Based on document review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to ensure transfer risks were documented with all transferred patients/responsible parties and physicians. See A 2409.

Based on observation and interview, the facility failed to post EMTALA signs in areas likely to be noticed by all individuals that visit the emergency department (ED), resulting in the potential for all ED patients to not be informed of their rights to have a medical screening exam and stabilizing treatment in the ED. Findings include: During the observational tour of the ED, on 3/20/18 between the hours of 1030 - 1215 while accompanied by the ED Director and the Director of Accreditation and Risk Management, it was noted that there were no EMTALA signs posted in the triage rooms, treatment areas and at the ambulance entrance. On 3/21/17 at approximately 1230, ED Director Staff C was queried about the lack of signs and he stated, "I'll get those signs posted in those areas immediately."

Based on document review and interview the facility failed to ensure patient transfer forms were signed by the physician for 2 patients (#11 and #20) out of 4 patients reviewed for transfer and the facility failed to ensure the patient or responsible party signed the transfer forms for 2 patients (#6 and #11) of 4 patients reviewed for transfers that explained the risks and benefits of a transfer out of a total of 20 sampled patients resulting in the potential for less than optimal patient outcomes. Findings include: On 3/20/18 between 1400 and 1600 a review of the medical records for patient #6 and #11 were conducted with Emergency Department Director Staff C and the following was revealed: A review of patient #6's chart revealed a patient transfer form dated 10/24/17 that was not signed by the patient. However, the form was signed by a witness and a physician on 10/24/17. There was no evidence in the medical record that documented the patient refused to sign the transfer form. A review of patient #11's chart revealed the patient transfer form was not signed by the patient and/or responsible party or the physician. The form dated 1/17/18 documented the receiving physician had agreed to accept the patient and the patient was to be transferred via ambulance with advanced life support to a local acute care facility. Further review of the medical record for patient #11 revealed a "Critical Care Air/Ground Transfer Certification Form" dated 1/17/18. However, there was no physician's signature that documented the physician had certified the transfer. During an interview on 3/20/18 at 1630 Staff C was queried regarding the lack of patient signatures for transfer for patient #6 and #11. Staff C confirmed the signatures should have been obtained. Staff C said the registration staff members were responsible for obtaining and witnessing patient signatures for transfers. A review of patient #20's chart was reviewed on 3/21/18 at 0915 with Staff C. A patient transfer form dated 12/6/17 revealed the physician did not sign the form. During an interview on 3/21/18 at 1050 Staff C was queried regarding the lack of physician signatures for patient transfers for patient #11 and #20. Staff C confirmed the physician should have signed the patient transfer forms. On 3/21/18 at 1330 a review of the facility's undated "Emergency Medical Screening, Treatment, Transfer and On-Call Roster" policy documented the following: Transfer: C. Upon transfer, the Emergency Department shall provide appropriate medical records regarding its treatment of the individual including, but not limited to, observations of signs or symptoms, preliminary diagnosis, treatment provided, results of any test, informed written consent or transfer certification, and the name and address of any on-call physician who has refused or failed to appear within a reasonable period of time to provided stabilizing treatment.