Freestone Medical Center

“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: 28422 Based on a review of clinical records, facility documentation and an interview with staff, the facility failed to effect an appropriate transfer for 1 of 20 patients. Findings were: Patient #1 was taken to Freeston Medical Center (FMC) on 1-22-24 at 12:44 am by a [nearby city] police officer. Nursing notes stated the following: “Presentation: 01/22 00:59 Presenting complaint: Patient states: Reports being suicidal. States that he feels worthless in life and has an overwhelming urge to end it. Pt has a plan and the means of carrying it out. Pt brought to ER by [nearby city] PD and needs to be medically cleared so [nearby city] PD can take him to [hospital #2] for treatment, per officer [redacted] with [nearby city] PD. Transition of care: patient was not received from another setting of care. Coronavirus Screening: Patient negative for fever and symptoms of lower respiratory illness (e.g., cough, difficulty breathing). Patient denies exposure to infectious person. Patient denies travel in the 14 days before illness onset. No symptoms or risks identified at this time. General: Appears in no apparent distress, comfortable, Behavior is appropriate for age, cooperative, flat. Pain: Complains of pain in Headache Pain currently is 4 out of 10 on a pain scale. Quality of pain is described as aching, Pain began 1 day ago. Neuro: No deficits noted. Cardiovascular: No deficits noted. Respiratory: No deficits noted. GI: No deficits noted. Derm: No deficits noted. Musculoskeletal: No deficits noted. ... Suicide Risk Assessment: Credible Suicide Plan - Yes (3 points), Family History of Suicide - No (0 points), Lives Alone - Yes (1 point), Means to Kill Self Available - Yes (3 points), Past Attempts - No (0 points), Has Serious Health Problem - No ( 0 points), Suicidal Thinking Present - Yes ( 2 points), Total Suicide Risk Assessment Score: Score of 3 or Greater (Substantial risk for suicide). Patient placement close to nurses station, Legal authorities with patient.” Physician documentation stated the following: “HPI: 01/22 This 24 yrs old Caucasian Male presents to ED via Law Enforcement with complaints of Medical Clearance. 01:22 The patient presents to the emergency department with suicide ideation. Past psychiatric history: Prior diagnosis: no previous psychiatric diagnosis known, Psychiatric medications include: none, Primary psychiatric physician: the patient does not have a primary psychiatric physician, the patient has not had a prior suicide gesture, the patient does not have a previous inpatient psychiatric history, the patient’s last psychiatric treatment was saw outpatient counselor for three weeks. Severity of symptoms: At their worst the symptoms were moderate in the emergency department the symptoms are unchanged. The patient has experienced similar episodes in the past. Family stressors today made patient’s suicidal ideations spike. ... Data reviewed: vital signs, nurses notes. ED course: the patient will be cleared medically and then sent to [hospital #2] for inpatient rehab. ED course: Patient being discharged into police custody for psychiatric Inpatient at [hospital #2].” Following medical clearance, the [nearby city] police officer left with the patient, stating that the [nearby city] PD had an agreement with [hospital #2] to accept all of their psychiatric patients after medical clearance. Facility policy titled “EMTALA Medical Screening, Treatment, and Transfer Policy” states, in part: “PURPOSE: The purpose of this policy and procedure (“Policy”) is to establish a mechanism to be utilized by the staff of Freestone Medical Center (“Hospital”) to respond effectively to individuals who come to the Emergency Department and request an examination or treatment for a medical condition. It is the policy of the Hospital to comply with all applicable laws and regulations relating to the provision of emergency services, including the Emergency Medical Treatment and Labor Act (“EMTALA”), EMTALA applies to all hospitals with emergency departments that participate in the Medicare program. EMTALA provides benefits to all individuals presenting to emergency departments, regardless of the individual’s Medicare or Medicaid eligibility or their ability to otherwise pay for the services rendered. Signs· specifying the rights of individuals under EMTALA will be posted in accordance with federal regulations. Pursuant to EMTALA, a medical screening examination will be performed by the E.D. physician. A medical screening examination will be provided to all individuals who come to the emergency department (or otherwise present to the Hospital) and request an examination or treatment for a medical condition. DEFINITIONS: For purposes of this Policy, the following defined terms shall have the meaning specifically defined below: 1. The term “appropriate transfer” shall mean, with respect to a person with an emergency medical condition: 2. a. The transferring hospital provides, within its capacity, medical treatment that minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child; 3. b. The transferring hospital obtains permission from the receiving hospital to transfer the individual and documents its communication with the receiving hospital, including the date and time of the transfer request and the name of the person accepting the transfer; 4. c. Necessary medical records accompany the transferred individual, but the transfer is not delayed in order to retrieve records or receive test results. Records and results that become available after the individual is transferred will be telephoned, and mailed or sent via electronic transmission to the receiving hospital; and 5. d. The transfer is effected through qualified personnel and equipment as determined by the physician at the transferring hospital and may include a physician or some other specialist.” In an interview with staff #4 on 2-26-24, she was asked what she could recall about the event involving patient #1. She stated that she came to work on the morning of 1-22-24 and found patient #1’s chart, but no MOT (memorandum of transfer). She stated that staff #6 (ER physician) told her that the [nearby city] police officer told him that it was fine to transfer the without an MOT, as the [nearby city] PD “had a contract” with [hospital #2] to take all of their psychiatric patients that were on an EDO (emergency detention order). She stated that she then provided re-education to all ER staff on 4 different shifts. Staff #4 stated that again on 1-26-24, she encountered the same [nearby city] police officer at the ED desk, telling the staff about the contract he had with [hospital #2] and that he only needed FMC to provide medical clearance and that he would transport the patient without the need for acceptance of the patient by [hospital #2]. She said that she told him that FMC would need to secure an appropriate transfer to [hospital #2] and that an MOT would need to be completed. He again spoke of a “contract” and offered to show it to staff #4. Staff #4 stated that the officer showed her an email (sent by the [nearby city] Chief of Police) on his cell phone, which confirmed what the officer was saying. She said that she reiterated to him that an appropriate transfer needed to occur and that an MOT would need to be completed. She stated that he became very annoyed at her instruction and stated that he was the only [nearby city] police officer on duty at the time and that he needed to get back to work. Staff #4 was able to provide documentation that an appropriate transfer to [hospital #2] had then been effected by the ED doctor for the patient needing psychiatric services on 1-26-24. The above was confirmed in an interview with the CEO and other administrative staff on 2-26-24.”