HospitalInspections.org

Based on review and interview the facility failed to ensure that all individuals that present to the emergency room are given a medical screening exam by a physician for one out of 20 patients in a survey sample. (Patient identifier #1)

Findings include:

On 2/23/2016 Facility notifies the RO (Regional Office) in Boston of an EMTALA(Emergency Medical Treatment Act) violation and on the same day the facility notifies the SA (State Agency)
A complaint investigation was conducted on site on 3/2/2016

Review of the ED ( Emergency Department) medical record identified that on 02/07/2016 Patient #1 presented to the emergency department by EMS at 4:33 am. The patient presented with the question of sexual assault. Patient received a Triage assessment including vital signs and was registered as a patient. The facility attempted to locate a SANE (Sexual Assault Nurse Evaluator) Nurse. They also contacted the nursing director of the emergency department. Being unable to locate their own SANE nurse, the director advised that she would need to go to Dartmouth Hitchcock Medical Center, and if willing could go with police if she felt uncomfortable with the EMS. Patient chose to go with police.

Dartmouth Hitchcock was called at 5:02 am to arrange for the availability of a SANE nurse and they were informed that a nurse was available and would be waiting the patients arrival. Police were waiting for another officer to arrive for area coverage while the other officer was transporting this patient to Dartmouth Hitchcock. At 5:26 am the patient left with the Haverhill Police Department. An addendum note in the medical record identified that the patient was " more comfortable with law enforcement transfer than an ambulance transfer to Dartmouth Hitchcock Medical Center". The nursing note indicates that the patient was discharged by MD order. There was no documented evidence that the
patient received a medical screening exam by any qualified individual or that a discharge order was completed by a physician.

Review of the facility sexual assalt policy and procedure (A#4) identified that in the event that a SANE nurse was not available the patient will be seen by by an ED nurse and a medical screening exam would be performed by the ED pyshician.

Interview with Staff A (Emergency Room Director) and Staff B (Clinical Supervisor) on 3/2/16 confirmed the above.