Corewell Health Reed City Hospital

“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: 28042 Based on interview and record review, the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases] by failing to obtain written consent from 4 (#6, 8, 13, and 17) of 20 patients for transfer to another facility, resulting in the potential for patients making uninformed healthcare decisions which could result in potential for poor outcomes. Findings include: See A-2409 Failure to complete transfer form.”

“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: 28042 Based on interview and record review, the facility failed to obtain written consent for 4 patients (P-6, P-8, P-13, and P-17) , failed to send complete medical records for 3 patients (P-6, P-13, P-17), and failed to provide stabilizing treatment for 1 patient ( P-13) of 20 patients reviewed for transfer to another facility, resulting in the potential for patients making uninformed healthcare decisions and the potential for poor outcomes. Findings include: Review of the medical record of P-6 on 03/20/2024 at 1345 revealed the patient was a 47-year-old male who was transferred to another facility for methadone overdose of undetermined intent, motor vehicle collision, and chest wall contusion. Review of the “Emergency Medical Treatment and Labor Act (EMTALA)/Transfer form” revealed the section labeled “Patient’s Consent to Transfer”, lines for time, date and signature of Patient or Authorized person signature was blank. The boxes for the two choices of “ Check here if the patient is unable to sign but verbally consents to the transfer and transportation”; and/or “Check here for involuntary commitment” were not checked. The section of the Transfer form which indicated, “Medical records copied and sent by:” was blank. Physical exam documented in provider note for P-6 indicated P-6 had slow garbled speech, follows commands, but slowly and had a GCS of 13. Review of the medical record of P-8 on 03/20/2024 at 1410 revealed the patient was a 78-year-old female who was transferred to another facility for atrial fibrillation, leukocytes, elevated bilirubin, and pneumonia. Review of the “Emergency Medical Treatment and Labor Act (EMTALA)/Transfer form” revealed the section labeled “Patient’s Consent to Transfer”, lines for time, date and signature of Patient or Authorized person signature was blank. The boxes for the two choices of “ Check here if the patient is unable to sign but verbally consents to the transfer and transportation”; and/or “Check here for involuntary commitment” were not checked. Physical exam documented in provider note for P-8 indicated P-8 was alert and oriented to person, place and time with a normal mood. Review of the medical record of P-13 on 03/20/2024 at 1430 revealed the patient was a 59-year-old male who was transferred to another facility for Gastrointestinal hemorrhage. The emergency department provider note dated 01/28/2024 indicated P-13 presented profoundly anemic, with a hemoglobin of 3.5, platelets of 10. The provider note indicated P-13 was treated with intravenous Protonix bolus to treat a potential upper gastrointestinal bleeding source and 20 meq of potassium. The provider note did not indicate that P-13 received any IV fluids prior to transfer. Review of the “Emergency Medical Treatment and Labor Act (EMTALA)/Transfer form” revealed the section labeled “Patient’s Consent to Transfer”, lines for time, date and signature of Patient or Authorized person signature was blank. The boxes for the two choices of “ Check here if the patient is unable to sign but verbally consents to the transfer and transportation”; and/or “Check here for involuntary commitment” were not checked. The section of the Transfer form which indicated, “Medical records copied and sent by:” was blank. Physical exam documented in provider note for P-13 indicated P-13 was awake, alert and and moving all extremities with mental status at baseline. Review of the medical record of P-17 on 03/20/2024 at 1430 revealed the patient was a 70-year-old male who was transferred to another facility for NSTEMI (non ST elevation myocardial infarction - less severe type of heart attack). Review of the “Emergency Medical Treatment and Labor Act (EMTALA)/Transfer form” revealed the section labeled “Patient’s Consent to Transfer”, lines for time, date and signature of Patient or Authorized person signature was blank. The boxes for the two choices of “ Check here if the patient is unable to sign but verbally consents to the transfer and transportation”; and/or “Check here for involuntary commitment” were not checked. The section of the Transfer form which indicated, “Medical records copied and sent by:” was blank. Physical exam documented in provider note for P-17 indicated P-17 was alert and oriented to person, place and time. On 03/22/2024 at 1030, Review of facility, Emergency Medical Condition/Treatment/Transfer Policy (Emergency Medical Treatment and Active Labor Act-EMTALA), policy, version #5, effective dated 07/16/2021, section 3.5.3.1. “The hospital must send to the receiving facility copies of available medical records related to the individuals emergency medical condition available at the time of transfer...” and section 3.7.1.1. “The facility” recognizes that treatment must be done with the consent of the patent. Any competent patient has the right, at any point, to accept or refuse treatment. In an interview on 03/22/2024 at 0850, Staff A stated during Covid, the process changed to just obtaining verbal consent for transfers from all patients. Staff A said the change back to obtaining signed consent got lost due to leadership change and staff are still on the Covid process. All patients being transferred are not signing consent for transfer.”