HospitalInspections.org

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Based on interview and document review, the hospital failed to implement their policies and procedures for evaluation and treatment of a patient that presented for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health outcomes, injury and death.

Findings included:

The hospital failed to ensure that a patient received a medical screening exam before they left the emergency department (ED).

Cross reference: C-2406

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Based on interview and document review, the hospital failed to implement its policies and procedures to provide a medical screening exam for a patient that came to the emergency department (ED) seeking emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) for 1 of 25 patient records reviewed (Patient #1).

Failure to provide a medical screening exam for patients before they leave the ED puts patients at risk for harm from a medical or psychological emergency that is not screened and treated.

Findings included:

1. Document review of the hospital's policy titled, "Emergency Medical Treatment and Active Labor Act," last reviewed 03/16, showed that the hospital was to provide a medical screening exam to any person coming to the emergency department (ED) to determine whether or not the patient had an emergency medical condition that required stabilizing treatment.

2. Review of Patient #1's medical record showed that:

a) The patient walked into the emergency department (ED) on 12/26/21 at 1:09 PM with a stated complaint of suicidal thoughts.

b) At 1:25 PM on 12/26/21 it was charted the patient left the ED after yelling they did not want to wait to be seen.

3. Review of the local police department record for 12/26/21 showed that:

a) On 12/26/21 at 1:56 PM, the police received a call from the hospital that Patient #1 was screaming in the ED (emergency department) and the location of the patient was unknown.

b) At 2:01 PM, the police department received a call from a bystander that Patient #1 was seen getting in to a vehicle and nearly hit another vehicle leaving the hospital. The car spun out of control and was parked on the side of the road near a local business.

c) At 2:02 PM, a bystander approached Patient #1. Patient #1 indicated she was thinking about harming herself. The bystander called the police.

d) At 4:25 PM, the police officer arrived and was told by Patient #1 that she needed help and had a history of a mental health diagnosis. The police officer took the patient to the ED parking lot. The ED staff advised the police that Patient #1 was hostile in the lobby earlier. The ED staff requested that the patient not return for the day due to her behavior. The police officer put Patient #1 in their patrol car to keep warm. The police officer called the crisis worker to arrange an evaluation of the patient but due to weather condtions, the crisis worker was unable to drive to the hospital.. The patient talked to the crisis worker by phone. The patient calmed down and was released to her husband.

4. On 04/06/22 at 10:00 AM, the investigator interviewed a physician (Staff #1). Staff #1 stated that all patients that came to the ED were to be given a medical screening exam to rule out a medical or psychiatric emergency. No patients were to be turned away from receiving care and treatment.

5. On 04/06/22 at 11:00 AM, the investigator interviewed a registered nurse (Staff #3). Staff #3 verified that all patients were to be given a medical screening exam to rule out an emergency medical condition and this included psychiatric emergencies. No patients were to be turned away that presented to the ED.

6. On 04/06/22 at 1:22 PM, the investigator interviewed the Patient Registration Representative (Staff #6). Staff #6 recalled that Patient #1 came into the ED to register to be seen and walked out before registration could be completed. Staff #6 stated that Patient #1 did not want to wait. Thirty minutes later Patient #1 came back to the ED and was offered to be registered into the system. Patient #1 pulled her mask off and was yelling she wanted to harm herself. The nurse on duty was called but the patient had run out before he could talk to the patient. Staff #6 stated that she thought the nurse called the police about the patient running out of the ED. Patient #1 was found by the police across the street. The police brought Patient #1 back to the parking lot of the hospital. Patient #1 did not come back into the ED. The patient stayed in the police car.

7. On 04/06/22 at 3:22 PM, the investigator interviewed Patient #1. Patient #1 stated that she was having a mental health crisis and stormed out the ED while registering to be seen. She got into her car and due to weather conditions crashed her car less than a mile from the hospital. The police officer brought her back to the ED. The nurse on duty declined to let Patient #1 have a medical screening exam. The patient stayed with the police officer in the police officer's car until her husband took her home.

8. On 04/07/22 at 7:00 AM, the investigator interviewed the police officer that had transported Patient #1 to the ED. The officer remembered bringing the patient back to the hospital after Patient #1 had slid her car off the road. The nurse on duty told Patient #1 in the parking lot she would not be seen unless she could agree not to be hostile. The police officer kept Patient #1 for 2 hours in the parking lot and Patient #1 calmed down and went home with her husband.

9. On 04/11/22 at 9:20 AM, the investigator interviewed a registered nurse (Staff #9). Staff #9 was working on the day Patient #1 came to the ED. Staff #9 remembered being called to the ED waiting room to talk to the patient. When Staff #9 arrived in the ED waiting room, Patient #1 had run out of the ED. Staff #9 was then called out to the hospital parking lot by the local police department. Patient #1 was sitting in the police car. Staff #9 told the police officer that Patient #1 displayed hostile behavior in the ED waiting room towards registration staff and had run out of the ED waiting room without being seen several hours earlier. Staff #9 explained that Patient #1 could be seen if she could agree to be less hostile. Patient #1 then refused to be seen in the ED. Staff #9 left the patient with the police officer.

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