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Based on document review, observation, and interview, the facility failed to comply with the requirements for 489.24 and the related requirements of 489.20.

Findings:

Please see specific findings under A2402; A2404; A2405; A2406; and A2409.
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Based on observation and interview, the facility failed to post signs that meet the requirements of this provision.
Findings:
During a tour of the emergency department on October 7, 2013 at 11:30 AM and October 8, 2013 at 1:00 PM, it was identified that there were no signs posted in the triage, registration, and waiting areas or the treatment rooms. This was confirmed with staff # 1 and staff # 35 at 1:30 on 10/8/13 .
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Based on document review, observation and interview, the facility failed to maintain an on-call list that was up to date and readily accessible to emergency department staff to assure that patients received stabilizing treatment for their emergency medical conditions.
Findings:
During a tour of the emergency department on October 7, 2013 at 12:00, staff were asked to provide a copy of the most current on-call list. The list could not be located at that time. Staff were again asked to produce a copy of the most current on-call list during an interview with staff # 29 at 3:00 on October 8, 2013. Survey staff were advised that the hospital operator had the most up to date list. However, when the operator was asked who was on call, the operator did not know. The facility was not able to provide the most up to date on call list to survey staff until October 9, 2013.
Staff # 29 also informed survey staff that it is often very difficult to get the on call physicians to respond to the emergency department. Many times calls are not made to the on call physicians; instead physicians who are known to readily respond to requests for consults are contacted for specialty consultations.
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Based on document review and interview, the facility failed to maintain a complete central log for each individual presenting to the emergency department. Specifically, the facility failed to assure that all entries were complete and accurate.
Findings:
A review of the facility ' s emergency department log on 10/8/2013, identified missing diagnoses, complaints and accurate discharge dispositions for 5/11 patients who presented to the emergency department on 7/26/13 between 11:22 and 13:11. Each of these missing entries indicated that the patients were discharged between 06:59-07:00 on 7/27/13. Based on interview with staff #3 on 10/11/13 at 3:00 and a review of the medical record for patient # 32 confirmed that the disposition was not accurate. This patient was discharged from the emergency department the following morning but was referred to the obstetrical unit for evaluation and treatment.
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Based on medical record review, the facility failed to provide a medical screening examination for all patients presenting to the emergency department seeking examination or treatment.
Findings:
Patient # 25
This patient presented to the emergency department for an evaluation following a rape. A physical examination by a qualified medical practitioner was not documented in the patient ' s medical record.
Patient # 12
This patient presented to the emergency department for potential exposure to a sexually transmitted disease. The patient ' s mother was requesting an evaluation for " bumps in the patient ' s genital area " . A physical examination by a qualified medical practitioner was not documented in the patient ' s medical record.
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Based on medical record review, the facility failed to assure an appropriate transfer to another medical facility. Specifically, the facility failed to assure that the physician certified that the benefits of transfer to another facility outweighed the specific risks for each interfacility transfer. The risks noted were generic reasons such as automobile accident or death.
Findings:
Patient # 1
This pediatric patient presented to the emergency department with a chief complaint of fever, vomiting and diarrhea for 6 days. A decision was made that the patient required an inpatient admission for intravenous fluids and monitoring; however, due to the inability to accept pediatirc admissions, the patient was transferred to another facility. The physician failed to document the specific risks of transfer for this patient. The risks of transfer for this case were injury from motor vehicle accident involving the ambulance, decompensation or death.
Patient # 18
This patient presented to the emergency department with complaints of generalized headache, with dizziness, nausea and vomiting. Patient had been treated at another facility ten days prior for a subdural hematoma and brain contusion following a motorcycle accident. Diagostic studies were positive for an increase in the patient's hematoma and increased midline shift. The decision was made to transfer the patient for neurosurgical intervention. The physician failed to document the specific risks associated with this transfer. The risks of transfer were noted as "injury from motor vehicle accident involving ambulance or ambulette."
Patient # 26
This patient presented to the emergency department for attempted suicide. The patient was accepted for transfer for inpatient psychiatric care. The physician failed to document the specific risks associated with this transfer. The only risks noted for the transfer were risks of injury from a motor vehicle accident involving the ambulance or ambulette.
Patient # 30
This patient presented to the emergency department by ambulance for alcohol intoxication. Medical screening examination identified a non-displaced skull fracture. Decision was made to transfer patient to another facility for further neurological work-up. The physician failed to document the specific risks associated with this transfer. The risks of transfer were noted as " injury from motor vehicle accident, decompensation, death " .