HospitalInspections.org

Based on observations, interview, and review of the Emergency Department's Policy and Procedures, the hospital failed to ensure appropriate signs specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; and to post conspicuously information indicating whether or not the hospital or rural primary care hospital participates in the Medicaid program under a State plan approved under Title XIX were placed and visible to individuals presenting to the emergency department for care and services.


The findings are:


On 9/6/17 from 2:45 p.m. to 3:10 p.m., during a tour in the hospital's Emergency Department in the triage area, observations revealed there were no Emergency Medical Treatment and Labor Act (EMTALA) postings for the public to read. The findings were verified with Director 2, 3, and 4 on 9/6/2017 from 2:45 p.m. to 3:10 p.m. at the time of the observations. Director 4 stated," It used to hang right here while pointing to a wall near the entrance door of triage area, but since construction has been under way the past two weeks, they must have forgotten to put it back up."

Review of the hospital's policy, titled, "EMTALA - Signage", reads, "....All emergency departments and any other place likely to be noticed by all individuals entering the emergency department....must post conspicuously, appropriate signage notifying individuals of their right to an MSE and stabilization or treatment for an EMC and required services for women in labor as specified under EMTALA as well as information indicating whether or not the hospital participates in the Medicaid program....".

Review of the hospital's procedure, titled, "EMTALA-Signage", reads, "....all hospitals must post signage that, at a minimum, meets the following requirements:....entering the emergency department....signage must be readable from anywhere in the area....wording on signage must be clear and in simple terms in a language(s) that is (are) understandable....".

Based on review of the hospital's emergency department central log and interview, the hospital failed to ensure the emergency department's central logs showed the disposition of 69 patients who presented to the hospital's emergency department from May 2016 through September 2017.

The findings are:

On September 6, 2017 at 9:00 a.m., review of the hospital's central log from May 15, 2016 through September 5, 2017, there were 69 entries without the patient's disposition recorded.

1. May 15, 2016 at 1428: The hospital's emergency department central log revealed Random Sample Patient #46 presented to the emergency department for Psychosis, but the patient's disposition was omitted on the hospital's central log.

2. June 5, 2016 at 0958.: The hospital's emergency department central log revealed Random Sample Patient #43 presented to the emergency department for abdominal pain, but the patient's disposition was omitted on the hospital's central log.

3. June 24, 2016 at 0332: The hospital's emergency department central log revealed Random Sample Patient #22 presented to the emergency department for Hypoglycemia, but the patient's disposition was omitted on the hospital's central log.

4. June 24, 2016 at 0423: The hospital's emergency department central log revealed Random Sample Patient #23 presented to the emergency department for labor, but the patient's disposition was omitted on the hospital's central log.

5. May 8, 2017 at 2334: The hospital's emergency department central log revealed Random Sample Patient #41 presented to the emergency department for seizures, but the patient's disposition was omitted on the hospital's central log.

6. May 8, 2017 at 2029: The hospital's emergency department central log revealed Random Sample Patient #42 presented to the emergency department for blood in urine, but the patient's disposition was omitted on the hospital's central log.

7. May 8, 2017 at 1623: The hospital's emergency department central log revealed Random Sample Patient #44 presented to the emergency department for abnormal lab values, but the patient's disposition was omitted on the hospital's central log.

8. May 8, 2017 at 1657: The hospital's emergency department central log revealed Random Sample Patient #45 presented to the emergency department for migraine, but the patient's disposition was omitted on the hospital's central log.

9. May 8, 2017 at 1025: The hospital's emergency department central log revealed Random Sample Patient #47 presented to the emergency department for Code Neuro, but the patient's disposition was omitted on the hospital's central log.

10. May 8, 2017 at 0831: The hospital's emergency department central log revealed Random Sample Patient #48 presented to the emergency department for chest pain, but the patient's disposition was omitted on the hospital's central log.

11. May 11, 2017 at 1408: The hospital's emergency department central log revealed Random Sample Patient #36 presented to the emergency department for shortness of breath, but the patient's disposition was omitted on the hospital's central log.

12. May 9, 2017 at 1031: The hospital's emergency department central log revealed Random Sample Patient #37 presented to the emergency department for weakness with shortness of breath, but the patient's disposition was omitted on the hospital's central log.

13. May 10, 2017 at 1653: The hospital's emergency department central log revealed Random Sample Patient #35 presented to the emergency department for overdose, but the patient's disposition was omitted on the hospital's central log.

14. May 11, 2017 at 1931: The hospital's emergency department central log revealed Random Sample Patient #32 presented to the emergency department for Hyperglycemia, but the patient's disposition was omitted on the hospital's central log.

15. May 11, 2017 at 1450: The hospital's emergency department central log revealed Random Sample Patient #33 presented to the emergency department for lethargic sleepy, but the patient's disposition was omitted on the hospital's central log.

16. May 11, 2017 at 0716: The hospital's emergency department central log revealed Random Sample Patient #34 presented to the emergency department for shortness of breath, but the patient's disposition was omitted on the hospital's central log.

17. May 13, 2017 at 1554: The hospital's emergency department central log revealed Random Sample Patient #30 presented to the emergency department for left hip fracture, but the patient's disposition was omitted on the hospital's central log.

18. May 14, 2017 at 1600: The hospital's emergency department central log revealed Random Sample Patient #17 presented to the emergency department for abdominal pain, but the patient's disposition was omitted on the hospital's central log.

19. May 15, 2017 at 2334: The hospital's emergency department central log revealed Random Sample Patient #14 presented to the emergency department for abdominal pain, but the patient's disposition was omitted on the hospital's central log.

20. May 15, 2017 at 1146: The hospital's emergency department central log revealed Random Sample Patient #16 presented to the emergency department for dizziness when standing, but the patient's disposition was omitted on the hospital's central log.

21. May 17, 2017 at 1413: The hospital's emergency department central log revealed Random Sample Patient #15 presented to the emergency department for chest pain, but the patient's disposition was omitted on the hospital's central log.

22. May 18, 2017 at 2204: The hospital's emergency department central log revealed Random Sample Patient #54 presented to the emergency department for syncope, but the patient's disposition was omitted on the hospital's central log.

23. May 19, 2017 at 1055: The hospital's emergency department central log revealed Random Sample Patient #55 presented to the emergency department for ATE AA Battery and 4 Razor Blades, but the patient's disposition was omitted on the hospital's central log.

24. May 21, 2017 at 2236: The hospital's emergency department central log revealed Random Sample Patient #56 presented to the emergency department for needs to get Foley removed, but the patient's disposition was omitted on the hospital's central log.

25. May 25, 2017 at 1023: The hospital's emergency department central log revealed Random Sample Patient #65 presented to the emergency department for chest pain, but the patient's disposition was omitted on the hospital's central log.

26. May 27, 2017 at 2239: The hospital's emergency department central log revealed Random Sample Patient #66 presented to the emergency department for eye pain, but the patient's disposition was omitted on the hospital's central log.

27. May 28, 2017 at 2115: The hospital's emergency department central log revealed Random Sample Patient #67 presented to the emergency department for surgical site bleeding, but the patient's disposition was omitted on the hospital's central log.

28. May 28, 2017 at 2137: The hospital's emergency department central log revealed Random Sample Patient #68 presented to the emergency department for dog bite in leg, but the patient's disposition was omitted on the hospital's central log.

29. May 30, 2017 at 1815: The hospital's emergency department central log revealed Random Sample Patient #69 presented to the emergency department for abdominal pain, but the patient's disposition was omitted on the hospital's central log.

30. June 4, 2017 at 1122: The hospital's emergency department central log revealed Random Sample Patient #13 presented to the emergency department for Altered Mental Status, but the patient's disposition was omitted on the hospital's central log.

31. June 4, 2017 at 2059: The hospital's emergency department central log revealed Random Sample Patient #12 presented to the emergency department for Klonopin withdrawal, but the patient's disposition was omitted on the hospital's central log.

32. June 11, 2017 at 1639: The hospital's emergency department central log revealed Random Sample Patient #11 presented to the emergency department for compartment syndrome, but the patient's disposition was omitted on the hospital's central log.

33. June 14, 2017 at 1348: The hospital's emergency department central log revealed Random Sample Patient #10 presented to the emergency department for cold like symptoms, but the patient's disposition was omitted on the hospital's central log.

34. June 15, 2017 at 1357: The hospital's emergency department central log revealed Random Sample Patient #9 presented to the emergency department for tremors, but the patient's disposition was omitted on the hospital's central log.

35. June 16, 2017 at 2034: The hospital's emergency department central log revealed Random Sample Patient #8 presented to the emergency department for high blood sugar, but the patient's disposition was omitted on the hospital's central log.

36. June 17, 2017 at 1728: The hospital's emergency department central log revealed Random Sample Patient #6 presented to the emergency department for altered mental status, vomiting blood, but the patient's disposition was omitted on the hospital's central log.

37. June 17, 2017 at 1811: The hospital's emergency department central log revealed Random Sample Patient #7 presented to the emergency department for sore throat, but the patient's disposition was omitted on the hospital's central log.

38. June 20, 2017 at 1218: The hospital's emergency department central log revealed Random Sample Patient #4 presented to the emergency department for weakness, but the patient's disposition was omitted on the hospital's central log.

39. June 20, 2017 at 1309: The hospital's emergency department central log revealed Random Sample Patient #5 presented to the emergency department for unresponsive, but the patient's disposition was omitted on the hospital's central log.

40. June 26, 2017 at 2136: The hospital's emergency department central log revealed Random Sample Patient #2 presented to the emergency department for feels bad, but the patient's disposition was omitted on the hospital's central log.

41. June 26, 2017 at 1525: The hospital's emergency department central log revealed Random Sample Patient #3 presented to the emergency department for kidney stones, but the patient's disposition was omitted on the hospital's central log.

42. June 28, 2017 at 1325: The hospital's emergency department central log revealed Random Sample Patient #1 presented to the emergency department for left foot skin graft coming off, but the patient's disposition was omitted on the hospital's central log.

43. August 5, 2017 at 0847: The hospital's emergency department central log revealed Random Sample Patient #18 presented to the emergency department for leg pain, but the patient's disposition was omitted on the hospital's central log.

44. August 7, 2017 at 0726: The hospital's emergency department central log revealed Random Sample Patient #21 presented to the emergency department for shortness of breath, but the patient's disposition was omitted on the hospital's central log.

45. August 8, 2017 at 2043: The hospital's emergency department central log revealed Random Sample Patient #20 presented to the emergency department for full arrest, but the patient's disposition was omitted on the hospital's central log.

46. August 9, 2017 at 1103: The hospital's emergency department central log revealed Random Sample Patient #19 presented to the emergency department for second round of rabies, but the patient's disposition was omitted on the hospital's central log.

47. August 10, 2017 at 2151: The hospital's emergency department central log revealed Random Sample Patient #49 presented to the emergency department for wheezing, but the patient's disposition was omitted on the hospital's central log.

48. August 10, 2017 at 1718: The hospital's emergency department central log revealed Random Sample Patient #50 presented to the emergency department for lower abdominal pain, but the patient's disposition was omitted on the hospital's central log.

49. August 12, 2017 at 1130: The hospital's emergency department central log revealed Random Sample Patient #24 presented to the emergency department for abdominal pain, but the patient's disposition was omitted on the hospital's central log.

50. August 12, 2017 at 1212: The hospital's emergency department central log revealed Random Sample Patient #25 presented to the emergency department for right wrist injury, but the patient's disposition was omitted on the hospital's central log.

51. August 12, 2017 at 1301: The hospital's emergency department central log revealed Random Sample Patient #26 presented to the emergency department for right leg pain, but the patient's disposition was omitted on the hospital's central log.

52. August 12, 2017 at 1609: The hospital's emergency department central log revealed Random Sample Patient #27 presented to the emergency department for right foot injury, but the patient's disposition was omitted on the hospital's central log.

53. August 12, 2017 at 2003: The hospital's emergency department central log revealed Random Sample Patient #51 presented to the emergency department for out patient no use ER Doctor, but the patient's disposition was omitted on the hospital's central log.

54. August 15, 2017 at 1320: The hospital's emergency department central log revealed Random Sample Patient #29 presented to the emergency department for Gastritis, but the patient's disposition was omitted on the hospital's central log.

55. August 22, 2017 at 1156: The hospital's emergency department central log revealed Random Sample Patient #28 presented to the emergency department for needs staples removed, but the patient's disposition was omitted on the hospital's central log.

56. August 24, 2017 at 1348: The hospital's emergency department central log revealed Random Sample Patient #31 presented to the emergency department for abscess tooth, but the patient's disposition was omitted on the hospital's central log.

57. August 25, 2017 at 1716: The hospital's emergency department central log revealed Random Sample Patient #52 presented to the emergency department for dizzy/hands and feet numbness, but the patient's disposition was omitted on the hospital's central log.

58. August 26, 2017 at 1727: The hospital's emergency department central log revealed Random Sample Patient #53 presented to the emergency department for psych eval, but the patient's disposition was omitted on the hospital's central log.

59. August 29, 2017 at 1611: The hospital's emergency department central log revealed Random Sample Patient #38 presented to the emergency department for headache nausea vomiting, but the patient's disposition was omitted on the hospital's central log.

60. August 29, 2017 at 1726: The hospital's emergency department central log revealed Random Sample Patient #39 presented to the emergency department for not able to void, but the patient's disposition was omitted on the hospital's central log.

61. August 31, 2017 at 1840: The hospital's emergency department central log revealed Random Sample Patient #40 presented to the emergency department for ED OB, but the patient's disposition was omitted on the hospital's central log.

62. September 1, 2017 at 0753: The hospital's emergency department central log revealed Random Sample Patient #57 presented to the emergency department for knee pain, but the patient's disposition was omitted on the hospital's central log.

63. September 1, 2017 at 2306: The hospital's emergency department central log revealed Random Sample Patient #58 presented to the emergency department for cardiac arrest, but the patient's disposition was omitted on the hospital's central log.

64. September 2, 2017 at 1402: The hospital's emergency department central log revealed Random Sample Patient #59 presented to the emergency department for neck and arm pain/numbness, but the patient's disposition was omitted on the hospital's central log.

65. September 4, 2017 at 0947: The hospital's emergency department central log revealed Random Sample Patient #60 presented to the emergency department for swelling to feet and legs, shortness of breath , but the patient's disposition was omitted on the hospital's central log.

66. September 4, 2017 at 1039: The hospital's emergency department central log revealed Random Sample Patient #61 presented to the emergency department for shortness of breath, but the patient's disposition was omitted on the hospital's central log.

67. September 4, 2017 at 1112: The hospital's emergency department central log revealed Random Sample Patient #62 presented to the emergency department for mental eval, but the patient's disposition was omitted on the hospital's central log.

68. September 5, 2017 at 1004: The hospital's emergency department central log revealed Random Sample Patient #63 presented to the emergency department for abdominal pain, but the patient's disposition was omitted on the hospital's central log.

69. September 5, 2017 at 1803: The hospital's emergency department central log revealed Random Sample Patient #64 presented to the emergency department for left foot injury, but the patient's disposition was omitted on the hospital's central log.

On September 7, 2017 at 12:30 p.m., the findings were verified with Administrative Assistant 1 and Director 2.

Review of the hospital's Policy/Procedure, titled, "EMTALA- Central Log", reads, "....3. The Central Log, including all additional logs incorporated into the Central Log by reference, shall be maintained in the same manner and with the same central core of information. The logs must contain, at a minimum, the name of the individual: refused treatment, was refused treatment, was transferred, was admitted and treated, was stabilized and transferred, was discharged, or expired....".



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Review of Policy/Procedure, "EMTALA- Central Log", reads "....3. The Central Log, including all additional logs incorporated into the Central Log by reference, shall be maintained in the same manner and with the same central core of information. The logs must contain, at a minimum, the name of the individual: refused treatment, was refused treatment, was transferred, was admitted and treated, was stabilized and transferred, was discharged, or expired....".