HospitalInspections.org

Based on medical record (MR) review, interview and document review, in 7 of 11 medical records reviewed (Patients #2, #3, #4, #5, #6, #7, #8) the facility did not provide an appropriate medical screening exam to determine if an emergency medical condition existed. Specifically, Patients #2, #3, #4, #5, #6, #7, #8 presented to the emergency department with a chief complaint of a sexual assault and did not have a genitourinary exam performed to determine the extent or presence of any injuries.

Based on observation and interview, the hospital failed to post EMTALA (Emergency Medical Treatment and Labor Act) signage in all areas likely to be noticed by all patients arriving to the emergency department. Specifically, EMTALA signs were not posted in the ambulance entrance area of the ED. This lack of notification could affect patient's rights.

Findings include:

-- During a tour of the emergency department on 3/12/2024 at 9:30 am, there was no EMTALA signage posted in the entrance to the emergency department where patients arrive via ambulance. Staff A, Emergency Department Manager, acknowledged this finding at the time of observation.

Based on medical record review, interview and document review, in 7 of 11 medical records reviewed (Patients #2, t #3, #4, #5, #6, #7 and # 8) the facility did not provide an appropriate medical screening exam to determine if an emergency medical condition existed. Specifically, Patients #2, #3, #4, #5, #6, #7, #8 presented to the emergency department with a chief complaint of a sexual assault and did not have a genitourinary exam performed to determine the extent or presence of any injuries.

Findings include:

-- Review of Patient #2's medical record revealed she, a minor (a person under the age of full legal responsibility), under the age of 16, presented to the emergency department on 11/10/2023 at 12:00 pm following a sexual assault. Patient #2, reported that her mother's boyfriend had given her marijuana, touched her breasts and abdomen, and placed his mouth on her nipples. Patient #2 denied rectal or vaginal penetration. Patient #2 denied vaginal pain, bleeding, or discharge. An exam was not completed to ascertain the extent or presence of any genitourinary injuries. Patient #2 was instructed to follow up with the Child Advocacy Center and discharged.

-- Review of Patient #3's medical record revealed she, a minor under the age of 8, presented to the emergency department on 12/22/2023 at 11:05 pm for groin swelling and a potential sexual assault. The patient had reported pain in her private area previously, and her mother noted redness and inflammation to the vaginal area and marks on the patient's back, a complete exam of these areas was not documented.

-- Per interview on 3/13/2024 at 1:30 pm of Staff B, Physician, he/she/they were told by the Child Advocacy Center not to complete a sexual assault exam on Patient #3. The Child Advocacy Center also gave direction not to provide post exposure prophylaxis or labs to Patient #3. Staff B takes the direction of the Child Advocacy Center.

-- Review of Patient #4's medical record revealed she, a minor under the age of 18, presented to the emergency department on 12/29/2023 at 5:46 pm following a sexual assault. The patient reported vaginal discharge. There was no documentation of a genitourinary exam.

-- Review of Patient #5's medical record revealed she, a minor under the age of 16, presented to the emergency department on 12/29/2023 at 5:46 pm following a sexual assault. There was no documentation of a genitourinary exam.

-- Review of Patient #6's medical record revealed she, a minor under the age of 8, presented to the emergency department on 1/1/2024 at 5:49 pm following a sexual assault. Patient #6, reported being assaulted by a family friend earlier in the day. Patient #6 reported she was touched in her genitourinary area. The provider documented Patient
#6's genitourinary exam was deferred. Patient #6 was discharged with directions to be seen the following day at the local Child Advocacy Center.

-- Review of Patient #7's medical record revealed she, a minor under the age of 16, presented to the emergency department on 1/14/2024 at 11:23 pm with a chief complaint of a sexual assault. There was no documentation of a genitourinary exam provided.

-- Review of Patient #8's medical record revealed she, a minor under the age of 16, presented to the emergency department on 2/4/2024 at 10:17 pm with a sexual assault. There was no genitourinary exam documented. The patient was discharged with instructions to follow up with the Child Advocacy Center for a full exam.

-- Review of facility's policy and procedure "Sexual Assault: Care of the Pediatric Patient," last revised 12/2022, indicated "a forensic examination should be completed if a patient presents within 72-hours post assault. If the patient presents more than 72 hours after the assault, he/she should receive a medical screening examination."

-- Per interview on 3/12/2024 at 10:50 pm of Staff I, Physician, providers are specially trained to perform examinations of sexual assault victims. Every provider and physician can perform an assessment/examination of a sexual assault victim. All providers perform examinations and give stabilizing treatment to patients.

-- Per interview of Staff J, Emergency Department Medical Director, on 3/13/2024 at 8:30 am, he/she/they opined that the providers are not comfortable doing the pediatric sexual assault examinations. The providers would take care of the medical portion of the exam and ensure the patient is stable. A physical exam would be conducted if there was a concern for bleeding. There is no separate training for providers to learn to do sexual assault examinations, providers use what they have learned during residency.

-- During interview on 3/13/2024 at 9:03 am, Staff A, Emergency Department Manager, he/she/they confirmed the above findings.