HospitalInspections.org

As directed by the Centers for Medicare & Medicaid Services (CMS), an unannounced on-site allegation survey was conducted at this facility from 10/17/17 to 10/18/17 to determine compliance with Emergency Medical Treatment And Labor Act (EMTALA) under the Responsibilities of Medicare Participating Hospitals in Emergency Cases, 42 CFR 489.20(l) and 42 CFR 489.24(a).

The facility's failure to enter into the Emergency Department (ED) log one patient who presented to the ED and failure to provide a medical screening examination within the capability and capacity of the hospital, could have resulted in possible injury or death to patients who required immediate medical care.

Please refer to the 2567 for details.

Based on interview, record review and review of video surveillance, the Hospital failed to enter into the Emergency Department (ED) log one patient (#24) of 24 patients' medical records reviewed, who presented to the ED. This failure had the potential to affect all patients who presented to the ED.

Findings included:

1. Review of the Hospital's policy titled, "Registration Log," revised 11/2016, showed the directive for staff that all individuals seeking care in the ED shall be logged into the control register, and this information was to be entered into the electronic medical record (EMR) databank/log (ED log) without exception.

2. Review of the Hospital's undated education materials titled, "The Joint Commission: EMTALA," showed that staff would document every patient who presented to the ED along with information about the treatment of each patient's emergency condition.

3. Review of video surveillance dated 10/13/17, showed the following:
- On 10/13/17 at 9:47:03 AM, an ambulance appeared into camera's view of the ED's ambulance bay with Patient #24 (identified by the facility);
- At 9:47:20 AM, EMS personnel exited the ambulance and entered the ED;
- At 9:48 AM, EMS personnel on camera view appeared to be talking to Staff I, Registered Nurse (RN); and
- At 9:51 AM, Ambulance drove out of the ambulance bay, and out of the camera's view.

During an interview on 10/18/17 at 8:35 AM, Staff I, RN, stated that:
- She remembered Patient #24 and the events on 10/13/17;
- She had taken report from the EMS;
- EMS ambulance arrived to the ambulance bay, on Hannibal Regional Hospital's property;
- She told EMS to divert to Hospital B;
- She never retrieved the name or date of birth, and/or entered Patient #24 into the ED log.

During an interview on 10/17/17 at 8:45 AM, Staff E, ED Unit Clerk, stated that registration personnel were responsible for "checking in" all patients who presented to the ED for emergency care, which placed the patients on the ED log.

During an interview on 10/18/17 at 8:45 AM, Staff L, Director of the ED, stated that any patient that presents to the ED and/or on hospital grounds, should have been entered into the ED log.

Review of the ED log, dated 10/13/17 showed no evidence of Patient #24's arrival to the ED, that he requested care or that he left the ED without receiving an examination based on staff I's suggestion.

Based on interview, review of Emergency Department (ED) logs, Medical Records, review of Video Surveillance, and Policy review the hospital failed to provide a medical screening examination (MSE) within its capabilities and capacity to determine whether an emergency medical condition (EMC) existed for one patient (#24) of 24 ED records reviewed from May 2017 through October 2017.

Findings included:

1. Review of the Hospital's policy titled, "Emergency Medical Screening Examination (EMTALA)," dated 12/18/16, showed the directives for staff to perform a MSE:
- The purpose was to ensure that all patients have access to and received a medical screening examination and stabilization of emergency medical conditions, and to provide expectations and guidance for care of the patient;
- Any individual who presents to the hospital and who requests the examination of, or treatment for, an emergency medical condition, shall be provided a medical screening examination (MSE) and when necessary, stabilizing treatment, within the capabilities of the Hospital; and
- Physicians who were on-call (and, if appropriate, backup contacts) will need to provide the treatment necessary to stabilize an individual with an EMC after the initial MSE had been performed.

2. Review of the video surveillance dated 10/13/17 showed the following:
- On 10/13/17 at 9:47:03 AM, an ambulance arrived into camera's view to the ED's ambulance bay with Patient #24 (identified by the facility);
- At 9:47:20 AM, Emergency Medical Services (EMS) personnel exited the ambulance and entered the ED;
- At 9:48 AM, EMS personnel on camera view appeared to be talking to Staff I, Registered Nurse RN;
- At 9:51 AM, The ambulance exited the camera's view and the ambulance bay; and
- From 9:47 AM through 9:51 AM, Patient #24 remained in the ambulance, and no ED personnel, including a physician enter the camera's view or entered the ambulance.

3. During a telephone interview on 10/18/17 at 5:00 PM, EMS personnel stated that:
- She remembered Patient #24 and the events on 10/13/17;
- She transported Patient #24 to Hannibal Regional Hospital's ambulance bay;
- Upon arrival to the hospital, she spoke with a nurse that directed her to take Patient #24 to Hospital B, because they did not have a Urologist (a physician that focus on diseases of the urinary tract) on call;
- She never removed Patient #24 from the ambulance; and
- No physician or any staff approached the ambulance to examine Patient #24.

4. During an interview on 10/18/17 at 8:35 AM, Staff I, RN, stated that:
- She remembered Patient #24 and the events on 10/13/17;
- She had taken report from the EMS;
- The report was that Patient #24 had suprapubic catheter (sterile tube inserted through the abdomen into bladder) problems;
- She looked at the on call list, and saw there was no Urologist on call;
- She spoke with ED Physician H, who directed her to divert the ambulance to Hospital B;
- She had given the directions to divert (go to another hospital) to Hospital B to dispatch, but never spoke to the ambulance crew;
- EMS ambulance arrived to the ambulance bay, on Hannibal Regional Hospital's property;
- She told EMS to divert to Hospital B;
- She never told the physician that Patient #24 had arrived on hospital property; and
- No physician or any staff had went out to the ambulance bay.

5. During a telephone interview on 10/17/17 at 1:30 PM, Staff H, ED Physician, stated that:
- He has the knowledge to treat or attempt to stabilize any medical condition that presents to the ED;
- He remembered Patient #24 and the events on 10/13/17;
- He was the only physician working in the ED at the time of the event;
- He was unaware that the patient arrived at the hospital;
- He never examined Patient #24; and
- Once Patient #24 arrived on the hospital's property, the patient should have received an examination and treatment.

6. Review of Hospital B's ED Physician's note dated 10/13/17, showed the following:
- An 88 year old man, who was a resident of a Nursing Home;
- Had urinary retention (unable to release urine), that was managed with suprapubic (inserted through abdomen into bladder) catheter;
- He was transferred (by EMS) from a nursing home to Hannibal Regional Hospital, then on to Hospital B; and
- Patient #24 was admitted to Hospital B.

During an interview on 10/18/17 at 8:45 AM, Staff L, Director of the ED, stated that:
- She remembered Patient #24 and the events on 10/13/17;
- On 10/13/17, Hannibal Regional Hospital was not at any time on a full diversion, or incapable of providing care to any ambulance that requested examination of their patients;
- Patient # 24 did not receive a MSE from a physician; and
- Staff I, RN, should have not let the ambulance leave the hospital grounds, without the physician examining the patient.

During a telephone interview on 10/18/17 at 9:15 AM, Staff O, ED Medical Director, stated that an ED Physician has the knowledge to treat and/or the ability to attempt to stabilize any medical condition that presents to the ED. If a patient's request that we examine them, it was the hospital's responsibility to see that patient.