HospitalInspections.org

Based on staff interviews, hospital policy and procedure review, and the Hospital Medicare Database Worksheet the hospital failed to follow their policy and failed to provide a medical screening examination to a patient that presented to the hospital Emergency Department (ED) for one of 20 sampled records (patient #1).

Findings include:

- The hospital's policy EMTALA Screening, Stabilization, Management of Transfer reviewed on 8/20/12 at 11:00am directed "...The provisions of EMTALA (Emergency Medical Treatment and Active Labor Act) apply to individuals who attempt to gain access to a hospital for emergency care...to provide an appropriate medical screening examination to all individuals presenting at the emergency department requesting examination or treatment of a medical condition..."

- The Hospital Medicare Database Worksheet prepared on 8/20/12 by hospital staff, reviewed on 8/22/12 at 11:00am, indicated the hospital had a dedicated ED and the capability to provide a medical screening examination.

- Review of patient #1's emergency room record on 8/20/12 at 1:00pm revealed an ED questionnaire indicating the patient presented to the ED at Salina Regional Medical Center on 7/31/12. Under what brings you to the emergency department today listed " Sent by Junction City Police Department Detective [name] ". A note in the upper left corner of the questionnaire documented "2110 (9:10pm) mother and child here-told to call and schedule appointment" and initialed cm. The ED log failed to include patient #1's encounter at the ED on 7/31/12. The record failed to include a medical screening exam including vital signs to determine if an emergency medical condition existed.

A second questionnaire indicating the patient again presented to the ED at Salina Regional Medical Center on 8/1/12. Under what brings you to the emergency department today listed "Detective [name] sent us from Junction City, Kansas ". The medical record indicated patient #1 received an examination on 8/1/12.

Staff E, interviewed on 8/22/12 at 3:25pm acknowledged they were the physician on duty in the ED the evening of 7/31/12. Staff E did not have knowledge patient #1 was in the hospital that evening. Staff E acknowledged they could complete a medical screening exam if needed.

Staff C, ED triage nurse on duty the evening of 7/31/12, interviewed by telephone on 8/22/12 at 4:15pm revealed they had a message from Staff D (SANE/SART nurse-Sexual Assault Nurse Examiner) that patient #1's mother was to call Staff D and set up an appointment. Staff C voiced the mother said nothing about why they presented to the ED. Staff C acknowledged they only had a message to deliver to the mother. Staff C indicated they only knew what was on the questionnaire. The mother did not mention her daughter.

Staff D, interviewed on 8/22/12 at 4:25pm acknowledged the SANE/SART Unit has a nurse on call 24/7. They do take call, are called and do come to the hospital. They would have come to the ED if called the night of 7/31/12. The ED physician could have examined patient #1.

Patient #1's mother interviewed on 8/22/12 at 8:21pm and confirmed she had taken patient #1 to the ED at Salina Regional Medical Center on 7/31/12. When they entered the ED door, no one greeted them or spoke to them. They filled out a paper and slid it thought the slot. About 20 minutes later they went into a room and told they could not help them now, the SANE nurse had left. They had been told someone would be there to help them. The ED nurse indicated the SANE nurse lives a half hour out and wasn't going to call her back. Patient #1's mother asked if anyone could help now and the nurse said no. The nurse told them there was no reason to call the SANE nurse back now and to see them tomorrow. The next day they went to Salina Regional Health Center and the SANE nurse did an examination.

The hospital's SANE/SART call schedule reviewed on 8/20/12 at 11:00am revealed an on call nurse to the unit 24 hours a day. Staff D, was on call on 7/31/12 between 7:00am to 7:00am.

Based on document review and interview the hospital failed to provide a medical screening exam to determine whether an emergency medical condition existed for one of twenty sampled Emergency Department (ED) patients between 6/1/12 to 8/20/12 (patient #1).

Findings include:

- The hospital's policy EMTALA Screening, Stabilization, Management of Transfer reviewed on 8/20/12 at 11:00am directed "...The provisions of EMTALA (Emergency Medical Treatment and Active Labor Act) apply to individuals who attempt to gain access to a hospital for emergency care...to provide an appropriate medical screening examination to all individuals presenting at the emergency department requesting examination or treatment of a medical condition..."

- Review of patient #1's emergency room record on 8/20/12 at 1:00pm revealed an ED questionnaire indicating the patient presented to the ED at Salina Regional Medical Center on 7/31/12. Under what brings you to the emergency department today listed " Sent by Junction City Police Department Detective". A note in the upper left corner of the questionnaire documented "2110 (9:10pm) mother and child here-told to call and schedule appointment" and initialed cm. The ED log failed to include patient #1's encounter at the ED on 7/31/12. The record failed to include a medical screening exam including vital signs to determine if an emergency medical condition existed.

A second questionnaire indicating the patient again presented to the ED at Salina Regional Medical Center on 8/1/12. Under what brings you to the emergency department today listed "A Detective sent us from Junction City, Kansas". The medical record indicated patient #1 received an examination on 8/1/12.

Staff E, interviewed on 8/22/12 at 3:25pm acknowledged they were the physician on duty in the ED the evening of 7/31/12. Staff E did not have knowledge patient #1 was in the hospital that evening. Staff E acknowledged they could complete a medical screening exam if needed.

Staff C, ED triage nurse on duty the evening of 7/31/12, interviewed by telephone on 8/22/12 at 4:15pm revealed they had a message from Staff D (SANE/SART nurse-Sexual Assault Nurse Examiner) that patient #1's mother was to call Staff D and set up an appointment. Staff C voiced the mother said nothing about why they presented to the ED. Staff C acknowledged they only had a message to deliver to the mother. Staff C indicated they only knew what was on the questionnaire. The mother did not mention her daughter.

Staff D, interviewed on 8/22/12 at 4:25pm acknowledged the SANE/SART Unit has a nurse on call 24/7. They do take call, are called and do come to the hospital. They would have come to the ED if called the night of 7/31/12. The ED physician could have examined patient #1.

Patient #1's mother interviewed on 8/22/12 at 8:21pm and confirmed she had taken patient #1 to the ED at Salina Regional Medical Center on 7/31/12. When they entered the ED door, no one greeted them or spoke to them. They filled out a paper and slid it thought the slot. About 20 minutes later they went into a room and were told they could not help them now, the SANE nurse had left. They had been told someone would be there to help them. The ED nurse indicated the SANE nurse lives a half hour out and wasn't going to call them back. Patient #1's mother asked if anyone could help now and the nurse said no. The nurse told them there was no reason to call the SANE nurse back now and to see them tomorrow. The next day they went to Salina Regional Health Center and the SANE nurse did an examination.

The hospital's SANE/SART call schedule reviewed on 8/20/12 at 11:00am revealed an on call nurse to the unit 24 hours a day. Staff D, was on call on 7/31/12 between 7:00am to 7:00am.

Salina Regional Health Center failed to provide patient #1 with a medical screening examination to determine if a medical emergency existed.