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Based on record review, policy/procedure review and interviews with staff, the hospital failed to be in compliance with 42 CFR 489.24 as evidenced by the hospital's failure to accept the transfer of Patient #36 when the hospital had the capacity and capability to provide the needed specialized surgical treatment. The delay of 7 hrs. in accepting the transfer of Patient #36 from Hospital B resulted in Hospital B having to contact Hospital A in Texas in order to get emergent surgical treatment for the patient. (See findings cited at A2411)

Based on review of medical record, review of hospital policie/procedures and interviews with staff, the hospital failed to accept the transfer of a patient in a timely manner which required the specialized services for which the recipient hospital had the capability and capacity to provide. This occurred in 1 of 36 records reviewed. (patient #36) Findings:

Review of (Patient #36 ' s) Hospital B Emergency Department Record revealed that Patient #36, 51 year old male was admitted to Hospital B Emergency Department (E.D.) on 05/04/10 at 2344 (11:44 p.m.). The patient presented to the E.D. per ambulance, alert and oriented, + ETOH (alcohol intoxication), spine board and c-collar in place for an evaluation of status post altercation. Documentation reflected Patient #36 reported possible loss of consciousness, positive swelling and deformity noted to left jaw/face, and nasal bones. Swelling and bruising observed to left eye with laceration to left eyebrow. Initial Assessment timed 2355 (11:55 p.m.) reflected Patient #36 was in no acute distress but complained of pain to head, face, and back after being involved in an assault.

Review of Patient #36 ' s Hospital B's CT scan of facial bones revealed nondisplaced fractures through the left zygomatic arch. Mastoids and middle ears were clear. There were bilateral mandibular body fractures. There was a posterior body fracture on the left with marked lateral displacement up to about 8mm. There was a fracture of the anterior aspect of the right mandibular body displaced laterally about 2.5mm. Fractures of the left zygomatic arch included the posterior base as well as its mid and anterior aspects. Documentation reflected there was probably a small fracture of the anterior inferior aspect of the left maxillary sinus wall without displacement. There was left side nondisplaced nasal bone fracture and there was some rightward deviation.

Review of Huey P. Long Hospital ' s Policy & Procedure #05-008, titled Patient Transfer To LSUHC / Huey P. Long Emergency Department, revision date 05/09 read: POLICY 1. All emergency department requests to transfer to Huey P. Long ' s Emergency Department transfer requests shall be referred to the trauma physician ... ... ... ... ... .....PROCEDURE 1. The trauma physician shall obtain a detailed report of the patient ' s medical condition and reason for transfer. 2. Upon acceptance, the referring facility ' s call is then transferred to the House Manager for bed availability.

S2- M.D., Emergency Services, Huey P. Long was interviewed by phone on 05/10/10 at 1:50 p.m. S2- M.D., Emergency Services confirmed that he received a phone call from the E.D. physician at Hospital B on 05/05/10 at approximately 5:30 a.m. in reference to a transfer request. S2- M.D., Emergency Services stated that S7 M.D., Hospital B, E.D. telephoned him and asked if Huey P. Long Hospital still had S3 M.D., Oral Surgery on staff. S2- M.D., Emergency Services informed S7 M.D., Hospital B, E.D. that yes S3 M.D., Oral Surgery was still on staff and asked why. S2- M.D., Emergency Services stated that S7 M.D. Hospital B, E.D. stated that S3 " M.D., Oral Surgery told me whenever I have an indigent mandible fracture send them his way. " S2- M.D., Emergency Services stated that he contacted S3 M.D., Oral Surgery by telephone, reported the injuries and S3 M.D., Oral Surgery accepted the transfer. S2- M.D., Emergency Services reported that he informed S7 M.D. that S3 M.D., Oral Surgery was the official accepting physician and Huey P. Long would be expecting the patients ' arrival. S2- M.D., Emergency Services stated that his shift ended shortly after the phone conversation, reported the accepted transfer to his relief and left the hospital believing that the patient would be transferred.

S1- R.N., House Manager was interviewed on 05/12/10 at 8:15 a.m. S1- R.N., House Manager confirmed that she worked the 6:30 p.m. to 7:00 a.m. shift starting on 05/04/10 and ending 05/05/10. S1- R.N., House Manager reported that she recalled a phone call received from Hospital B at approximately 6:15 a.m. on 05/05/10 and notified her of a transfer that had been accepted by S2 M.D., Emergency Services and S3 M.D., Oral Surgery. S1- R..N., House Manager stated that she was advised that Patient 31 was diagnosed with Left Mandible Fracture, Facial Fractures and Nasal Fractures that required Oral Surgery services which Hospital B did not have on call for 05/05/10. S1- R.N., House Manager stated that during her phone conversation with the E.D. Nurse from Hospital B, she was informed that the patient was a Texas resident and had a " Texas indigent health care card. " S1- R.N., House Manager stated that she questioned about the patient ' s status as a Texas resident. S1- R.N., House Manager stated that the House Manager ' s office, at one time, had a " sticky note " on the wall reminding Managers ' to make sure all transfer patients were Louisiana residents. When asked, S1- R.N., House Manager stated that the " sticky note " was no longer on the House Manager ' s office wall. S1- R.N., House Manager stated that initially Hospital B informed her that the patient had just a mandible fracture but later informed her that the patient had facial and nasal fractures. When asked, S1- R.N., House Manager stated that she did not question Hospital B about the patient ' s position of receiving indigent health care in Texas. S1- R.N., House Manager reported that the telephone call from Hospital B occurred near shift change therefore she did not assign a bed and handed the information over to the on-coming House Manager, S4, R.N.

S4- RN., House Manager was interviewed on 05/10/10 at 2:30 p.m. S4- RN., House Manager confirmed that he worked in the capacity as House Manager on 05/05/10 from 6:30 a.m. to 7:00 p.m. and recalled the transfer attempt made by Hospital B on 05/05/10. S4- RN., House Manager reported that he received report from S1 House Manager on 05/05/10 in which he was informed of a transfer from Hospital B that required Oral Surgery and had been accepted by S2 M.D., Emergency Services and S3 M.D., Oral Surgery. S4- RN., House Manager confirmed that he was aware that S2 M.D., Emergency Services and S3 M.D., Oral Surgery had accepted the transfer of a patient who required Oral Surgery. S4- RN., House Manager reported he spoke with Hospital B, E.D. Nurse (unsure of name) on the morning of 05/05/10 but not certain of the time of day. S4- RN., House Manager stated he informed Hosptial B, E.D., RN that he was concerned about reimbursement from an out of state resident however he had not said that he would or would not accept the transfer. S4- RN., House Manager stated he informed Hospital B, E.D. Nurse that he needed additional guidance due to reimbursement concerns based on the patient ' s out of state residence status therefore he would pass the transfer request information on to Senior Administration.

During further interview with S4- RN., House Manager on 05/10/10 at 2:30 p.m. he indicated that when the HPL E.D. physician accepted a transfer from another hospital ' s E.D. and a bed was available, normally Senior Administration approval was not necessary. When asked by this surveyor about the availability of a bed on 05/05/10 at the time of the requested transfer, S4- RN., House Manager confirmed that the hospital did have beds available. When asked if he (S4) had been informed by any staff member from Hospital B that the hospital was pursuing an EMTALA complaint due to delay with getting acceptance, S4- RN., House Manager confirmed yes he was informed by Hospital B, E.D. Director S5. S4- RN., House Manager stated that after he was informed by S5- R.N., E.D. Director that Hospital B was pursuing an EMTALA complaint, (unsure of time) he transferred the phone call to S6- R.N., DON. When asked, how well versed were you with EMTALA regulations, S4- R.N. replied " minimally. "

S6- R.N., DON, Huey P. Long was interviewed on 05/12/10 at 9:40 a.m. S6- R.N., DON reported that she became aware of a pending transfer from Hospital B on 05/05/10 at approximately 10:30 a.m. when S4- R.N., House Manager informed her that S5- R.N., ED Director from Hospital B had informed him that Hospital B was pursuing an EMTALA complaint due to delay in care. S6- R.N., DON reported that she telephoned Hospital B on 05/05/10 at approximately 10:45 a.m., spoke to S5- R.N., E.D. Director Hospital B and inquired about the extent of injuries because HPL had not received the patient ' s medical record at that time. S6- R.N., DON stated that S5 reported that the patient had a Mandible and Maxillary Fracture with severe Facial Fractures.

S6- R.N., DON reported that she informed S5 E.D. R.N. at Hospital B, that she was concerned about the " severe facial fractures " and wanted S3 M.D., Oral Surgery to have the opportunity to review the radiology report to make certain that the patient did not need ENT services which HPL Hospital did not provide. S6- R.N., DON reported that S5 R.N., Hospital B offered to fax the patient ' s information to HPL at that time. S6- R.N., DON reported that she received the faxed patient report at approximately 11:00 a.m. S6- R.N., DON stated that once she received the faxed patient report, she telephoned S3 M.D., Oral Surgery but he was performing a surgical case at the time and was unavailable to review the patient record. S6- R.N., DON stated that she informed S5 that S3 M.D., Oral Surgery was doing a surgical case but would have him review the patient record as soon as he completed the surgery.

During further interview with S6- R.N., DON on 05/12/10 at 9:40 a.m. she reported that S3M.D., Oral Surgery completed his surgical case and arrived in her office at 1:15 p.m. to review the patient ' s radiology reports. S6- R.N., DON states that she received a telephone call from S5 Hospital B, E.D. Director at 1:45 p.m. which at that time S6- R.N., DON informed S5 that S3 M.D., Oral Surgery had accepted the transfer. S6- R.N., DON reported that S5 Hospital B, E.D. Director informed her (S6) they had made arrangements to transfer the patient to another hospital due to excessive wait time.