HospitalInspections.org

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Based on interview and document review, the hospital failed to implement their policies and procedures for evaluation and treatment of a patient that presented for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening exam by a qualified medical professional and stabilizing treatment risks poor health outcomes, injury and death.

Findings included:

The hospital failed to ensure that security personnel alerted emergency department staff when a patient that was unable to move without assistance was left sitting alone on the sidewalk outside the hospital.

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Based on interview and document review, the hospital failed to implement its policies and procedures to provide a medical screening exam for a patient that presented to the hospital grounds seeking emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) for 1 of 20 patient records reviewed (Patient #6).

Failure to provide a medical screening for patients that present to the hospital puts patients at risk for harm from a medical or psychological emergency that is not screened and treated.

Findings included:

1. Document review of the hospital policy titled, "Emergency Medical Treatment and Active Labor Act Compliance With," last reviewed 11/21, showed that the hospital was to offer a medical screening exam for patients with a serious impairment to bodily function.

2. Review of Patient #1's record showed that:

a) The patient arrived in the emergency department (ED) on 01/23/23 at 12:17 PM. The patient told the triage nurse they had fallen off their bed while trying to get in their wheelchair. The patient was complaining of pain to her breast from the fall.

b) At 12:24 AM, the ED physician went to assess the patient but staff was unable to locate the patient.

c) At 1:11 AM, the patient appeared in the waiting room and was yelling. The social worker was called to talk to the patient as the patient wanted to leave against medical advice. The ED physician came to assess the patient but the patient stated they did not want to see anyone. The patient directed security to take the patient outside of the ED.

3. Review of the security log for 01/23/23 at 1:30 PM showed that:

a) The security officer (SO) wheeled the patient outside to the sidewalk by the ED.

b) The SO supervisor arrived and confirmed with the ED, the patient had left against medical advice (AMA). The SO supervisor directed staff to take the patient to the 2-hour outside parking lot.

c) The patient told the security supervisor they could not stand on their own. The security supervisor proceeded to leave the patient on the ground in the parking lot and took the hospital wheelchair from the patient.

d) The patient stated to the security officer that they had called for someone to come pick them up.

4. On 03/16/23 at 9:00 AM, investigator #1 interviewed a registered nurse (Staff #1). Staff #1 stated that security personnel were to get the registered nurse or physician from the ED to come to talk to patients that were loitering around on hospital grounds to ensure the patient received a medical screening exam and treatment if needed. Staff #1 stated that security staff were not to leave patients that were unable to care for themselves alone on the hospital grounds. Staff #1 stated that even if a patient had refused a medical screening exam earlier the patient should be seen by ED personnel and offered another medical screening exam.

5. On 03/16/23 at 9:30 AM, investigator #1 interviewed a security officer (Staff#3). Staff #3 verified that security staff were to notify the ED nurse and physicians to come talk to patients on hospital grounds and offer the patients a medical screening exam and treatment even if the patient had previously refused treatment. Staff #3 stated that security personnel could not make decisions to leave patients alone on hospital property.

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