Thomas H Boyd Memorial Hospital

“APPROPRIATE TRANSFER CFR(s): 489.24(e)(1-2) (1) General If an individual at a hospital has an emergency medical condition that has not been stabilized (as defined in paragraph (b) of this section), the hospital may not transfer the individual unless - (i) The transfer is an appropriate transfer (within the meaning of paragraph (e)(2) of this section); and (ii)(A) The individual (or a legally responsible person acting on the individual’s behalf) requests the transfer, after being informed of the hospital’s obligations under this section and of the risk of transfer. The request must be in writing and indicate the reasons for the request as well as indicate that he or she is aware of the risks and benefits of the transfer. (B) A physician (within the meaning of section 1861(r)(1) of the Act) has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual or, in the case of a woman in labor, to the woman or the unborn child, from being transferred. The certification must contain a summary of the risks and benefits upon which it is based; or (C) If a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as determined by the hospital in its bylaws or rules and regulations) has signed a certification described in paragraph (e)(1)(ii)(B) of this section after a physician (as defined in section 1861(r)(1) of the Act) in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certification. The certification must contain a summary of the risks and benefits upon which it is based. (2) A transfer to another medical facility will be appropriate only in those cases in which - (i) The transferring hospital provides medical treatment within its capacity that minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child; (ii) The receiving facility (A) Has available space and qualified personnel for the treatment of the individual; and (B) Has agreed to accept transfer of the individual and to provide appropriate medical treatment. (iii) The transferring hospital sends to the receiving facility all medical records (or copies thereof) related to the emergency condition which the individual has presented that are available at the time of the transfer, including available history, records related to the individual’s emergency medical condition, observations of signs or symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of the studies, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) required under paragraph (e)(1)(ii) of this section, and the name and address of any on-call physician (described in paragraph (g) of this section) who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment. Other records (e.g., test results not yet available or historical records not readily available from the hospital’s files) must be sent as soon as practicable after transfer; and (iv) The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer. This Standard is not met as evidenced by: 50771 Based on record review and staff interview, it was determined for 3 of 22 (Pt #1, Pt#11, Pt#17) patients who presented to the Emergency Department (ED), the hospital failed to ensure that patients with a pscychiatric emergency medical condition (EMC) were transported to other facilities by qualified personnel by a contracted service provider. Findings include: 1. Pt #1’s record was reviewed throughout the survey. Pt#1’s record indicated, Pt #1 arrived to the ED on 1/17/2026 at 11:26 PM with complaint of homicidal behavior. A Medical Screening exam (MSE) was completed at 11:34 PM. The “Petition for Involuntary/Judicial Admission” was completed and signed on 1/17/2026 at 11:09 PM by Mental Health Professional (MHP) from (outside outpatient mental health facility). The “Inpatient Certificate” was completed by ED Medical Doctor (MD - E #13). Pt #1 eloped from the hospital on 1/18/2026 at 12:33 AM. Pt was then brought back to the hospital by local police at 3:00 AM. Another MSE was completed. An ED Provider note dated 1/18/2026 at 9:00 AM authored by ED physician (E #14) indicated, “ ...38 year old who presents to the ED for evaluation of Homicidal behavior and suspected acute psychosis ...patient exhibits homicidal behavior and is at risk for self-harm ...Plan of care: transfer to psychiatric facility, Instruction/plan notes: patient is medically cleared for transfer to psychiatric unit.” Pt #1 was ultimately transferred via (secure car transport agency) to (a psychiatric hospital) on 1/18/2026 at 3:15 PM. 2. Pt #10’s record was reviewed and indicated, Pt #10 arrived to the ED on 1/5/2026 at 7:11 PM with complaint of “autism with violent outburst.” A MSE was completed at 7:19 PM and noted a transfer indication of “Autism with violent outburst.” Pt#10 was agitated in the ED, combative with MD and family member. Parental consent obtained so no petition or certificate was necessary as the patient is a minor. Pt#10 was transferred via (secure car transport agency) to (a psychiatric hospital) on 1/6/2026 at 3:58 PM. 3. Pt #17’s record was reviewed and indicated, Pt #1 arrived to ED on 2/22/2026 at 3:03 PM with complaint of suicidal ideation. A MSE was completed at 3:08 PM at and noted a transfer indication of “Suicidal ideations with psychosis, aggression with violent behavior.” Pt #17 was violent and combative with staff while in the ED and required a 1:1 (one on one) sitter for safety. The “Petition for Involuntary/Judicial Admission” was completed and signed on 2/22/2026 at 7:20 PM by Mental Health Professional (MHP) from (outside outpatient mental health facility). The “Inpatient Certificate” was completed by ED MD (E #13). Pt #17 was transferred via (secure car transport agency) to (a psychiatric hospital) on 2/23/2026 at 1:09 PM. 4. An interview was conducted with Quality and Safety Officer (E#1) on 2/25/26 at approximately 10:15 AM. E#1 verbally confirmed there is no contract between the Hospital and the (secure car transport agency) used for mental health patients. E#1 stated “we don’t use that company often, but I am new and cannot find a contract with them. E#1 verbally agreed the facility did not review the company or company drivers prior to utilizing the transport service to ensure the mental health patients were transported by qualified personnel. E #1 verbalized understanding the necessity of ensuring qualified personnel were transporting the mental health patients and the need for a contract with the transport agency.”