HospitalInspections.org

Based on policy review, medical record review, video review, document review and interview, the hospital failed to comply with the Emergency Medical Treatment and Active Labor Act (EMTALA).

Findings include:

Staff (C), Physician Assistant, refused to perform a medical screening examination for Patient #1, to determine if an emergency medical condition existed. (See Tag A-2406).

Based on policy review, medical record review, video review, and interview, in 1 of 20 medical records reviewed, the facility failed to provide an appropriate medical screening exam (Patient #1).

Finding include:

Review on 09/05/24 of the policy "Emergency Medical Treatment and Active Labor Act- EMTALA," effective 02/2024 indicated, "acute pain as defined by an emergency medical condition, psychiatry disturbances, and substance abuse including alcohol are defined as emergency conditions. All individuals presenting and requesting examination/treatment shall be offered a medical screening examination to determine if the individual has an emergency medical condition by a physician or qualified member of the medical staff."

Review on 09/05/24 of the emergency department medical record for Patient #1, dated 08/06/24, revealed:
- At 12:44 AM, Patient #1 arrived at the hospital via Emergency Medical Services (EMS) via ambulance.
- At 12:44 AM, Staff (C), Physician Assistant, documented a triage assessment that indicated Patient #1 was having constant, aching lower back pain at a level 10 (0 is no pain, 10 is the worst pain). A negative review of systems was documented except for back pain, alcohol abuse, emotional lability, and mood changes. Patient #1's complaint was back pain.
- At 12:55 AM, Staff (C), Physician Assistant, note revealed Patient #1 refused to allow Staff (C) to evaluate them and was derogatory towards Staff (C) and female staff. Per the documentation, Patient #1 was ultimately ordered from the building without evaluation.
- At 01:02 AM, Staff (D), Registered Nurse, the nursing head to toe assessment was negative except for the following: pain was associated with personality changes, agitation, and rages; tenderness was noted to the lower back; heart rate high was 122 (normal range is 60 to 100 beath per minute); and was agitated, aggressive, combative with alcohol noted on their breath. Patient #1's complaint was back pain. Patient #1 was aggressive towards Staff (C), Physician Assistant. Patient #1 was uncooperative and threatening.
- At 01:21 AM, Staff (D), Registered Nurse, documented they spoke at length with Patient #1 about their behavior and how to speak with the doctor to get testing performed. Patient #1 remained agitated, demanding, and threatening. The provider was respectful to Patient #1 upon arrival, but Patient #1 refused to answer. Patient #1 was disrespectful towards all female staff. Patient #1 was escorted to the lobby where they left the building and started walking down the road. Staff (D) observed Staff (C), Physician Assistant, attempt several times to evaluate Patient #1, but they were hostile during every attempt.
- At 01:34 AM, Staff (D), Registered Nurse, documented Patient #1 eloped. The charge/triage nurse and security were notified at 01:30 AM. The nursing supervisor was notified.
-At 08:32 AM, Staff (N), Attending Physician, documented "I reviewed documentation and I agree with plan and management."

Review on 09/05/24 of the security body camera footage from 08/06/24 revealed the following:
-At 00:49 AM- Staff (C), Physician Assistant walked out of the provider office and said to Patient #1 "since I'm the only provider listen, and I can't be near you sir, you can't have an evaluation. Your welcome to leave or then I can check you out, its up to you." Patient #1 said "I don't want nothing to do with your evaluation, I'm talking with him." Staff (C) said "yeah, OK, well unfortunately he can't order any tests or medicine for you." Patient #1 stated "If you change your attitude and then come back." Staff (C) said "I don't have an attitude sir, I just had to know if." Patient # 1 interrupted and stated, "you heard what I just said." Staff (C) said "OK, I'll come back in a couple hours then." Staff (C) turned and started to walk down the hallway. Patient #1 stated "you can come back whenever you want, I'll just get help." Staff (C) said "OK, have a good night."
-At 00:50 AM- Staff (D), Registered Nurse, returned and was taking Patient #1's blood pressure and vital signs. Patient #1 continued to discuss their interaction with Staff (C), Physician Assistant.
-At 01:01 AM-Staff (C), Physician Assistant, came out of the provider office and said to Patient #1 "Alright, it's your last chance to be evaluated, no? yes? Maybe?" Patient #1 responded "I already told you it's on your attitude. Come out here with an attitude with me, I'm gonna give it right back. Staff (C), Physician Assistant said, "it's a yes or no, do you want me to evaluate you or not?" Patient #1 said "it's what I said." Staff (C), Physician Assistant said "Goodbye, have a good night, sir." Staff (C), Physician Assistant walked away down the hall. Patient #1 said "whatever." Staff (C), Physician Assistant said, "it was a yes or no question." Patient #1 said "Stop your attitude and you're more that welcome to do what you gotta do. Don't come out here and act like a pissy little brat."
-At 01:04 to 01:11 AM- Staff (D), Registered Nurse approached Patient #1 and started to speak with Patient #1. Patient #1 started to talk on their phone to their wife using the speaker, cutting off Staff (D) Registered Nurse.
-At 01:11 to 01:14 AM- Staff (D), Registered Nurse, began to speak calmly with Patient #1. Security remained around the corner and in the hallway. Staff (D), Registered Nurse explained to Patient #1 that Staff (C), Physician Assistant, was the only one here to see them, that can order tests. Patient #1 continued to talk about Staff (C), Physician Assistant's attitude and stated, "I'll lose my attitude if she loses hers." Staff (D), Registered Nurse stated, "I need you to help me." Patient #1 states that "if Staff (C), Physician Assistant speaks to him like you are, I'll speak with her. I seriously want to know what's wrong." (Patient #1 agreed to be evaluated by Staff (C), Physician Assistant).
-At 01:19 AM- Staff (D), Registered Nurse, turned and entered the nursing station (to call Staff (C), Physician Assistant).
-At 01:20 AM- Staff (D), Registered Nurse returned and stated to Patient #1 "she wants you to go to Corning. She is not going to be able to help you." Patient #1 said "Ok. My neighbor says she is refusing my order, I'll sign myself out, so at some point if there is something seriously wrong with me, I have my backup lawsuit."
-At 01:21 AM- Staff (K), Public Health Officer asked Staff (D), Registered Nurse "you want him out of here?" Staff (D), Registered Nurse shook their head yes and walked into the nursing station. Staff (K) approached Patient #1 who was still sitting on the gurney texting on their phone.
-At 01:22 AM- Staff (L), Public Safety Officer asked Patient #1 if they had a ride. Patient #1 responded "I'm calling right now. "Patient #1 remained sitting on the gurney texting on their phone. Patient #1 stood and started to walk out of the emergency department with Staff (K) and Staff (L), Public Safety Officers.
-At 01:23 AM- Patient #1 walked out into the parking lot alone.
(The first encounter between Patient #1 and Staff (C), Physician Assistant, was not documented by body camera footage).

Interview on 09/04/24 at 01:50 PM with Staff (D), Registered Nurse, revealed Patient #1 came to the emergency department by ambulance. Patient #1 was hostile, guarded, and angry seeking help for back pain. According to the ambulance crew, Patient #1 had consumed alcohol. Staff (C), Physician Assistant approached Patient #1 to find out what was going on. Patient #1 instantly stated Staff (C), Physician Assistant was not respectful and would not answer their questions and calling them names. Staff were able to obtain vital signs and triage Patient #1. Staff (D) was able to talk and calm Patient #1 down. Staff (C), Physician Assistant attempted to speak with Patient #1 a second time, who again became hostile. Staff (C), Physician Assistant left, and Patient #1 continued to make inappropriate comments about female staff. Staff (C), Physician Assistant attempted to speak with Patient #1 a third time stating, "you have one more chance," but Patient #1 refused stating they would only speak to Staff (D). Staff (C), Physician Assistant left the area. Staff (D) continued to talk with Patient #1 for a long time and was able to calm Patient #1. Patient #1 was willing to speak with Staff (C), Physician Assistant to get treatment. Staff (D) called Staff (C), Physician Assistant indicating Patient #1 was now willing to speak with them. Staff (C), Physician Assistant stated that they had tried three times to speak with Patient #1, they had already written their note, and that Patient #1 could go to another hospital. Staff (D) had to tell Patient #1 that they were sorry, but Staff (C) would not see them, there was nothing they could do, and maybe Patient #1 could go to another hospital to get the help they needed. Once told they had to leave, Patient #1 stormed out of the emergency department on their own with security following. Staff (D) stated "the provider could have gotten an xray, we could have done something. The situation did not need to escalate."

Interview on 09/04/24 at 02:45 PM with Staff (C), Physician Assistant revealed Patient #1 arrived in the emergency department by ambulance and wasn't sure why, possibly back pain. Staff (C) started talking to Patient #1 about a second issue that occurred at home but wasn't sure what the issue was. Patient #1 stated "nope, here for back pain, you can't ask me any other questions." Staff (C) stated Patient #1 "basically fired me," became more agitated and hostile, and told Staff (C) to be quiet. Patient #1 stated they weren't suicidal and then "kinda told me to get out of here." Staff (C) tried to give Patient #1 time to cool off. Staff (C) stated they reviewed Patient #1's vital signs and was observing them from a distance. Staff (C) felt Patient #1's condition was chronic and there was not an acute problem. Staff (C) came back and asked Patient #1 if they were sure they did want to be evaluated, they were the only provider. Patient #1 stated he wanted Staff (D), Registered Nurse. Staff (C) gave Patient #1 more time to de-escalate. Staff (C) could hear when Patient #1 called their spouse, who was coming to pick them up. Staff (D), Registered Nurse, spoke with Patient #1 and Patient #1 left the department. Patients have the right to refuse care, and Patient #1's behavior kept escalating.

Interview on 09/05/24 at 08:00 AM with Staff (K), Public Safety Officer, revealed they remember walking into the back hall and seeing Patient #1 on a bed. Another Public Safety Officer was standing in the corner with their body camera on Patient #1. Staff (K) had their body camera on also. Staff (K) stated they believe Patient #1 came in by ambulance for back pain. The provider was being rude to Patient #1 and Patient #1 was being rude back refusing care. Staff (D), Registered Nurse, was with Patient #1 talking and calming them down. Staff (D), Registered Nurse spoke with the provider on the phone who refused to speak with Patient #1. Patient #1 was mad that the provider wouldn't talk with them and stated they were going to another hospital. Staff (K) and the other Public Safety Officer walked with Patient #1 out to the front door.

Interview on 09/05/24 at 12:30 PM with Staff (N), Attending Physician and supervising physician for Staff (C), Physician Assistant was called the morning after the event by Staff (C), Physician Assistant who reported Patient #1 was alcohol intoxicated and eventfully left without being seen. Patient #1 would not cooperate with Staff (C), Physician Assistant or the nurses. Staff (N) spoke with Staff (C) and discussed that anyone who comes in (to the emergency department) needs to be triaged and treated, which should have happened.