CMS conducted a review of this facility and found 6 out of 20 medical records reviewed failed to meet EMTALA standards for appropriate transfer (Tag A2409).
Patient #3 was diagnosed with a heart attack and required transfer “to a higher level of care”. There is no evidence of physician to physician contact to accept the transfer as specified in the hospital protocol. Risks of transfer only included a generic reference to transportation problems, deterioration of condition up to and including death, and limitations of personnel present in vehicle. There was no patient-specific reference to cardiac related risks per the citation.
Patient #4 was diagnosed with Acute Respiratory Failure and required transfer to a higher level of care due to lack of ICU beds. Again, there is no physician to physician contact per protocol documented in the CMS findings and no patient-specific risks regarding respiratory failure per the citation.
Patient #7 presented for chest pain and required transfer to a higher level of care for equipment not available at the original hospital. Again, there is no physician to physician contact per protocol documented in the CMS findings and no patient-specific risks regarding chest pain per the citation.
Patient #14 was diagnosed with Acute Coronary Syndrome and required transfer to a higher level of care for equipment not available at the sending hospital. Again, there is no physician to physician contact per protocol documented in the CMS findings and no patient-specific risks regarding ACS.
Patient #15 was diagnosed with paranoid schizophrenia and required transfer for “continuity of care.” Again, there is no physician to physician contact per protocol documented in the CMS findings and no patient-specific risks regarding psychiatric issues.
Patient #16 was diagnosed with ACS and required transfer for continuity of care and lack of specialized equipment. Again, there is no physician to physician contact per protocol documented in the CMS findings and no patient-specific risks regarding ACS.
Comments:
CMS will enforce hospital protocols as standards for EMTALA compliance, even if the protocols are more demanding than EMTALA standards. In this case, the protocol required physician to physician contact to obtain advance acceptance. While this is frequently considered the most appropriate standard by hospitals, EMTALA does not itself require physician to physician contact – it only requires that the receiving hospital gives acceptance for the transfer. CMS expects detailed documentation on who placed the call and who received the call and gave acceptance on behalf of the receiving facility.
On the issue of documenting risks, CMS does not forbid generic risks from being included, but typically expects at least one hand-written risk specific to the patient and their condition. Be assured, there are risks for all transfers and those risks should be clearly stated “worst-case” scenarios. Without full disclosure, CMS will not accept the consent and a court would potentially rule that the patient had not given “informed consent.”
On the issue of reasons for transfers, CMS typically will not accept “continuity of care” as a justification for transfer, as EMTALA requires that transfer be for care or equipment that is not available at the sending facility. When using the “not available here” rationale, it is wise to document the specific equipment, specialty, or circumstances that are available at the destination that are not available at the sending facility at the time of the transfer.
The facility was also cited for lack of an EMTALA sign in the waiting area (Tab 2402).
A2409-WI-2013-3-5