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Based on review of facility records and staff interviews, The Department determined the hospital failed to enforce policies and procedures that comply with the requirements of 42CFR 489.20, responsibilities of Medicare participating hospitals in emergency cases.

Findings Include

Hospital policy titled, " Emergency Medical Treatment and Labor Act " , revealed: " PURPOSE The purpose of this policy is to describe the manner in which HonorHealth and its facilities comply with the Emergency Medical Treatment and Labor Act (EMTALA). POLICY It is the policy of HonorHealth to comply with the Emergency Medical Treatment and Labor Act ( " EMTALA " ) and related laws and requirements, 42 U.S.C. ...1395cc; 42 C.F.R. 489.20 et seq.,489.24 HonorHealth does not discriminate against persons requesting emergency services based on the person race, religion, national origin, age, sex, disability, economic status, or ability to pay for services rendered ...E. Accepting transfers from Other Hospitals. HonorHealth will accept transfers of any un-stabilized person with an emergency medical condition from another hospital without regard to the person's ability to pay if 1. The transferring hospital does not have the specialized capability and equipment to provide the necessary stabilizing treatment. 2. HonorHealth has the specialized capability (if HonorHealth has the required on-call physician and he is available, then HonorHealth has the specialized capability) to provide the necessary stabilizing treatment and a physician is able to accept the referred patient; and 3. HonorHealth has the capacity to provide this treatment (including bed availability, staffing, equipment, etc.) ...All transfers will be initiated in the HonorHealth Transfer Center. A Transfer Center Coordinator will be responsible for Determining if the HonorHealth hospital has the bed capacity (including Appropriate equipment) and hospital staff availability. Determine if the hospital has an accepting physician. Facilitate a conversation between the sending and receiving physicians .... "

Hospital document titled " EMTALA and ON-Call Physicians " revealed: " ...Reasons why a physician may decline a transfer. The physician is not privileged to perform the procedure the transferring patient needs. The physician is currently performing a procedure and would not otherwise be available by the time the patient arrives at the hospital .... "

Hospital document titled, " Patient Intake Sheet " , dated 07/19/2024, revealed: Request Type: Transfer-Incoming ...Admission Date and Time: 7/19/2024 ...Source Level of Care: Emergency Medicine ...Diagnosis Acute Left Otitis Media ...Priority Normal ...Level of Care Med/Surg ...Reason No specialty at sending facility ...Service ENT ...Requested to SOMC Osborne Medical Center Request began ... Ownership claimed by [Carmen Morrow, CNA] ...Spoke with [Coleen] Decline transfer due to not being contracted] "

A review of Patient # 1 ' s medical record from Tohono O ' odham Nation Health Care, dated 07/19/2024, revealed: " ...ED Course/Medical Decision Making: 32 y/o [male] with acute left otalgia with examination c/w acute otitis externa wh (sic) met sepsis criteria (HR, temperature and Leukocytosis) at the time of presentation. CT was performed ...which demonstrated radiographic changes of the left mastoid process suggestive of mastoiditis. The patient was clinically and hemodynamically stable and grossly non-toxic appearing but given the potential for rapidly evolving otitis exsterna with complications transfer to a higher level of care for specialty consultation was coordinated .... "

Audio recordings dated 07/19/2024 of transfer requests were provided by employee # 9. The recordings revealed that the transfer center from the referring facility, Arizona Reach, asked to initiate a transfer for a patient needing " med surge " .
The receiving transfer center took the information. Employee # 17 from the receiving facility called the referring transfer center back and declined the patient due to not accepting the patient's insurance. The referring facility questioned, " Even though the patient is in the ED " ? The receiving facility stated " Yes "

Employee # 9 confirmed in an interview dated 09/04/2024, that the process when receiving a call at the transfer center is to follow the external transfer flowsheet process. They will check with the 6 HonorHealth Hospitals to confirm who has the service requested. It was confirmed that the Transfer Center staff receive EMTALA Training upon hire and annually. Employee # 9 confirmed when asked why wasn ' t the process followed, stated [she] didn ' t know. [She] stated that [she] questioned the staff member and they could not provide an explanation for what happened.

Employee # 20 confirmed during an interview conducted on 09/03/2024, that the only reason the facility would not be able to take a patient is if the specialty required did not have a physician on call. They would look to their sister hospitals to find a place for the patient. Employee # 20 confirmed in an interview on 09/03/2024, that John C. Lincoln Medical Center had an ENT physician on call.

Based on facility records and interviews,the Department determined the administrator failed to ensure emergency services were provided to an individual (patient # 1) who was refused treatment due to their insurance.
This deficient practice poses a risk to the health and safety of patients when emergency care is not provided to patients that are experiencing life threatening situations.

Findings Include

Hospital policy titled, " Emergency Medical Treatment and Labor Act " , revealed: " PURPOSE The purpose of this policy is to describe the manner in which HonorHealth and its facilities comply with the Emergency Medical Treatment and Labor Act (EMTALA). POLICY It is the policy of HonorHealth to comply with the Emergency Medical Treatment and Labor Act ( " EMTALA " ) and related laws and requirements, 42 U.S.C. ...1395cc; 42 C.F.R. 489.20 et seq.,489.24 HonorHealth does not discriminate against persons requesting emergency services based on the person race, religion, national origin, age, sex, disability, economic status, or ability to pay for services rendered ...E. Accepting transfers from Other Hospitals. HonorHealth will accept transfers of any un-stabilized person with an emergency medical condition from another hospital without regard to the person's ability to pay if 1. The transferring hospital does not have the specialized capability and equipment to provide the necessary stabilizing treatment. 2. HonorHealth has the specialized capability (if HonorHealth has the required on-call physician and he is available, then HonorHealth has the specialized capability) to provide the necessary stabilizing treatment and a physician is able to accept the referred patient; and 3. HonorHealth has the capacity to provide this treatment (including bed availability, staffing, equipment, etc.) ...All transfers will be initiated in the HonorHealth Transfer Center. A Transfer Center Coordinator will be responsible for Determining if the HonorHealth hospital has the bed capacity (including Appropriate equipment) and hospital staff availability. Determine if the hospital has an accepting physician. Facilitate a conversation between the sending and receiving physicians .... "

Hospital document titled " EMTALA and ON-Call Physicians " revealed: " ...Reasons why a physician may decline a transfer. The physician is not privileged to perform the procedure the transferring patient needs. The physician is currently performing a procedure and would not otherwise be available by the time the patient arrives at the hospital .... "

Hospital document titled, " Patient Intake Sheet " , dated 07/19/2024, revealed: Request Type: Transfer-Incoming ...Admission Date and Time: 7/19/2024 ...Source Level of Care: Emergency Medicine ...Diagnosis Acute Left Otitis Media ...Priority Normal ...Level of Care Med/Surg ...Reason No specialty at sending facility ...Service ENT ...Requested to SOMC Osborne Medical Center Request began ... Ownership claimed by [Carmen Morrow, CNA] ...Spoke with [Coleen] Decline transfer due to not being contracted] "

A review of Patient # 1 ' s medical record from Tohono O ' odham Nation Health Care, dated 07/19/2024, revealed: " ...ED Course/Medical Decision Making: 32 y/o [male] with acute left otalgia with examination c/w acute otitis externa wh (sic) met sepsis criteria (HR, temperature and Leukocytosis) at the time of presentation. CT was performed ...which demonstrated radiographic changes of the left mastoid process suggestive of mastoiditis. The patient was clinically and hemodynamically stable and grossly non-toxic appearing but given the potential for rapidly evolving otitis exsterna with complications transfer to a higher level of care for specialty consultation was coordinated .... "

Audio recordings dated 07/19/2024 of transfer requests were provided by employee # 9. The recordings revealed that the transfer center from the referring facility, Arizona Reach, asked to initiate a transfer for a patient needing " med surge " .
The receiving transfer center took the information. Employee # 17 from the receiving facility called the referring transfer center back and declined the patient due to not accepting the patient's insurance. The referring facility questioned, " Even though the patient is in the ED " ? The receiving facility stated " Yes "

Employee # 9 confirmed in an interview dated 09/04/2024, that the process when receiving a call at the transfer center is to follow the external transfer flowsheet process. They will check with the 6 HonorHealth Hospitals to confirm who has the service requested. It was confirmed that the Transfer Center staff receive EMTALA Training upon hire and annually. Employee # 9 confirmed when asked why wasn ' t the process followed, stated [she] didn ' t know. [She] stated that [she] questioned the staff member and they could not provide an explanation for what happened.

Employee # 20 confirmed during an interview conducted on 09/03/2024, that the only reason the facility would not be able to take a patient is if the specialty required did not have a physician on call. They would look to their sister hospitals to find a place for the patient. Employee # 20 confirmed in an interview on 09/03/2024, that John C. Lincoln Medical Center had an ENT physician on call.