HospitalInspections.org

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Based on observation, interview, record review, review of hospital policies and procedures and medical staff bylaws, the hospital failed to develop and implement policies and procedures for evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health outcomes, injury, and death.

Findings included:

1. The hospital failed to a) ensure that the hospital's medical staff bylaws identified the qualifications of physicians, and mid-level providers who performed medical screening examinations (MSE) in the hospital's Emergency Department and to ensure MSE's were performed by qualified health care providers

Cross Reference: Tag C2406

2. The hospital failed to provide evidence that 1 of 6 patients were a) informed of the risks and benefits of transfer if stabilization was not possible; b) the hospital ensured there was an accepting physician and hospital prior to transferring the patient ; c) the hospital ensured patients were appropriately monitored during transport; and d) the hospital sent copies of all medical records pertaining to the patient's emergency care to the receiving facility when patients were transferred to another hospital (Patient #19).

Cross Reference: Tag C2409
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Based on observation, interview, record review, review of hospital policies and procedures and medical staff bylaws, the hospital failed to develop and implement policies and procedures for evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health outcomes, injury, and death.

Findings included:

1. Review of the hospital policy titled, "Application of and Compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA)," #1800, effective date 03/06/17, showed that those practitioners designated to perform medical screening examinations are to be identified in the hospital by-laws or in the rules and regulations governing the medical staff.

2. Review of the hospital document titled, "Columbia County Hospital District #1 Medical Staff By-Laws of Dayton General Hospital," #1767 effective date 12/27/18, showed that there was no evidence of practitioners designated to perform medical screening examinations.
Review of the hospital document titled, "Dayton General Hospital Medical Staff Rules and Regulations," no number, dated 03/01/19, showed that there was no evidence of practitioners designated to perform medical screening examinations.

3. During an interview with the investigator on 03/07/22 at 12:30 PM, the Director of Quality (Staff #6) stated that the By-Laws and Medical Staff Rules and Regulations do not include identification of personnel designated for performing Medical Screening Examinations.

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Based on interview, record review and review of hospital policies and procedures,the hospital failed to provide evidence that 1 of 6 patients were a) informed of the risks and benefits of transfer if stabilization was not possible; b) the hospital ensured there was an accepting physician and hospital prior to transferring the patient ; c) the hospital ensured patients were appropriately monitored during transport; and d) the hospital sent copies of all medical records pertaining to the patient's emergency care to the receiving facility when patients were transferred to another hospital (Patient #19).

Failure to comply with EMTALA transfer requirements risks violation of patient rights to consent to transfer and risks poor patient outcomes and lack of care continuity.

Findings included:

1. Review of the hospital policy titled, "Medical Evaluation Prior to Transfer," #156 effective date: 03/21/17, showed that the Authorization for Transfer/COBRA Form shall be fully completed and retained in the medical record. A copy of the completed form shall accompany any patient who is transferred to another facility.

2. Review of 6 medical records showed that the Authorization for Transfer forms were missing from Patient #19's medical record.

3. During an interview with the investigator on 03/07/22 at 2:25 PM, the Case Manager (Staff #3) confirmed that the Authorization for Transfer/COBRA form was missing in Patient #19's medical record.