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Based on staff interview it was determined the facility failed to comply with 42 CFR 489.24 related to failure to provide a Medical Screening Examination (MSE) for 1 (#21) of 20 sampled patients. The facility failed to comply with 42 CFR 489.20 related to failure to maintain a central log for 1 (#21) of 20 sampled patients.


Interview with the Director of the ED on 11/2/11 at approximately 10:30 a.m. revealed the following information. On 9/15/11 the grandmother of patient #21 reported that the patient had been taken to the facility's ED on 9/10/11 with the complaint of burning and stiffness of his hands. The grandmother stated he was refused care. Review of the ED central log revealed there was no information concerning the patient.
Refer to A2405 and A2406

The facility had taken corrective actions.

Based on staff interview and review of facility documents it was determined the facility failed to ensure patient name and information was entered into the Emergency Department (ED) log for 1 (#21) of 21 sampled patients. This practice does not ensure accurate monitoring and information of the patients seeking care from the emergency department or allow for improved patient care needs.

Finding include:

On 11/2/11, during an interview at approximately 10:30 a.m., the following information was provided by the Director of ED. On 9/15/11 the grandmother of patient #21 reported that the patient had been taken to the facility's ED with the complaint of burning and stiffness of his hands. She indicated the patient was refused care.

Review of the ED central log revealed there was no information concerning the patient.

Nursing staff who were on duty at the time of the incident were interviewed by the ED Nursing Director. The interviews revealed the patient presented to the facility's ED on 9/10/11 with the above complaint. The patient was taken directly to the Express Care section of the ED. The Nurse Practitioner who was on duty in the Express Care briefly looked at the patient's hands and told the patient she would not see him. The Nurse Practitioner directed the staff that it would not be necessary to register the patient or add his information into the ED log. The grandmother and the patient immediately left the ED.

The ED Nursing Director stated the following actions were taken. The facility's policies regarding registration and maintenance of the ED log were reviewed for compliance.
All staff involved were interviewed. The staff said they thought the incident was wrong, but did not take any immediate action or report the incident to management, as required by the facility's Chain of Command policy.
The process for patients who present as a non-emergency and are sent to Express Care had been revised.
All ED staff, including physicians and mid level practitioners, received additional training regarding Emergency Medical Treatment and Labor Act (EMTALA) regulations and following the Chain of Command policy by 9/30/11.

Based on staff interview and facility document review it was determined the facility failed to provide a Medical Screening Examination (MSE) to 1 (#21) of 21 sampled patients. This practice does not ensure a patient is evaluated for the presence of an emergency medical condition and may cause a negative outcome.

Findings include:

Interview with the Director of the ED on 11/2/11 at approximately 10:30 a.m. revealed the following information. On 9/15/11 the grandmother of patient #21 reported that the patient had been taken to the facility's ED on 9/10/11 with the complaint of burning and stiffness of his hands. The grandmother stated he was refused care.

The ED Nursing Director stated the Nurse Practitioner was interviewed. The Nurse Practitioner looked at the patient's hands and stated she would not see him. The ED Nursing Director indicated the staff reported believing that was wrong, but did not report it to management or take any immediate action.

The ED Nursing Director reviewed policies for compliance with Emergency Medical Treatment and Labor Act (EMTALA) regulations and interviewed staff. The ED Nursing Director reviewed the competencies of all staff and determined that all had appropriate competencies and all had EMTALA training. The ED Nursing Director provided additional education to all ED staff. The chain of command policy was also reviewed. All available staff had received the education by 9/30/11. A presentation on EMTALA and Chain of Command is scheduled for the leadership team meeting the second week in November.

The mid level practitioners received the training from the ED Medical Director. The ED Medical Director addressed the incident with the Nurse Practitioner involved in the incident. The ED Medical Director is monitoring for compliance.