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Based on medical record review and interviews, the hospital failed to ensure compliance with the requirements of 42 CFR 489.24 as evidenced by a deficiency issued at Tag #411, 42 CFR 489.24(e).

Based on documentation and interviews, the hospital failed to accept an appropriate transfer from Hospital #1, of a patient (patient #1) who required specialized care. Findings include:

Review of patient #1's ED record from Hospital #1 revealed that patient #1 arrived via ambulance at
Hospital #1's ED at 12:25 p.m. on Saturday 4/3/10. The record indicated the patient had a history of heart disease/heart attack, dementia and associated memory loss, bipolar disorder and behavior problems. At the time of admission to the ED, patient #1 complained of chest pain and difficulty swallowing, and she exhibited paranoid and agitated behavior. The record revealed that the patient's chest pain resolved while she was in the ED. Physician (I) assessed patient #1's condition and determined that due to her mental health issues and inappropriate behavior she needed to be transferred from hospital #1 to an acute care hospital with a specialized geriatric-psychiatric unit. Interviews revealed that Hospital #1 contacted Unity Hospital (UH) and requested that patient #1 be transferred to UH's specialized geriatric-psychiatric unit. However, UH refused to accept the transfer, although there were available beds, and told Hospital #1 that UH does not admit patients to the geriatric-psychiatric unit from other hospitals on the weekends and in the evening during the week. The record revealed that patient #1 was accepted for admission to another hospital's (Hospital #2) specialized geriatric-psychiatric unit, which was a long distance from Hospital #1. Patient #1 was transferred via ambulance to Hospital #2 at 3:00 p.m. on 4/3/10.

UH's EMTALA policy states "The hospital must accept an appropriate transfer of a patient with an emergency medical condition if the hospital provides specialized capabilities (e.g., a psychiatric unit) not available at the transferring hospital, and the receiving hospital has the current capacity to treat the patient."

Physician (I) was interviewed by phone on 5/6/10 and 5/10/10, and he stated he was working in Hospital #1's ED on 4/3/10 and provided care to patient #1. He stated he contacted UH on 4/3/10 and requested a transfer of patient #1 to UH's specialized geriatric-psychiatric unit. The unit had three available beds, but UH refused the transfer and told him UH restricted admissions to the geriatric-psychiatric unit from other hospitals on weekends and evenings during the week. He stated he contacted Hospital #2 and requested a transfer of patient #1 to Hospital #2's specialized geriatric-psychiatric unit, and Hospital #2 accepted the transfer.

Employee (J)/Referral Clinician was interviewed by phone on 5/10/10, and she stated she recalls speaking with staff from Hospital #1's ED on 4/3/10 regarding a request to transfer patient #1 to UH's specialized geriatric-psychiatric unit. Employee (J) stated there were available beds on the unit on 4/3/10. She stated she told ED staff from Hospital #1 that UH's geriatric-psychiatric unit does not accept transfers from other hospitals on weekends. Hospital #1 staff told employee (J) that they would transfer patient #1 to another hospital.

Physician (E) was interviewed in person on 5/3/10, and he stated it has been the policy and practice of UH's specialized geriatric-psychiatric unit not to admit patients from other hospitals on the weekends and evenings during the week. This practice is being reviewed, and the goal is to have the geriatric-psychiatric unit open 24/7 to all hospitals.