HospitalInspections.org

Based upon medical record review, policy review, document review and interview, the facility did not comply with all the provisions for maintaining a central log and conducting a medical screening exam.

Please reference findings under Tag A 2405 and 2406.

Based on policy review, document review and interview, the facility failed to ensure all individuals presenting to the Emergency Department (ED) are entered into the central log for 1 of 20 patients (Patient #1). This failure could result in the patient not receiving a medical screening exam.

Findings include:

Review on 06/14/19 of policy "Patient Transfers- EMTALA/COBRA," effective 09/18/2017 indicates it is the responsiblity of the hospital to maintain a central log which records each patient who presents for treatment or is transferred to another facility.

Review on 06/14/19 of the ED central log dated 05/22/19 revealed no evidence that Patient #1 presented to the ED.

Review on 06/14/19 of the Security Incident Report dated 05/22/19 by Staff (V), Security Officer, revealed at 10:00 AM Patient #1 came to the ED with her mother to be seen.

Review on 06/14/19 of the Security Incident Report dated 05/22/19 by Staff (L), Security Officer, revealed at approximately 10:00 AM he responded to the lobby of the ED. Patient #1 was screaming obscenities and stated she did not want to live anymore. She banged her head lightly on the outside window and exited the ED.

Interview on 06/13/19 at 12:48 PM with Staff (A), Quality & Patient Safety Director, verified that on 05/22/19 Patient #1 was not entered into the ED central log.

Based on policy review, document review and interview, the hospital clinical staff did provide a medical screening exam (MSE) for 1 of 21 patients (Patient #1), who presented to the Emergency Department (ED) with a psychiatric emergency. A lack of a MSE could result in an emergency medical condition not being identified and treated.

Findings include:

Review on 06/13/19 of policy " Patient Transfers (EMTALA/COBRA), " effective 09/18/17, indicates all persons presenting to the hospital requesting medical treatment shall receive a medical screening examination. An emergency medical condition includes psychiatric disturbances, that in the absence of immediate medical attention, could reasonably result in placing the health of the individual in serious jeopardy. If a person requiring emergency medical care is on hospital property or within 250 yards of the hospital, 911 should be called and ED clinical staff should respond. Hospital property includes the entire hospital campus including parking lots, sidewalks, driveways and any buildings owned by the hospital within 250 yards of the main building of the hospital.

Review on 06/14/19 of the Security Incident Report dated 05/22/19 by Staff (V), Security Officer, revealed at 10:00 AM Patient #1 came to the ED with her mother to be seen. Patient #1 making herself throw up. Patient #1 started screaming at her mother. The security officer approached her and asked her to lower her voice. The patient continued to scream and stated that she did not want to live anymore. Patient #1 stormed out of the ED and slammed her head into the pillars and railing. Security intervened and at 10:09 AM, police arrived and took over the situation.

Review on 06/14/19 of the Security Incident Report dated 05/22/19 by Staff (L), Security officer, revealed at approximately 10:00 AM he responded to the lobby of the ED. Patient #1 was screaming obscenities and stated she did not want to live anymore. She banged her head lightly on the outside window and exited the ED. Her mother was on the phone with Crisis Services and followed her daughter to the ED parking lot, and both got into a truck. Patient #1 got out of the truck and was alarming and annoying visitors. The police were called at that time.

Review on 06/14/19 of the Town of Tonawanda Police Report dated 05/22/19 revealed Patient #1 was sitting on a curb in front of the ED entrance surrounded by facility security staff. Patient #1 ' s mother indicated she is diagnosed with Bipolar disorder, Attention-deficit/hyperactivity disorder and Obsessive-compulsive disorder. Patient #1 continued to scream and was attempting to get up and walk away, including walking into hospital traffic. Patient #1 was forcing herself to throw up. Patient #1 stated she wanted to overdose, no longer wanted to live and banged her head off a large concrete pillar several times. When a paramedic refused to give her a drink, Patient #1 dug her nails into his right wrist, causing redness and scratch marks. Patient #1 was handcuffed for her own safety as she was attempting to harm herself and fall onto the pavement. Due to Patient #1 ' s actions, the officer determined that she would be transported to another hospital with a Comprehensive Psychiatric Emergency Program (CPEP) for evaluation.

Review on 06/17/19 of the Town of Tonawanda EMS (emergency medical services-Paramedics) patient care record dated 05/22/19 revealed upon arrival, Patient #1 was sitting on the curb of the walk-in entrance of the ED. She was in the care of several members of staff security, police and her mother. Patient #1 is conscious but very distraught and in visible emotional distress. Patient #1 was placed in handcuffs due to safety. She calmed down to the point where she was ambulatory to the ambulance and placed on the stretcher. She was put in 4-point restraints and a spit hood due to becoming more combative.

No evidence was found to indicate a medical screening examination was conducted prior to Patient #1's transport to another hospital for evaluation.

Interview on 06/13/19 at 12:48 PM with Staff (A), Quality & Patient Safety Director revealed that on 05/22/19 Patient #1 was outside of the facility, banging her head. Security called 911. The police came and handcuffed her. She was on the hospital grounds but was not brought into the facility.