failed to provide a medical screening examination by a qualified medical person in order to determine whether an emergency medical condition existed to one of three patients (Patient #2 of Patient #2, 4, and 7) who transferred to the hospital's burn unit requesting examination and treatment for a perceived emergency medical condition and whose records were reviewed.

Findings:

1. The hospital's Medical Staff by-laws and Rules and Regulations record the "Emergency Department physicians and supervised credentialed extenders as Quality Medical Persons who are qualified to perform Medical Screening Examinations..." (This quote was found on Page 6 of the by-laws.) Both talk about specialty physicians presenting to examine patients. The Rules and Regulations, on Section I Admission of Patients, "...1.9 Transfers From Other Facilities. If, according to the transferring facility, an inbound transfer may require immediate care beyond the scope of the admitting physician, the On-Call Specialist will be notified by the HMC (abbreviation of the hospital name) Transfer Coordinator and/or Hospitalist. The On-Call Specialist is obligated to be physically present to evaluate the patient as described in IV. Emergency Coverage/Department, #6.3 ... "

2. The One Call "Transfer Sheet" for Patient #2 documented another hospital called on 06/02/2013 at 1510, requesting transfer with further evaluation and treatment of a patient with burns from grease. The requesting hospital was told to send the patient to the burn tank for evaluation. The patient was transferred from the requesting hospital and brought to the burn unit. Documentation only showed the nurse assessed the patient on presentation on the afternoon of 06/02/2013. The record did not demonstrate the patient received a medical screening examination by either the ER physician on the specialty physician on-call. The first entry by the physician was on 06/03/2013.

3. This finding was reviewed and verified with hospital staff on the evening of 11/20/2013.
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on review of medical records, policies and procedures and hospital documents and interviews with hospital staff, the hospital failed to develop and enforce policies and procedures to ensure compliance with the requirements of 42 CFR 489.24. The hospital failed to:

a. Develop a policy and procedure if a request was made to transfer a patient in need of burn specialty services to ensure an appropriate medical screening exam was provided.

b. Enforce its policies and procedures:
1. Concerning recipient hospital responsibilities. This occurred for one (Patient #A) of nine patients (Patients #A, 2, 4, 5, 6, 7, 15, 17, and 18), whose medical records were reviewed and a request for transfer from a referring hospital was received at the hospital.
2. Concerning providing a medical screening examination. This occurred for one (Patient #2) of three patients that were to be taken to the burn unit's "tank" room for evaluation after transfer from another facility.

Findings:

1. Acceptance of transfer policies:
a. The hospital's policy, 2500-GO-101 with an effective date of May 21, 2010, on page 8 requires, "...The Hospital has the obligation to accept an appropriate Transfer of an individual with an Unstabilized Emergency Medical Condition who requires specialized Capabilities or facilities if the Hospital has the Capacity to treat the individual..."

b. Hospital policy, 2500-GO-102 Acceptance of Emergency Transfers, with an effective date of May 21, 2013, further states the hospital will develop policies and procedures for receiving requests for Transfers.

c. On 07/15/2013 at 2120, a request for transfer of Patient #A to the hospital's burn unit. The hospital did not follow its policy, Patient #A was not accepted for transfer.

d. On 11/20/2013 at 1700, Staff T told the surveyor the the One-Call transfer center initially took the calls. She stated that if a request was made to burn services, her staff would then transfer the call to the Burn center/unit and they would handle the call. The Burn unit staff would complete the One-Call "Transfer Sheet" and return it to One-Call to file and complete the request log. When asked for the Policy for this, the surveyors were told no policy had been developed.

2. Medical Screening Examination:
a. The hospital Medical Staff by-laws and Rules and Regulations designate the "...Emergency Department physician and supervised credentialed extenders as Quality Medical Persons who are qualified to perform Medical Screening Examinations." The by-laws and Rules and Regulations document on-call specialty physicians presenting to examine patients.

b. The hospital's policy, 2500-GO-104 Medical Screening Examination and Stabilization, with an effective date of May 21, 2010, states, "...The Medical Screening Examination must be performed by a Physician or a Qualified Medical Person in the Dedicated Emergency Department or another Department of the Hospital on Hospital Property.

c. On 06/02/2013, Patient #2 presented to the hospital's Burn unit. The hospital did not follow its policy. The patient did not receive a medical screening examination by a physician or credential extender.
VIOLATION: RECIPIENT HOSPITAL RESPONSIBILITIES Tag No: A2411
Based on review of medical records, hospital documents and other documents supplied to the surveyors, and interviews with hospital staff, the hospital failed to accept, from a referring hospital, an appropriate transfer of an individual who required the specialized capabilities and facilities of the hospital in one of nine medical records (Patient #A of Patients #A, 2, 4, 5, 6, 7, 15, 17, and 18), whose medical records were reviewed and a request for transfer from a referring hospital was received at the hospital. On the date and time of the proposed transfer for one patient (Patient #A), the hospital had the capability and capacity to treat the individual.

Findings:

1. According to the hospital's One Call "Transfer Sheet", on 07/15/2013 at 2120, the hospital received a call from a requesting hospital for transfer of a patient who received burns when fireworks in the back of his truck caught fire. The nurse taking the call documented contacting the specialty physician on call, Dr. B. at 2140. The nurse documented, "Talked with Dr. B Described burns as told to me. He said they could send him & we could take a look & then prob (probably) send him home and see him in a.m. Relayed info to (name of the requesting emergency room physician). He was going to keep pt (patient) up there overnight for pain control then send here..." The form also contained a OPBC (outpatient burn clinic) appointment for 07/16/2013 at 1100.

2. According to documentation at the requesting hospital, the patient arrived at their emergency department (ED or ER) around 2057 by private vehicle with complaints of burns to right leg, right arm and back of head. The patient was seen and treated by the ER physician. The ER physician documented, "...ED plan is to transfer by EMS (ambulance) to Hillcrest Burn Center. Dr B (name of the specialty physician at Hillcrest) does not accept patient tonight but states he will see him at 9 a.m. tomorrow. Will plan to admit to hospitalist at (name of the requesting hospital), (name of hospitalist omitted) will consult in ER..."

The requesting hospital's hospitalist documented, "I went down and examined the patient. After seeing the severity of the patients burns and amount of pain that he was in, the fact that he had been blown out of his truck I contacted (name of another acute care hospital)..." The patient was accepted by that hospital and transferred to that facility by air ambulance at 0043 on 07/16/2013.