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Based on interview and record review the hospital failed to comply with 480.24 by not providing an appropriate medical screening examination to 1 individual (Patient 1) who was reported to be laying in the street at the hospital bus stop, shaking, lying in urine but breathing.

Findings:

Patient 1 is a 41 year old male who was reported by a prudent layperson, on 4/30/10 via 911, to be laying in the street at the hospital bus stop, shaking, lying in urine but breathing. In addition several calls were received by the hospital dispatcher reporting a person at the bus stop needing help. Security at the hospital called the police to remove Patient 1 from the hospital premises. A police officer (Officer 1) responded to the call. When he arrived a hospital emergency department (ED) nurse (RN), a hospital security guard, and two paramedics were present. Officer 1 did not feel that Patient 1 looked good. He wanted Patient 1 taken to the hospital ED. Following a contentious conversation between the ED RN and Officer 1 the security guard and ED RN left the bus stop. Officer 1 called for assistance. He and another police officer took Patient 1 to a local mental health hospital where Patient 1 was eventually admitted.
(Cross reference A2406)

Based on interview and record review, the hospital failed to ensure that an individual (Patient 1) received appropriate emergency medical screening after a prudent layperson reported to authorities, by calling 911, that Patient 1 was observed laying in the street at the hospital bus stop, shaking, lying in urine but breathing.

Findings:

According to a police report, dated 4/30/10, Officer 1 arrived at a bus stop located near the hospital "to check the welfare of a white male...who was seen at the bus stop shaking but breathing." Upon arrival Officer 1 met with a security guard from the hospital, a registered nurse (RN) from the Emergency Department (ED), and two paramedics. In his report, Officer 1 stated that "Based on my immediate observations of (Patient 1) and my training and experience, it looked as though he was medically in distress or had some type of mental disorder." It was documented by Officer 1 in his report that Patient 1 was known to the ED RN. Officer 1 also documented that "I asked the nurse further what was wrong with (Patient 1) and she said, "nothing, he is just an idiot who is an alcoholic"... I asked the nurse again, what would you like me to do with the subject. The nurse responded, "I don't know, (a mental health facility) or something or arrest him for trespassing." Officer 1 further documented in his report that he explained to the nurse that he could not arrest Patient 1 for trespassing because he was sitting at a bus stop. The ED RN replied, "sure you can, he is on (hospital) grounds and we want him gone." Officer 1 then told the ED RN that he would handle it from there. The ED RN and security left the area. Officer 1 placed Patient 1 in handcuffs, called for assistance from another officer and took Patient 1 to a local mental health facility where he was eventually admitted.

On 5/18/10 at 10:45 A.M., an interview was conducted with the ED RN. The ED RN stated that about 45 minutes after the incident with Patient 1 at the bus stop with the police she received a call from a physician (MD) at a local mental health hospital. The MD asked the ED RN why the hospital had sent Patient 1 to the mental health hospital. The ED RN responded that they had not. She told the MD that she thought that the patient had been arrested. The MD told the ED RN that the police officer told her that the hospital refused medical treatment for Patient 1.

An interview was conducted with the Manager of Patient Transportation and Security on 5/18/10 at 1:10 P.M. The Manager stated that on 4/30/10 several people had called the hospital dispatcher reporting a person at the bus stop that needed help. The Manager went to the bus stop and arrived shortly before the ED RN and security guard. After they arrived, the Manager stated that the ED RN told the police that she did not want Patient 1 returning to the ED if he was going to continue exposing himself and having behaviors in general.