Riverside Medical 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: 50453 Based on record reviews and interviews, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider’s agreement which requires hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by failing to ensure the physician certification and transfer record contained the risk and benefits of the transfer for 3 (#7, #9, #14) of 6 medical records reviewed for an appropriate transfer (see findings tag A-2409).”

“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: 50453 Based on record review and interview, the hospital failed to ensure the physician certification and transfer record contained the risk and benefits of the transfer for 3 (#7, #9, #14) of 6 medical records reviewed for an appropriate transfer. Findings: Review of hospital policy number T-13, titled “Transfers,” review date 01/2026, revealed in part: “PURPOSE: To establish guidelines based on EMTALA standards for patients in the Emergency Department and patients admitted as observation status to ensure adequate care is given. PROCEDURES: 3. Certification of necessary transfer will be completed by the attending physician for patients at risk of deterioration during transfer based on the reasonable risks and benefits to the patient, the medical treatment at the receiving hospital outweighing risks to the patient as a result of transfer. 4. The Transfer Record (To Another Facility) shall be completed for all transfers of patients that are referred to another medical facility after the need of transfer is determined by the attending physician and this need is explained fully to the patient/responsible party. 5. The Authorization For Transfer (To Another Facility) is required for all transfers to another facility. The patient/responsible person should sign this form after the physician explains the risks involved in transfer. This form must have a patient/responsible party signature and witness signature of nurse completing form.” Review of hospital policy number B-38, titled “Emergency Medical Treatment,” review date 01/2026, revealed in part: “STABILIZATION AND TRANSFER: If it is determined that an emergency medical condition exists, Riverside Medical Center will stabilize the condition or effect an appropriate transfer. A patient whose condition has not been stabilized may be transferred to another facility if the individual, after being informed of the risks and the hospital’s obligations, requests a transfer; or a physician has signed a certificate that the benefits of the transfer to another medical facility outweighs the risk to the individual. Physicians certifying the transfer should state reasons for transfer and risks and benefits.” Patient #7 Review of the emergency department (ED) record for Patient #7 revealed the patient arrived to the ED on 07/28/2026 at 3:56 AM with complaints of difficulty swallowing and difficulty breathing. Patient was transferred to Hospital B on 07/28/2026 at 6:22 AM. Review of Patient #7’s physician note revealed in part: “Patient recently had an anterior approach cervical disc fusion. Patient was seen less than 24 hours ago and CT (computed tomography) scan of the soft tissue neck with IV (intravenous) contrast revealed significant amount of swelling. An attempt was made to get the patient transferred back to where his surgical team could evaluate him by the surgeon, [stated name], stated that this was not an unexpected finding and the patient should be discharged home with a Medrol Dosepak. The patient’s symptoms have worsened since that time and now he cannot tolerate oral intake. Patient states he has throat pain. “ CT Soft Tissue Neck revealed in part: “Impression: Very limited study due to artifact. Extensive prevertebral edema without well-defined abscess. Air in the soft tissue most likely postoperative.” Patient is being transferred for ENT (Ear Nose and Throat) and/or GI (Gastrointestinal) services. Impression and Plan: Diagnosis: Dysphagia. Condition: Guarded. Disposition: Transfer to Hospital B. Review of Patient #7’s Transfer Record (To Another Facility), signed by S6MD, revealed in part: Diagnosis: Prevertebral Edema Emergency Medical Condition: Yes Reason for Transfer: Prevertebral Edema Post Op Cervical Fusion Condition on Transfer: Stable/Not at risk to deteriorate Certification of Necessary Transfer: Benefits: (blank); Risks: (blank) Further review of Patient #7’s medical record and the physician certification failed to reveal documented evidence that detailed the risks and benefits of the transfer discussed with the patient/responsible party by S6MD. In an interview on 08/25/2026 at 1:09 PM, S1CO and S3CNO confirmed the above-mentioned findings. Patient #9 Review of the ED record for Patient #9 revealed the patient arrived to the ED on 06/03/2026 at 11:34 PM for a psychiatric evaluation. Patient #9 was placed on a physician emergency consent (PEC). Patient was transferred to Hospital C on 06/04/2026 at 5:45 AM. Review of Patient #9’s Transfer Record (To Another Facility), signed by S7MD, revealed in part: Diagnosis: Violent Behavior Emergency Medical Condition: Yes Reason for Transfer: Psych Condition on Transfer: Stable/Not at risk to deteriorate Certification of Necessary Transfer: Benefits: (blank); Risks: (blank) Further review of Patient #9’s medical record failed to reveal documented evidence of a physician certification explaining the risks and benefits or the reason for the transfer by S7MD. In an interview on 08/25/2026 at 1:25 PM, S1CO and S3CNO confirmed the above-mentioned findings. Patient #14 Review of the emergency department (ED) record for Patient #14 revealed the patient arrived to the ED on 06/23/2026 at 10:11 PM with complaints of chest pain. Upon arrival blood pressure was 190/117 with a heart rate of 70. Patient #14 was transferred to Hospital B on 06/24/2026 at 2:40 AM. Review of Patient #14’s physician note revealed in part: “Patient presents with chest pain/epigastric pain. No cardiac history. Positive history of esophagitis with GERD (Gastroesophageal Reflux Disease). Initial Troponin is 81 with EKG (electrocardiogram) that is NSR (Normal Sinus Rhythm with nonspecific T wave issues. Second EKG clearly shows lateral ischemia as evidenced by T wave inversion in lateral pattern. Second Troponin 82 (high normal here is 18). Patient has one kidney and a creatinine of 4.1. Other labs are unremarkable and Chest X-ray is also unremarkable.” “Patient received nitroglycerin sublingual, GI cocktail, heparin bolus, and was started on a heparin IV infusion.” Impression and Plan: Diagnosis: Biomarker positive MI (Myocardial Infarction) with associated central/epigastric pain; Lateral Ischemia on EKG; Hypertensive Urgency. Disposition: Transfer to Hospital B. Review of Patient #14’s Transfer Record (To Another Facility), signed by S8MD, revealed in part: Diagnosis: Biomarker positive MI with Chest Pain Emergency Medical Condition: Yes Reason for Transfer: Needs Cardiology Condition on Transfer: Stable/Not at risk to deteriorate Certification of Necessary Transfer: Benefits: (blank); Risks: (blank) Vital Signs on Discharge: Blood pressure 159/99, heart rate 68 Treatment orders enroute: Heparin drip, cardiac monitor. Further review of Patient #14’s medical record and the physician certification failed to reveal documented evidence that detailed the risks and benefits of the transfer discussed with the patient/responsible party by S8MD. In an interview on 08/25/2026 at 2:25 PM, S1CO and S3CNO confirmed the above-mentioned findings. In an interview on 08/26/2026 at 9:49 AM, ED Medical Director confirmed any patient is at risk to deteriorate during a transfer.”