The NP absolutely could have sent the patient to the ER. The vast majority of patients admitted to a hospital come in through the ER.
The NP could still have done it, but it would have been against two different doctors and the organization who employs her practices. The sad thing is that this probably happens often, this is just the first time someone sued over the death.
edit to add: possibly the NP went up the chain of command precisely because the doctors there wanted veto power on hospital admissions. they didn't want pesky underlings getting in the way of whatever motivated their decisions.