Memorial Hospital and Health Care Center

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 50584 Based on document review, observation and interview, it was determined that 1 of 10 (P21) medical records reviewed of patients who presented to the hospital requesting services, the facility failed to ensure compliance with 489.24 in that the facility failed to accept a patient transfer when they had the capacity and specialty services available. Findings Include: 1. See findings cited at 42 CFR 489.24, A2411”

“RECIPIENT HOSPITAL RESPONSIBILITIES CFR(s): 489.24(f) A participating hospital that has specialized capabilities or facilities (including, but not limited to, facilities such as burn units, shock-trauma units, neonatal intensive care units, or (with respect to rural areas) regional referral centers, which, for purposes of this subpart, means hospitals meeting the requirements of referral centers found at §412.96 of this chapter) may not refuse to accept from a referring hospital within the boundaries of the United States an appropriate transfer of an individual who requires such specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual. This requirement applies to any participating hospital with specialized capabilities, regardless of whether the hospital has a dedicated emergency department. This Standard is not met as evidenced by: 50584 Based on document review, interview and observation, facility failed to accept a patient (P21) transfer when they had the capacity and specialty services available. Findings include: 1. Facility policy titled Transfer, PolicyStatID: 17398040, Last Reviewed Date: 2/2025, Page 3, under Procedure: B. No patient will be transferred without positive acceptance by the receiving facility with transferring physician to accepting physician contact. This should be documented in the EMR (Electronic Medical Record). 2. On 12/3/25 at approximately 1500 hours listened to audio recording from 11/8/25 regarding transfer of P21. a. On 11/7/25 at 2350 hours phone call #1 indicated F2 (critical access hospital) phoned F1 (acute care hospital) on-call center with a transfer request for P21 with diagnosis of NSTEMI (Non-ST Elevation Myocardial Infarction) . The patient had no cardiology specialist, EKG (electrocardiogram) was normal, Troponin level was critical at 1.91. Normal range (0.0000-0.3400). The patient had come to F2 two nights ago, went to another facility, and refused a heart catheterization. F1 on-call staff would page hospitalist and call F2 back. F1 was the only facility with beds in the network. b. On 11/8/25 at 0003 hours CST (Central Standard Time) phone call #2 indicated F1 on call center phoned MD2 (hospitalist) and informed him/her of a request for a patient transfer. On-call staff informed MD2 P21 diagnosis was NSTEMI, elevated Troponin level and that two days ago the patient had refused a heart catheterization. MD2 indicated due to patients age and elevated troponin he/she wanted a cardiologist involved in accepting the patient transfer. MD2 indicated it was unusual at the patients age to have chest pain and an elevated troponin level and he/she would like to pick the brain of a cardiologist regarding the case. c. On 11/8/25 at 0007 hours CST phone call #3 indicated on-call staff phoned MD1 (cardiologist) on call and explained that F2 was wanting to transfer a 29-year-old patient with diagnosis of NSTEMI and elevated Troponin level that had refused a heart Cath two days ago. On-call staff indicated to MD1 that MD2 did not want to accept the patient without cardiologist being involved and discussing the case with MD3. MD1 stated that he/she would not speak to MD3 and would not accept the patient on MD2 behalf. If MD2 wanted to admit the patient, MD1 would consult and order an echocardiogram but was not speaking to anyone. MD1 indicated a patient that young having heart problems was unlikely and he/she would not take P21 for a heart catheterization. d. On 11/8/25 at 0008 hours CST phone call #4 indicated on-call staff returned a call to MD2 indicating the phone call with MD1 did not go well, and that MD1 was refusing to call MD3 and speak with anyone, because the patient is not likely having cardiac problems. MD2 indicated he/she would not accept a cardiology patient, especially one at that young age, without a cardiologist speaking with the transfer facility first. On-call staff reported MD1 would consult but was not talking to anyone. MD2 was not accepting the patient without cardiologist input and knowing he/she had back-up. e. On 11/8/25 at 0016 hours CST phone call #5 indicated on-call staff returned a call to F2 and informed them that the cardiologist refused to speak with them and that MD2 would not accept the transfer without the cardiologist speaking with MD3. F1 was the only facility with beds in the network, but the patient could be put on a wait list at another facility. The wait time may have been 1-2 days before the patient could be placed. The call was then transferred to MD3. On call staff then informed MD3 that the cardiologist would not speak with him/her to accept transfer because the patient refused a heart catheterization two days ago. MD3 then indicated to on-call staff that the patient did not refuse a heart catheterization two days ago and if she would have it was irrelevant to the current symptoms P21 was experiencing. P21 came to F2 two days ago, signed out AMA (Against Medical Advice), went to another facility, was admitted, cardiologist at that facility discussed a heart catheterization including risks and benefits of the procedure with the patient, and the patient did not refuse procedure but decided to try maximal medical therapy first and follow-up in 2 weeks. P21 returned to F2 with recurring chest pain and an elevated Troponin level, even higher from two days ago. On-call staff indicated to MD3 that MD2 would not accept the patient without the cardiologist weighing in on the case. MD3 then indicated that MD1’s refusal to speak with him/her and accept the patient’s transfer was an EMTALA violation and it would be reported. MD3 also indicated that the on-call staff report it to their administration. On-call staff then offered MD3 for P21 to be put on a wait list at another F1 facility. MD3 did not want patient to be on the wait list because of his/her symptoms and P21 was ready to do something about the symptoms. MD3 would circle back if he/she could not find another facility to transfer P21 to. 3. Review of transfer intake for P21 at F1 indicated: a. Intake information: Medical reason for transfer or consult- NSTEMI, Emergent Intervention needed: no, Anticipated specialty services needed: Cardiology. Pertinent lab: Troponin 1.91. b. On 1/7/25 at 2350 hours call received from F2 with P21 transfer details. c. On 11/8/25 at 0004 hours contacted MD2, MD2 requested cardiology be consulted due to patient’s age. MD1 refused to speak with referring physician stating he/she would consult. MD2 would not accept a cardiology patient without cardiology’s input, and the patient may need to be sent elsewhere. d. On 11/8/25 at 0005 hours called to connect referring facility per MD2 due to P21 age and elevated Troponin. MD1 stated he/she would not speak with referring physician and that MD2 can admit P21 and MD1 would consult. e. On 11/8/25 at 0012 hours Declined reason: Declining provider. f. On 11/8/25 at 0016 hours called F2 and informed them of F1 refusal for transfer and offered wait list for another facility. MD3 (ED [Emergency Department] Physician) stated he/she would check elsewhere and call back to place P21 on wait list if needed. g. On 11/8/25 at 0027 hours Transfer request cancelled. Reason: Transfer process stopped before physician was able to accept or decline. 4. In interview on 12/3/25 at approximately 1330 hours with A2 (CLinical Quality Specialist), he/she confirmed that on 11/8/25 F1 had the capacity and the specialty services for P21 to be transferred to F1. 5. In phone interview on 12/4/25 at approximately 0717 hours with MD2, he/she indicated receiving a call on 11/8/25 from the on-call center regarding a transfer from F2 to F1 involving P21 with a diagnosis of NSTEMI. MD2 indicated the odds of P21 having a clogged coronary artery or ischemic disease due to his/her age was unlikely, but due to P21’s elevated troponin level and chest pain, MD2 indicated he/she wanted a cardiology specialist to speak with the referring facility and weigh in on the case. The on-call center then phoned MD2 back after speaking with MD1 and informed MD2 that MD1 would consult on the case but was refusing to speak with the sending facility. MD2 indicated that he/she was left concerned that if P21 was transferred to the facility there would be no assistance from the cardiologist, and he/she did not want P21 transferred to F1 and then must be transferred again to another facility. MD2 indicated he/she learned from F1 on 12/3/25 that MD1 told the on-call center he would consult and order an echocardiogram if MD2 wanted to go ahead and accept the transfer. MD2 indicated if he had known this information, he/she would have accepted the transfer, and they could have helped P21. MD2 indicated that there was miscommunication from the on-call center of what MD1 was offering. 6. In phone interview on 12/4/25 at approximately 1357 hours with MD1, he/she indicated receiving a call from the F1 call center regarding the transfer of P21 from F2 to F1 with diagnosis of NSTEMI. MD1 confirmed he/she would not speak to MD3 regarding P21 and told the on-call service if MD2 wanted to receive the admission that he/she would consult on the case.”