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Based on medical record (MR) review, document review and interview, it was determined that in 2 (patient #1 and 7) of 22 MRs reviewed of patients who presented to the hospital requesting emergency services, the facility failed to ensure compliance with 489.24 in that the facility failed to provide an appropriate transfer.

Findings include;

1. See findings cited at 489.24(e) A2409.

Based on document review, medical record (MR) review and interview, the facility failed to follow its policy/procedure on patient transfers to another facility and failed to provide an appropriate transfer for 2 of 5 Emergency Department (ED) patients transferred to another facility in that the facility lacked documentation of a written request for transfer, lacked documentation of a signed physician certification which included risk and benefits, lacked documentation of communication with the receiving facility to indicate that the facility had accepted the patient and lacked any evidence that the required MR information was sent to the receiving facility for (Patient #1 and 7).

Findings include;

1. Review of policy/procedure Transfer of Patient to Another Facility indicated the following;
"Procedure
The following information must be completed prior to transportation:
1. The attending physician will give the order for transfer.
2. The physician must contact and obtain acceptance from the receiving physician.
3. The receiving facility must accept the patient transfer via House Supervisor assistance.
4. Patient and / or family consent to transfer.
5. All transfers (non urgent or emergent) must be approved and accepted by first the physician, the receiving hospital and patient / or family (if patient cannot give consent) before transfer is made. Note that if the patient is unable to give consent and family is unreachable, the patient can be sent without consent in emergent situations only as deemed by the physician as appropriate.
7. The physician is to sign the transfer sheet and state reasons for transfer."
This policy/procedure was last reviewed/revised on 03-02-13.

2. Review of policy/procedure EMTALA indicated the following;
"Policy:
Under EMTALA, a dedicated emergency department must:
A transfer to another medical facility is appropriate only when:
A. The patient is stabilized within the capabilities of the hospital and the risk and benefits are explained to the patient and / or significant other.
C. There is an accepting physician at the receiving facility who has discussed the patient with the FRHS physician."
This policy/procedure was last reviewed/revised on 03-02-13.

3. Review of patient #1's MR indicated that on 06-19-13 at 2005 hours presented to the facility Emergency Department (ED) with complaints of suicidal thoughts and depression. The ED physician's clinical impression was major depression, schizophrenia and suicidal ideations. On 06-20-13 at 0011 hours the ED physician completed the Application for Emergency Detention for Mentally Ill and Dangerous Persons. The patient was transferred to facility #2 on 06-20-13 at 0145 hours via police. Patient #1's MR lacked documentation that the ED physician had signed the Transfer Sheet, completed the Transfer form and the risks and the benefits were explained to the patient and or significant other.

4. Review of patient #7's MR indicated that on 06-07-13 at 2150 hours presented to the facility Emergency Department (ED) with complaints of anxiety, depression, sleeping difficulty, anger and specific suicidal thoughts. The ED physician's clinical impression was major depression and suicidal. On 06-08-13 at 0015 hours the ED physician completed the Application for Emergency Detention for Mentally Ill and Dangerous Persons. The patient was transferred to facility #3 on 06-08-13 at 0215 hours. Patient #7's MR lacked documentation there was an accepting physician who discussed the patient with the facility's ED physician, that the ED physician had signed the Transfer Sheet, completed the Transfer form and the risks and the benefits were explained to the patient and or significant other.

5. On 06-08-13 at 1330 hours MD #1 confirmed that Transfer forms for patient #1 were not completed.

6. Review of patient #1's MR from facility #2 lacked documentation that the ED MD at facility #1 had explained the risks and benefits of transfer and completed and signed the transfer form.

7. Review of patient #7's MR from facility #3 lacked documentation that the ED MD at facility #1 had explained the risks and benefits of transfer and completed and signed the transfer form.