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Based upon medical record review, policy review, document review and interview, the facility did not comply with all the provisions for providing a medical screening examination and necessary stabilizing treatment.

Please reference findings under Tag A 2407.

Based on medical record review, document review and interview the facility did not ensure the risks of leaving prior to receiving a medical screening examination and stabilizing treatment were provided to 1 of 20 patients who presented to the Emergency Department (ED) for evaluation. Failure to ensure all information is provided to the patient as required could result in the patient making an uninformed decision.

Findings include:

Review of Medical Screening Examination, Stabilizing Treatment & Appropriate Transfer policy # CH 950-232 effective 10/22/18 revealed a MSE (medical screening exam) will be performed by a qualified medical professional.
Patient request for Transfer or Discharge - If an individual with an unstabilized medical condition requests transfer or discharge against medical advice, he will be informed of the risks and benefits to the individual from the discharge ....Hospital staff will explain Hospital's obligation to provide necessary stabilizing treatment and appropriate transfer and will obtain the individual's written informed refusal/request on the applicable section of the Leaving the Hospital Against Medical Advice/Release of Responsibility for Discharge form.

Interview on 4/9/19 with Staff #8 nursing supervisor, revealed he was in the ED on 3/31/19 assisting with a critically ill patient when he was notified by staff that Patient #1 had become extremely agitated and verbally aggressive over the delay in being evaluated. Staff #8 presented to Patient #1's room and observed the patient on the phone arranging a ride home. The patient had pulled off the telemetry leads and was noted to be verbally aggressive. Staff (JIM) gave the patient his sneakers and clothing and told him he could leave. Staff #8 reported that due to the patient's threatening behavior, he asked security to remain with the patient until the patient had left the premises.

Review of the medical record for Patient #1 dated 3/31/19 revealed no documentation to indicate the patient was informed of the risks of leaving prior to receiving a medical screening examination and stabilizing treatment or that an attempt was made to secure the patient's written informed refusal in accordance with facility policy.