Based on the complaint allegation, interview of hospital staff, review of hospital policies, and review of other hospital records, the hospital failed to ensure that emergency department and administrative staff accepted a patient who needed dialysis in transfer from another hospital's emergency department for 1 of 25 patient records reviewed (Patient #1). Failure to receive a patient needing dialysis from a referring hospital when the recipient hospital had dialysis services and staff available risked the health and safety of the patient. Findings were: Patient #1 was a [AGE] year old with a past medical history significant for end stage renal disease. S/he had been on hemodialysis at Tri-State Memorial Hospital Dialysis Unit 3 times per week. Due to assaultive behaviors toward staff, the hospital issued a certified letter to the patient on 6/8/2015 giving a 30 day notice of terminating him/her as a patient of the dialysis unit (7/12/2015 was 30 days after the receipt of the letter). Included with the letter was information related to other local dialysis units available in the area. Review of hospital records showed the patient continued to use the Tri-State Hospital for care. For example, on 7/15/2015 the patient came to the emergency department with shortness of breath, received a medical screening exam and was diagnosed and treated for community acquired pneumonia and discharged to home (Potassium was within normal limits at 4.2); on 7/16/2015 the patient presented to the hospital in Orifino in need of dialysis. The patient was a direct admit to Tri State Hospital where s/he received dialysis treatments on 7/17-18 and was discharged on [DATE]. Interview with the vice president of patient care services during the course of this investigation revealed that staff believed the request from the emergency room doctor in Orofino on 7/22/2015 was for Tri State Hospital to receive Patient #1 as a direct admit to the Dialysis Unit, and not as an emergency transfer. Review of Patient #1's Discharge Summary record from the hospital in Idaho that accepted him/her in transfer on 7/22/2015 from the hospital in Orofino showed the patient was a direct admit and did not go through the emergency department. Hemodialysis was provided the following day, on 7/23 and 7/24/2015. The patient was discharged on [DATE] in stable condition. Arrangements had been made for a schedule of 3 times/week dialysis treatments at the Palouse Dialysis in Moscow, ID. Review of the complainant's letter alleging an EMTALA violation by Tri-State hospital on [DATE] read in part, "Because of the gravity of the (Patient #1's) condition, I wrote orders for a nurse to accompany the ambulance, with the patient on a monitor and the nurse carrying extra drugs for the possibility of a disturbance in cardiac rhythm." Review of the hospital's approved policies, "Medical Screening Exams," and "Patient Transfer Out to Acute Care Facility for Medical Care" did not evidence staff guidance on how to ensure compliance with requirements as a recipient hospital. Tri-State Hospital's refusal to accept a patient in transfer for hemodialysis treatment available at their facility risked the patient's health and well-being.