HospitalInspections.org

Based on interview, review of the Emergency Room (ER) log, and review of facility by-laws and policies, it was determined the facility failed to comply with 42 CFR 489.20(r)(3) in regard to the ER log, as well as 42 CFR 489.24(r) and 42 CFR 489.24(c) in regard to a Medical Screening Exam (MSE), within the capability of the hospital's ER for one (1) of twenty-one (21) sampled patients (Patient #1).

The facility failed to follow the policy for Patient Flow, dated September 2015, which stated all patients presenting to the ER will be entered on the ER log and receive an appropriate MSE.

Based on interview, review of the Emergency Room (ER) Log, review of facility policies and by-laws, and review of the facility's investigation, it was determined the facility failed to enter one (1) of twenty-one (21) sampled patients in the ER log (Patient #1).

The findings include:

Review of the facility By-Laws, dated November 2014, revealed all patients who presented to the ER were to be entered in the ER Log and receive an MSE.

Review of the Patient Flow ER policy, dated September 2015, it was revealed when a patient presented to the ER, the Registration Clerk should enter the patient's name, date of birth, and chief complaint on the ER log. The patient should then be triaged and seen by the Physician or Advanced Nurse Practitioner for an appropriate MSE.

Review of the facility's investigation, dated 06/02/16, revealed Patient #1 presented to the ER on 05/29/16 at approximately 3:10 PM. However, the patient exited the ER after being directed to go to another hospital due to the X-ray equipment being down.

Interview with Patient #1, on 06/06/16 at approximately 10:50 AM, revealed he/she presented to the ER on 05/29/16, and the physician told him/her the X-ray machine was down and he/she would be better off going to another hospital. Patient #1 stated he/she then left without being registered.

Review of the ER Log for 05/29/16 (Sunday), revealed there was no documented evidence Unsampled Patient #1 was entered on the ER log.

Interview with the ER Registration Clerk, on 06/06/16 at approximately 11:55 AM, revealed, on 05/29/16, Patient #1 presented to the ER and as she was attempting to enter the patient on the ER log, Physician #1 went into the hallway and told the patient the X-ray equipment was down and it would take a long time for him/her to get an X-ray. She stated the patient chose to leave the ER and was not entered on the ER log.

Interview with Physician #1, on 06/06/16 at approximately 12:20 PM, revealed, on 05/29/16, Patient #1 reported to the ER stating he/she had been in a motorcycle accident. He revealed he told the patient the X-ray equipment was down and after a visual assessment, the physician told him/her that he/she may want to go to another hospital, and the patient chose to leave at that time. The physician also stated he has received several EMTALA trainings.

Interview with the X-Ray Technician, on 06/07/16 at approximately 9:33 AM, revealed she was working on 05/29/16 from 11:30 AM until 7:30 PM. She stated the X-ray reader was down and had been all day that day; however, X-rays were being read from one (1) of the hospital's facilities approximately one (1) mile away. She revealed this caused a delay in patients getting their results.

Interview with the Assistant Administrator, on 06/06/16 at approximately 10:50 AM, revealed the ER Registration Clerk reported to him on 05/29/16 that Physician #1 had done something that may be a possible EMTALA violation. He stated the ER Registration Clerk reported to him Patient #1 presented to the ER and Physician #1 told the patient the X-ray equipment was down, and it would take a long time for him/her to get an X-ray, so the patient left the ER and was not entered on the ER log.

Interview with the Chief Compliance Officer, on 06/07/16 at approximately 9:00 AM, revealed the Assistant Administrator reported to her, that on 05/29/16, Patient #1 left the ER without being put on the ER log or receiving an MSE because Physician #1 told the patient the X-ray equipment was down and there would be a long wait. She stated the Assistant Administrator revealed he told Physician #1 this was not to be done, and all patients reporting to the ER were to be put on the ER log and receive an MSE.

Based on interview, review of patient records, review of the facility's investigation, and review of facility policies and by-laws, it was determined the facility failed to follow the policy and by-laws related to providing a Medical Screening Exam (MSE) for one (1) of twenty-one (21) sampled patients (Patient #1).

The findings include:

Review of facility By-Laws revealed all patients who present to the ER should be provided an MSE.

Review of the Patient Flow ER policy revealed when a patient presented to the ER, the patient should be triaged and seen by the physician or Advanced Nurse Practitioner for an appropriate MSE.

Review of the facility's investigation, dated 06/02/16, revealed Patient #1 presented to the ER on 05/29/16 at approximately 3:10 PM and left the ER after being directed to go to another hospital due to the X-ray equipment being down.

Review of Patient Records revealed there was no documented evidence Patient #1, had presented to the ER and/or was provided an MSE.

Interview with Patient #1, on 06/06/16 at approximately 10:50 AM, revealed he/she presented to the ER on 05/29/16, and the physician told him/her the X-ray machine was down and he/she would be better off going to another hospital. Patient #1 stated he/she then left without being registered.

Interview with the ER Registration Clerk, on 06/06/16 at approximately 11:55 AM, revealed, on 05/29/16, Patient #1 presented to the ER and as she was attempting to enter the patient on the ER log, Physician #1 went into the hallway and told the patient the X-ray equipment was down and it would take a long time for him/her to get an X-ray. She stated the patient chose to leave the ER without an examination from the physician and she was unable to get the patient's name to enter him/her on the ER log.

Interview with Physician #1, on 06/06/16 at approximately 12:20 PM, revealed, on 05/29/16, Patient #1 reported to the ER stating he/she had been in a motorcycle accident. He revealed he told the patient the X-ray equipment was down and after a visual assessment, the physician told him/her that he/she may want to go to another hospital, and the patient chose to leave at that time. The physician also stated he has received several EMTALA trainings.

Interview with the X-Ray Technician, on 06/07/16 at approximately 9:33 AM, revealed she was working on 05/29/16 from 11:30 AM until 7:30 PM. She stated the X-ray reader was down and had been all day that day; however, X-rays were being read from one (1) of the hospital's facilities approximately one (1) mile away. She revealed this caused a delay in patients getting their results.

Interview with the Assistant Administrator, on 06/06/16 at approximately 10:50 AM, revealed the ER Registration Clerk reported to him on 05/29/16 that Physician #1 had done something that may be a possible EMTALA violation. He stated the ER Registration Clerk reported to him Patient #1 presented to the ER and Physician #1 told the patient the X-ray equipment was down, and it would take a long time for him/her to get an X-ray, so the patient left the ER and did not receive an MSE.

Interview with the Chief Compliance Officer, on 06/07/16 at approximately 9:00 AM, revealed the Assistant Administrator reported to her, that on 05/29/16, Patient #1 left the ER without being put on the ER log or receiving an MSE because Physician #1 told the patient the X-ray equipment was down and there would be a long wait. She stated the Assistant Administrator revealed he told Physician #1 this was not to be done, and all patients reporting to the ER were to be put on the ER log and receive an MSE.