HospitalInspections.org

Based on policy and procedure review, document review, medical record review, and staff interview, the chief executive officer failed to ensure the policies and procedures for acceptance of appropriate transfers and indigent care of patients were implemented for one of twenty (RN1) closed patient medical records reviewed.

Findings:

1. Policy titled, "Accepting Appropriate Transfers", Classification: PC.1.10, reviewed on 3/15/10 at 2:47 PM, indicated on pg. 1, under Policy section, "[Receiving Facility] will accept appropriate transfers of individuals from other facilities who require the Hospital's specialized capabilities or facilities."

2. Policy (formerly titled "Indigent Care Policy) titled, "Sliding Fee and Charity Care Determination", Classification: FIN., reviewed on 3/15/10 at 4:30 PM, indicated on pg. 1, under Policy section, point I., "It is the policy of [Receiving Facility] to provide quality mental health and substance services to the general public regardless of the patient's ability to pay."

3. Review of closed patient medical records from transferring facility on 4/13/10 at 10:00 AM, indicated patient TN1:

A. presented to the Emergency Department (ED) on 3/13/10 at 04:08 AM for chief complaint of "alleges was attacked by someone...". Voiced suicidal ideations while in the ED and was admitted as inpatient.
B. per Psychiatric Consultation dictated 3/14/10 at 11:29 AM, "recommend transferring to the psychiatric facility for further stabilization."
C. per Physician's Orders dated 3/15/10 at 12:00 PM, medically stable for transfer today to [Receiving Facility].

D. per Patient Transfer Authorization and Physician's Order to Transfer form, reason for transfer "psychiatric care"; receiving facility "[Receiving Facility]"; mode of transfer "ambulance with basic life support"; receiving physician "[RD2]; risks and benefits; authorization to send copies of medical record; certification statement present and signed by physician on 3/15/10 at 12:00 PM; and consent to transfer at recommendation of patient's physician.

E. per Crisis Intervention Assessment Notes dated 3/15/10:
a. at 11:44 AM, "[RD2, accepting Physician from Receiving Facility] called back and admitted patient to [Receiving Facility]."
b. at 12:12 PM, "[physician] signed Transfer form and 72hr ed [Emergency Detention Order] completed."
c. at 1:00 PM, "[Nurse from Receiving Facility] called back and stated that he/she called [ambulance]."
d. at 2:19 PM, "[Officer] here to follow ambulance. [Ambulance] to transport with all paperwork given to them..." and "transported patient to [Receiving Facility]..."

4. Ambulance Run Report dated 3/15/10 was reviewed on 4/13/10 at 7:00 PM and indicated, "at 1500 advised by dispatch [Receiving Facility] is not accepting patient due to 'administrative decision', patient going back to [Transferring Facility]..."

5. Review of closed patient medical record from receiving facility on 4/13/10 at 4:00 PM indicated patient RN1:
A. was enroute to this facility on 3/15/10 at approximately 14:23 PM, when the transfer was terminated by administrative personnel at this facility and the patient was re-routed back to the transferring facility. Documentation in the medical record received from transferring facility included:

B. per Disposition and Initial Treatment Plan dated 3/15/10 at 1:03 PM, admission type was voluntary, admitting physician [RD2], and medically cleared.

C. per Eligibility Inquiry dated 3/15/10 at 3:41 PM, patient was "Not Eligible from 3/15/10 to 3/15/10 for Medicaid" and "No Other Private Insurance".

D. per Non-Billable Contact/Administrative Note dated 3/15/10 at 4:00 PM, "Prior to patient's arrival to [Receiving Facility], administrative staff, [PR5, Consultant for Clinical Compliance] put a stop to the admission since patient is uninsured and out of county. [Ambulance Service] was notified and returning patient to [Transferring Facility]. Staff Present: [PR4, Director of Admissions; PR3, Assistant Director of Admissions; PR5; and PR2]. [PR5] is refusing to accept patient. Admission blocked."

6. Receiving Facility Medical Staff RD2 was interviewed via phone on 4/13/10 at 10:39 AM and confirmed, accepted transfer of this patient and called in orders to staff. However, a female administrative personnel cancelled the transfer (cannot recall name of individual) for unknown reasons.

7. Receiving Facility Personnel PR4 was interviewed on 4/13/10 at 3:18 PM and indicated, spoke with PR5 who made the decision not to accept the patient.

8. Medical record for Patient RN1 at receiving facility had documentation indicating the patient was uninsured and facility refused to accept an appropriate transfer of this patient requiring specialized capabilities as required per facility policy and procedures.