Based on document review and staff interview, it was determined the hospital failed to: a. document and retain medical records for patients who were transferred from sending hospitals. See tag A-2403; b. screen and stabilize or execute an appropriate transfer for two mental health patients who arrived at the Integris Baptist Medical Center Spencer campus. See tag A-2406; and c. the hospital failed to accept transfers from a sending hospital when it had the capacity and capability to provide specialized care for two mental health patients who were transferred to the hospital. See tag A-2411. This had the potential to affect all patients who arrived at the Integris Baptist Medical Center Spencer campus.

Based on document review and staff interview, it was determined the hospital failed to accept transfers from a sending hospital when it had the capacity and capability to provide specialized care for two mental health patients who were transferred to the hospital. Findings: On May 06, 2016 and May 18, 2016, the Integris Baptist Medical Center Spencer campus, a mental health inpatient treatment facility, received patients transferred from a sending hospital. The sending hospital determined these patients needed emergent inpatient psychiatric care. The staff stated that on May 06, 2016 the Spencer facility did not have the capacity to admit the patient (patient #2) who they said arrived without notice from a sending hospital. Integris Spencer did not have documentation of this event and did not have documented evidence the facility was at capacity for this date. The patient was sent away with a law enforcement officer, allegedly to return to the sending hospital. The sending hospital did not have the specialized capabilities to care for psychiatric patients. The staff stated on May 18, 2016, another patient (patient #1) arrived without notice from the same sending hospital. The staff stated this patient was refused admission because he did not have an adequate medical clearance examination at the sending hospital emergency department. When the staff were asked if the Spencer campus had the capacity to admit the patient, they stated they did not know if a bed was available because "it (the situation) didn't get to that point." This patient was sent away with a law enforcement officer allegedly to return to the sending hospital. The sending hospital did not have the specialized capabilities to care for psychiatric patients. A hospital policy, dated 10/24/15 and titled, "Patient Transfers - EMTALA" documented, "... Requirement to accept transfers. [Integris Baptist Medical Center] must accept emergency patient transfers from other facilities if the individual requires specialized capabilities or facilities that are not offered or not immediately available at the transferring hospital... if [Integris Baptist Medical Center] has the capability and the capacity to treat the individual..."

Based on document review and staff interview, it was determined the hospital failed to screen and stabilize or execute an appropriate transfer for two mental health patients who arrived at the Integris Baptist Medical Center Spencer campus. Findings: A hospital policy, dated 6/15 and titled, "EMTALA Requirements and Flow Chart" documented, "The purpose of this policy is to set forth the requirements related to emergency medical screening... Patient comes to hospital property (on or off campus) requesting treatment for emergency condition... hospital provides triage... hospital provides medical screening examination by qualified medical personnel... 'Facility' means... any facility that is located off the main hospital campus but determined by the Health Care Financing Authority to be a hospital department... All patients presenting for treatment will receive, after initial triage, a medical screening examination by qualified medical personnel to determine whether an emergency medical condition exists..." On June 09, 2016, the Integris Spencer staff were asked to describe the events surrounding the arrival of the two mental health patients who presented to the Spencer campus unannounced from a sending hospital. They stated patient #2 arrived to the campus escorted by law enforcement on 05/06/2016 and patient #1 arrived to the campus escorted by law enforcement on 05/18/2016. Patient #1 Regarding patient #1, staff #8 stated she was notified of the patient's arrival. She stated there was no communication to anyone at the Spencer campus that a patient was expected. She stated she was familiar with the patient because he had been admitted there before. She stated she asked the patient what was "going on." She stated he said he was upset because the deputy "busted into his house and took him to [sending hospital name deleted]. He did not say specifically why he was then brought to Integris Spencer. She stated the patient was in hand cuffs and in the custody of a law enforcement officer. Staff #8 stated she remembered the patient had a history of alcoholism and "may have had high blood pressure and maybe cardiovascular disease," but she couldn't be sure. She was asked if the patient was evaluated by taking vital signs, assessment of symptoms, etc., by herself or any of the nursing staff. She stated he was not evaluated. She was asked if she obtained any other information about the patient's presenting symptoms. She stated she did not. She stated it was customary to assess the patient only after admission to an inpatient unit. Staff #7 stated she saw the patient with the law enforcement officer and asked the house supervisor to find out "what was going on." She stated she was told the sending hospital transferred the patient to Integris Spencer. Staff #7 stated the hospital had no knowledge of the transfer and there was no accepting physician. She stated no medical record was sent with the patient. She stated she spoke with the sending hospital's emergency department physician who told her the patient was seen by the previous shift physician and the record showed the patient had not had any lab studies or EKG, but a review of systems was done. The emergency department physician stated the previous shift ED physician had "medically cleared" the patient for transfer and documented the patient as "stable." The sending hospital's medical record for patient #1 documented he had a history of suicide attempts including overdose, and alcohol and drug abuse. The sending hospital's ED physician documented the patient appeared to be "slightly intoxicated" while he was at that hospital. Staff #7 stated she did not believe the sending hospital provided an adequate medical screening examination prior to the transfer and therefore the patient was not determined to be appropriate for admission to the Spencer psychiatric unit. She was asked if she evaluated the patient. She stated, "He looked OK to me, stable, no sweating and no tremors as if going through withdrawal." She stated she did not speak to the patient or to the law enforcement officer and did not perform a psychiatric evaluation. She was asked what happened next with the patient. She stated she told the sending hospital ED physician that "since the [sending hospital] ED physician started the work-up, he should probably finish it and that it was possible to start over at the Integris Baptist Medical Center ED but it was probably better for the patient to go back to [the sending hospital]." She stated the patient then left with the law enforcement officer and she assumed the patient went back to the sending hospital. The sending hospital had no record the patient returned to them. Since no one could identify the law enforcement officer, it could not be determined where the patient went after he left Integris Spencer. Staff #9 was asked about his recollection of the events with patient #1. He stated he and the law enforcement officer escorted the patient to the mobile assessment team room that was used to do a telemedicine evaluation by mental health staff at the Integris hospital main campus. He stated the patient became upset when it became clear to him that the staff were not going to admit him to the unit. He stated the patient wanted to be there. He stated the patient became so upset that he refused to sit in a chair that was offered to him and instead sat on the floor in the evaluation room. Staff #9 stated the patient was not evaluated by telemedicine and eventually the law enforcement officer and the patient were told he was not going to be admitted and that the officer should take the patient back to the sending hospital. Staff #9 was asked how other "unannounced patients" were handled at the Spencer campus. He stated they were always told to go back to where they came from or told to go to an emergency room ." He stated even some patients that were accepted for admission were sent away because the staff thought they needed a medical clearance first. He stated unannounced patients and patients who were expected for admission always left the facility by the transportation used at arrival. Patient #2 Patient #2 was seen in the emergency department at the sending hospital on May 06, 2016 for a suicide attempt and lacerations to both forearms. The medical record was unclear as to where the patient was transferred. The staff at Integris Spencer stated they had heard about this patient's unexpected transfer to the Spencer location but none of them were present when he arrived and they stated they did not know who on staff were involved in the situation. Staff #8 stated she was present when the patient arrived and the Spencer location had no beds available, so she called the sending hospital. The sending hospital could not give her the name of the accepting physician for Integris, so she said she told the sending hospital they were sending the patient back to them. She stated the patient did not receive any type of evaluation at the Spencer campus and the patient left with the law enforcement officer. She stated the hospital had no documentation of this event. Other staff verified Integris Spencer had no documentation of this patient's arrival or of any actions taken on his behalf. Staff #10 verified the Spencer location did not document walk-in patients or transfers in from sending hospitals. He stated that walk-in patients were told to go to the nearest emergency department or drive to the Integris Baptist Medical Center main campus ED. He stated that patients who arrived with law enforcement were told the same thing. He recalled a situation approximately six months prior when a patient walked in with symptoms that he said "met the criteria for admission." He stated there was no bed available at the Spencer location so he called another hospital with psychiatric services and secured a transfer to a bed there. He stated law enforcement was called to transport her. He was asked if there was any record of this event. He stated there was not. Staff #10 was asked if all walk-in patients were evaluated as he had done for this patient. He said they were not. He stated that after normal business hours, the Integris mobile assessment team (MAT) assessed patients by telemedicine. However, not all walk-in patients were assessed by MAT. He stated the hospital did not provide MAT assessments unless a bed was available at the Spencer location. He again stated those patients were told to go to an emergency room . He stated that patients who were suicidal or homicidal were transported to an ED by law enforcement. The hospital did not provide a policy and procedure that directed the Spencer staff on the use of the telemedicine assessment services. Staff #10 was asked if any walk-in patients were assessed for medical problems at the Spencer campus. He stated they were not, unless during his psychiatric evaluation a medical problem was discovered. He said those patients were told to get a medical clearance at a hospital emergency department before they could be admitted to the Spencer unit. A hospital policy, dated 10/24/15 and titled, "Patient Transfers - EMTALA" documented, "... In the event the patient does not present him/herself to the [Integris Baptist Medical Center Emergency Department] or labor and delivery unit and is identified as seeking or in need of emergency medical care, the patient will be assisted to the [Integris Baptist Medical Center Emergency Department]..." The hospital's QAPI plan for 2016 did not include assessment of EMTALA compliance.

Based on document review and interview, it was determined the hospital failed to document and retain medical records for patients who were transferred from sending hospitals to the Integris Baptist Medical Center Spencer campus. The hospital identified two patients who were transferred to the Spencer campus from a sending hospital. Findings: On 06/03/2016, the hospital documented in an e-mail to the Oklahoma State Department of Health that a male patient was inappropriately transferred to Integris Spencer on 05/06/2016 and another male patient was inappropriately transferred to Integris Spencer on 05/18/2016. The hospital alleged that both patients were transferred directly to the Integris Spencer campus from the sending hospital without acceptance from Integris Baptist Medical Center. During the complaint survey, the Spencer campus staff were asked for documentation of these transfers such as a medical record, log, occurrence report, security officer report or other record. The staff stated they did not have any documents related to these events and the patients had no medical records sent with them from the receiving hospital. The staff stated it was not the hospital's practice to document a record of direct transfers into the Spencer campus, so they were unable to identify all patients who were transferred in from other hospitals. It could not be determined if there were any other similar transfers at the Spencer campus. During interviews, the staff stated that even though they did not have any documentation, they could identify patient #1 because they were familiar with him as he had been a patient at the Spencer campus previously. They also stated they only had a physical description of patient #2 that they provided from memory. On 06/07/2016, it was confirmed through a review of the sending hospital's emergency department log for May 2016 that these two patients had been seen at the sending hospital on [DATE] and 05/18/2016. The sending hospital's emergency department record for patient #1 documented on 05/18/2016, "... chief complaint - pt. has bed at Integris psych unit but needs medical clearance..." The sending hospital's emergency department medical record for patient #2 was dated 05/06/2016 and documented details about the patient that matched the description given by the Integris Spencer staff. The record was unclear about where the patient was transferred. Integris Baptist Medical Center had no policy that directed staff at the Spencer campus to document transfers from other hospitals.

Based on review of hospital documents and interviews with hospital staff, the hospital failed to enforce policies and procedures to comply with EMTALA requirements. Findings: The hospital failed to follow its policies and procedures concerning: a. treatment within its capability for one (#4) of twenty patients, whose records were reviewed. See Tag A-2407 for further details. b. recipient hospital responsibilities for two of nine patients (#17, 18) with a request for transfer from a referring hospital. See Tag A-2411 for further details.

Based on review of medical records and hospital documents, and interviews with hospital staff, the hospital failed to provide treatment within its capability in one (#4) of twenty patients whose records were reviewed. Findings: Integris Baptist Medical Center is a 629 bed hospital that offers a a wide variety of adult specialty services and limited pediatric services. On 08/01/2015, at 10:47 a.m., Patient #4 presented with complaints of left lower leg/extremity (LLE) pain. The emergency department (ED) physician examined the patient and found an "obvious deformity to his LLE." X-rays confirmed the patient had "angulated fractures of the mid left tibia and fibula diaphysis (bone shaft)." No other injuries were confirmed. At 11:32 a.m., the ED physician consulted, by telephone, with the orthopedist on-call, Staff A. According to the ED physician's documentation, Staff A recommended the patient be transferred to another acute care hospital that specialized in pediatric services. The ED physician recorded Staff A stated he did not operate on this age group. The patient was transferred to the other hospital. According to Staff A's current privilege list, the physician had privileges at the hospital since 09/01/2014, that included, providing services to "patients of all ages"; "adult and pediatric orthopaedic disorders, diagnosis and management of"; "pediatric trauma"; "fixation of traumatic injuries"; "fracture and dislocations of lower extremities..."; and "acute trauma, diagnosis and care - both operative and nonoperative." The credential file and privilege list did not contain evidence any of the above privileges had been amended or deleted. This was confirmed with Staff N on 11/18/2015 at 2:20 p.m.

Based on review of hospital documents and medical records, and interviews with hospital staff, the hospital failed to accept patients from referring hospitals in two (#17 and 18) of nine patients where a request for transfer occurred from a referring hospital. Findings: Review of the hospital's policy title, "Patient Transfers - EMTALA", with a revision date of 10/24/2015, documented "...To the extent the Medical Center has the capability and capacity to treat the individual, the Medical Center will accept all appropriate transfers from other facilities..." 1. Patient #17 - According to the documentation on the Integris Baptist Medical Center's (IBMC's) Transfer Center, the Transfer Center received a call on 10/06/2015, at 7:58 p.m. from another acute care hospital's emergency department (ED) with a request for specialty of hand surgery. The Transfer Center Summary (TCS) form documented the patient had a right hand infection with possible sepsis. The TCS form documented conferences between physicians at IBMC and the requesting hospital. The TCS form recorded Staff B, the orthopedist on call for IBMC refused the patient and stated the patient needed to be transfer to (name omitted), another acute care hospital. On 11/20/2015, and 11/24/2015, IBMC provided data documenting Staff B was in surgery on 10/06/2015 from 7:47 p.m. until 9:35 p.m. The medical record of Patient #17, from the requesting hospital, was reviewed. According to the medical record, the patient did not sign the consent for transfer until 9:00 p.m. On 11/24/2015, at 2:00 p.m., a surveyor interviewed Staff S, one of the ED physicians, at the requesting hospital, involved in the care and transfer of Patient #17. Staff S stated Staff B did not mention having any surgeries until his last conversation with Staff B on the night of 10/06/2015. Staff S stated Staff B did not say he was currently in surgery. Staff S stated Patient #17 was not transferred until sometime after 9:00 p.m. The requesting hospital is approximately 90 miles away from IBMC. At the time the patient was transferred on 10/06/2015, Staff B would have been out of surgery and able to take care of Patient #17. 2. Patient #18 - According to the documentation 10/18/2015, at 0024, the hospital's Transfer Center received a call from another acute care hospital's ED physician with a request for transfer of a patient needing specialty orthopedic services. ~ The Transfer Center Log documented the patient had a pelvic fracture. ~ The ED Transfer Data Form listed the patient's injuries as left superior pubic ramus fracture; right non-displaced pubic ramus fracture with extension into the sacral iliac joint; possible right foot fracture; and laceration on the right chin. IBMC's ED physician took the call; consulted the on-call orthopedist, Staff E; and documented on the form that Staff E did not have the "capability to operate on these types of fractures." The transfer request was denied. The form documented that another orthopedist, Staff F was not on-call. (On the afternoon of 11/18/2015, Surveyors were told Staff F was the only physician who performed the acetabular fractures and complex pelvic fractures.) ~ On 11/18/2015, at 2:00 p.m., Staff E stated he did not perform "complex" pelvic fractures or acetabular fractures. He stated, as far as he knew, Staff F was the only orthopedist at IBMC that performed the surgeries. ~ Review of Staff E's current privilege list, the privileges included: closed (not compound), displaced and nondisplaced pelvic fractures; fixation of traumatic injuries; foot and ankle surgery; fracture and dislocations of lower extremities (including pelvis and hip);, hip and knee conditions, assessment and management of; primary total hip replacement surgery; total joint replacement, hip ,knee, shoulder, primary and revision; trauma, including multisystem trauma; and urgent and emergency orthopaedic problems, treatment evaluation. The was the same information that was listed on Staff F's privileges. This was reviewed and verified with Staff N and Q at the time of review on 11/18/2015.

Based on review of the hospital documents and interviews with hospital staff, the hospital failed to document the disposition of each individual that presented to the ED. The hospital's ED log for the months of November 2014 through May 2015 were reviewed. Findings: On 05/12/2015 at 2:30 p.m., the Administrative Director of the ED was asked who was responsible for maintaining the ED log. The Administrative Director of the ED stated the Clinical Director of the ED was responsible for the ED log. Later in the afternoon of 05/12/2015, the Clinical Director of the ED was asked who was responsible for the ED log. The Clinical Director of the ED stated the registration clerks were responsible for maintaining the ED log. The ED log did not contain accurate documentation on the disposition of the individuals that presented to the ED. The ED log documented a disposition of "routine discharge home" on patients who were either admitted to IBMC or transferred to another acute care hospital. This was confirmed by the Administrative Director of the ED on 05/12/2015. Policies and procedures regarding the EMTALA requirements for the ED log were not provided to the surveyors.

Based on review of hospital documents and interviews with hospital staff, the hospital failed to ensure on-call physicians were available to provide patient care. This occurred for nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) that required the services of an on-call physician. Findings: Integris Baptist Medical Center (IBMC) is a 629 bed hospital that offers a a wide variety of adult specialty services and limited pediatric services. The hospital also has an off-site inpatient psychiatric facility that is licensed as a part of the hospital. On-call schedules for IBMC's specialty services were requested and reviewed for the months of November 2014 through May 2015. The surveyors were not provided the on-call schedule for the hospital's psychiatric specialty. Patient #20 presented to IBMC with a psychiatric diagnosis. The patient was transferred from IBMC to a State operated inpatient psychiatric facility. Hospital 6 contacted IBMC requesting to transfer Patient #27 to IBMC. The on-call general surgeon refused to accept the patient. The patient was transferred to Hospital 1. The neurosurgery (NES) specialty schedule documented a physician on-call everyday. Various days of the monthly NES call schedule documented, " physician name/practice/divert ER [emergency department] except stroke." In an interview with the medical co-chair of the ER on 05/12/2015 at 12:55 p.m., he was asked to explain the comments documented on the NES call schedule. The co-chair stated that on those days the on-call NES would only take call for patients that presented to IBMC ER with a diagnosis of stroke and patients already established within the NES practice patients. All other patients, who required NES, that presented to IBMC ER that did not fall in either category would be diverted to the on-call Level 2 hospital. Patients # 1, 5, 10, 12 were diagnosed with neurological disorders that required the services of a NES. The patients were transferred from IBMC to other acute care hospitals. Integris Baptist Medical Center received a call from the Transfer and Referral Center (TReC) requesting to transfer Patient #26 to IBMC for NES. The patient was not accepted by IBMC. Patient # 26 was transferred to Hospital 3. Patient # 14 presented to IBMC ED with an open wound. The patient was transferred from IBMC to Hospital 1. See Tags A-2407 and A-2411 for more details.

Based on review of hospital documents and medical records, the hospital failed to ensure individuals request to transfer were in writing. This occurred in two of three patients (#22, 25) medical records reviewed who requested to transfer. Findings: A hospital policy titled, "Patient Transfers", documented, "...if the patient or the legally responsible person: (i) makes written request for transfer to another medical facility stating the reasons for the request.....(ii) acknowledges the request and understanding of the risks and benefits of the transfer by signing the Signature Page for patient's Request/Consent to Transfer on the Hospital transfer Form..." Patient #22 presented to IBMC ED with cardiac issues. The patient and the patient's family requested to be transferred to Hospital 5. The medical record did not contain a request to transfer in writing, from the patient or the legally responsible person acting on the patient's behalf. Patient #25 presented to IBMC ED with cardiac issues. The patient previously had a procedure at Hospital 5. Patient #25 requested to be transferred to Hospital 5. The medical record for Patient 25 did not contain a request to transfer in writing, from the patient or the legally responsible person acting on the patient's behalf. The transfer form documented, "Lack of facilities, services or staff", as the reason the patient was transferred.

Based on review of medical records and hospital documents and interviews with hospital staff, the hospital failed to provide treatment within its capability in nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) whose medical records were reviewed. Findings: Integris Baptist Medical Center (IBMC) is a 629 bed hospital that offers a a wide variety of adult specialty services and limited pediatric services. The hospital also has an off-site inpatient psychiatric facility that is licensed as a part of the hospital. Review of the hospital's Medical and Dental Staff Rules and Regulations, documented, ..."The "primary injury" should be the injury most potentially life threatening to the patient and which requires the most immediate attention. The physician with expertise in that specialty shall be notified to take responsibility as the admitting physician..." Review of the Professional Services Agreement between Integris Baptist Medical Center (IBMC) and the physicians documented, "...Provider shall respond to calls related to Provider's specialty timely and provide inpatient care and consultative services related to Provider's specialty to any patient seen in the INTEGRIS ER while on-call for Provider's specialty..." The Chief Medical Director was interviewed on 05/12/2015 at 10:35 a.m. He stated patients who were admitted through the IBMC ED with multiple health issues were admitted by the hospitalist. The hospitalist would direct the overall care of the patient, obtaining specialty physicians as needed to care for the patient. Review of the neurosurgery (NES) on-call schedules from November 2014 to May 2015, documented NES available everyday of the week. Patient #1 presented to IBMC via private vehicle. The medical record for Patient #1 documented a head injury and cervical fracture as the medical impression. No specialty consults were documented by the ED physician. The patient transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred. Patient #5 transferred to IBMC from Hospital 4 via emergency vehicle (EV). The medical record for Patient #5 documented acute subarachnoid hemorrhage as the medical impression. At IBMC, the ED physician consulted the on-call NES. The on-call NES recommended to transfer the patient due to no NES coverage at IBMC. Patient #5 was transferred to a third hospital, Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred. Patient #10 was transported from home to IBMC via EV per family request. The medical record for Patient #10 documented presumed basilar skull fracture and meningitis as the medical impression. The ED physician consulted with the on-call infectious disease specialist who recommended intravenous antibiotics. The patient transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred. Patient #12 was transported from a nursing home to IBMC via EV per patients "choice". The medical record for Patient #12 documented facial contusion, acute head injury and subdural hematoma as the medical impression. The patient was transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred. Patient # 14 an inpatient at Hospital 1 left against medical advise (AMA). After having surgery at Hospital 1, the patient presented at IBMC ED via private vehicle. The patient was transferred back to Hospital 1. The transfer form documented, "Alternative to transfer: stay @ IBMC" as the reason the patient was transferred. Patient #20 was transported from home to IBMC via EV per patients request. While in the IBMC ED the Mobile Assessment Team (MAT) evaluated the patient. The patient was transferred to a State operated mental health facility. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred. Patient #28 was transported to IBMC from the field after a motor vehicle accident via EV per the patients request. The ED physician consulted with the on-call orthopedist who recommended a "trauma transfer". The on-call orthopedist refused to admit the patient due to "altered sensorium". The patient transferred to Hospital 1. The transfer form documented, "Lack of facilities, services or staff" as the reason the patient was transferred. The ED medical co-chair was interviewed on 05/12/2015 at 12:55 p.m. He was asked to review the medical record for Patient #28. After review of the medical record, the co-chair stated the hospital "probably" could have taken care of Patient #28. He told the surveyors that the ED physician that provided the care would have to identify his reason for transferring the patient. The ED physician that provided care to Patient #28 was interviewed on 05/13/2015 at 8:45 a.m. The ED physician stated at the time of transfer Patient #28 did not have any neurological problems. The ED physician stated he did not consult or contact the on-call hospitalist or any other specialty services.

Based on review of hospital documents and medical records and interviews with hospital staff, the hospital failed to accept patients from referring hospitals This occurred in two of two patients (#26, 27) with a request for transfer from a referring hospital. Findings: Review of a IBMC policy title, "Patient Transfers", documented, "...The medical center encourages the Emergency Department physician to accept all responsible and medically necessary transfers from other facilities especially rural facilities that have limited resources for preservation of the patients' health and well being..." The IBMC ED Transfer Process documented, "...The Transfer Center will direct ALL trauma patients(neurosurgery, hand, ortho, etc) to TReC when Baptist is not on Level 2 Trauma Call for the day..." The Regional Trauma Transfer and Referral Center (TReC) called IBMC and requested to transfer Patient #26 to IBMC per the patients request. The ED physician who received the phone call from TReC was interviewed on 05/13/2015 at 8:45 a.m. He stated that he refused to accept Patient #26 because it was not the hospital's (IBMC) Trauma Level II day and all traumas should go to that hospital. The ED physician also stated the hospital (IBMC) did not have to accept the patient (Patient #26) because of the agreement with the Trauma System. Hospital 6 called IBMC requesting to transfer Patient #27. The ED physician at Hospital 6 documented, "...I try to transfer the patient to the Baptist facility since we are unable to admit patients under 15 at this facility. The Baptist facility felt that this was a patient we could handle at this facility..." Review of the IBMC ED Transfer Data Form documented, "...Per [name omitted] @ ctr [center]- Dr. [name omitted] stated they can handle in Edmond, transfer not coming..."

Based on review of hospital documents and interviews with hospital staff, the hospital failed to enforce policies and procedures to comply with EMTALA requirements. Findings: The hospital failed to follow its policies and procedures concerning: a. availability of on-call physicians for nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) that required the services of an on-call physician. See Tag A-2405 for further details. b. treatment within its capability for nine of twenty-eight patients (#1, 5, 10, 12, 14, 20, 26, 27, 28) whose medical records were reviewed. See Tag A-2407 for further details. c. appropriate transfers for two of three (#22, 25) patients who requested to transfer to another hospital. See Tag A-2409 for further details. d. recipient hospital responsibilities for two of two patients (#26, 27) with a request for transfer from a referring hospital. See Tag A-2411 for further details. e. the central log. See Tag A-2405 for further details.