HospitalInspections.org

Based on medical record review, facility policy review, review of facility medical staff bylaws and medical staff rules and regulations, and staff interview, the facility failed to ensure a medical screening examination was performed by an individual who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction (A-2406). The facility failed to ensure individuals transferred to another hospital had appropriate transfers including a physician signed certification with a summary of the risks and benefits of the transfer and failed to failed to ensure the individual (or a legally responsible person acting on the individual's behalf) requests the transfer in writing and indicates the reasons for the request as well as indicates that he or she is aware of the risks and benefits of the transfer (A-2409).

Based on facility policy review, review of facility medical staff bylaws and medical staff rules and regulations, and staff interview, the facility failed to ensure a medical screening examination was performed by an individual who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction. The facility's emergency department saw 84,283 patients in the preceding six months.

Findings include:

Review of the facility's policy titled, Emergency Medical Treatment and Labor Act (EMTALA) with a most recent revised date of April, 2021, directed that any individual who requests a Medical Screening Examination ("MSE") at an MHS ED (MetroHealth System), or who arrives to an MHS ED and appears to be experiencing an EMC (emergency medical condition), received a MSE by a Qualified Medical Provider (QMP). Patients may be registered following usual administrative procedures so long as the MSE is not delayed to ask the patient about payment/insurance status. "Qualified Medical Provider ("QMP") for purposes of this policy means a Workforce Member who is designated to perform MSEs in the MHS bylaws."

Review of the facility's Medical Staff Bylaws failed to designate or define who a Qualified Medical Provider (QMP) was and who was designated to perform the MSE (medical screening exam) to determine the presence of an emergency medical condition (EMC). Review of the facility Medical Staff Rules and Regulations also failed to define or designate who a QMP was or who was designated to perform the MSE to determine the presence of an emergency medical condition as referenced in the facility's EMTALA policy.

Interview with Staff R on 03/07/22 at 1:00 PM confirmed the Medical Staff Bylaws and Medical Staff Rules and Regulations failed to define or designate who the QMP was and who could perform the MSE to determine the presence of an emergency medical condition.

Based on medical record review, review of facility policy and procedures, and staff interview, the facility failed to ensure individuals transferred to another hospital had appropriate transfers including a physician signed certification with a summary of the risks and benefits of the transfer for four of five medical records of transferred patients reviewed (Patient #8, #9, #11, and #12) and failed to ensure the individual (or a legally responsible person acting on the individual's behalf) requests the transfer in writing and indicates the reasons for the request as well as indicates that he or she is aware of the risks and benefits of the transfer for one of five medical records of transferred patients reviewed (Patient #10). A total of 21 medical records were reviewed.

Findings include:

Review of the facility policy and procedure titled, Emergency Medical Treatment and Labor Act (EMTALA) with most recent revision date of April, 2021, revealed the patient or a legally responsible person acting on behalf of the patient is informed of the risks and benefits of the transfer. The patient or legally responsible person acting on behalf of the patient makes a written request to transfer the patient which verifies that he/she was informed of the risks and benefits of the transfer.

1) Review of the medical record for Patient #8 revealed an arrival date of 08/18/21 at 8:13 PM to the emergency department. The medical record contained documentation the patient was experiencing drug induced psychosis with hallucinations. The medical record contained documentation the patient was transferred to a psychiatric facility on 08/20/21 at 8:02 AM. The medical record lacked documentation of a transfer document that listed and explained the risks and benefits of the transfer nor was there evidence a legally responsible party acting on behalf of the patient was informed of the risks and benefits.

2) Review of the medical record for Patient #9 revealed an arrival date of 11/03/21 at 9:11 AM to the emergency department of the facility. Review of the medical record revealed the patient had a diagnosis of schizophrenia and bipolar disorder and was previously admitted as an inpatient to a behavioral health facility under Emergency Admission status ("pink slip") for the management of schizophrenia. The medical record indicated the patient incurred a change in medical status during the psychiatric inpatient stay and required a transfer to the emergency department of a medical facility for the treatment of uncontrolled hypertension and hyperglycemia. The patient was stabilized in the emergency department of the medical facility and was prepared for transfer back to the psychiatric inpatient facility on 11/05/21 at 11:05 AM. The medical record lacked documentation of a transfer document that listed and explained the risks and benefits of the transfer nor was there evidence a legally responsible party acting on behalf of the patient was informed of the risks and benefits.

3) Review of the medical record for Patient #10 revealed an arrival date of 08/19/21 at 11:44 PM to the emergency department. The medical record revealed the patient was a pediatric patient who was diagnosed with fever and seizures. The medical record documented the patient's family member desired a transfer to a pediatric facility. The facility was unable to provide documentation of a transfer document that listed and explained the risks and benefits of the transfer signed by the patient's representative.

4) Review of the medical record for Patient #11 revealed an arrival date of 02/07/22 at 11:42 AM to the emergency department. The medical record contained documentation the patient was experiencing shortness of breath, and lower extremity swelling consistent with congestive heart failure symptoms. The patient was transferred to another facility on 02/07/22 at 8:49 PM. The medical record lacked documentation of a transfer document that listed and explained the risks and benefits of the transfer nor was there evidence the patient was informed of the risks and benefits.

5) Review of the medical record for Patient #12 revealed an arrival date of 01/11/22 at 2:00 PM to the emergency department. The medical record contained documentation the patient presented with suicidal ideation, a mood disorder and was experiencing hallucinations. The medical record contained documentation the patient was transferred to a psychiatric facility on 01/12/22 at 1:35 AM. The medical record lacked documentation of a transfer document that listed and explained the risks and benefits of the transfer nor was there evidence a legally responsible party acting on behalf of the patient was informed of the risks and benefits.

Interview with Staff A on 03/09/22 at 4:00 PM confirmed the facility was unable to provide a transfer form for Patient #10. Staff A confirmed the risks and benefits of transfer were not contained on the transfer forms for Patient #8, Patient #9, Patient #11 and Patient #12 nor were they explained to a legally responsible party acting on behalf of patients transferred to other facilities per facility policy and procedure.