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Based on policy reviews, and staff interviews, the hospital failed to ensure 1 (Patient 21) of 21 sampled patients was provided a Medical Screening Examination (MSE) to determine within the hospital's capabilities the presence of an Emergency Medical Condition (EMC) existed, in accordance with the facility Emergency Medical Treatment and Transfer (EMTALA) policy titled: "Examination and Transfer of Emergency Patients Procedure" (Last Reviewed 10/01/2021). Patient 21 presented to the Emergency Department (ED) seeking medical care with a food bolus lodged in his throat and the staff failed to provide a MSE. The failure to follow the hospital's policy and procedure for performing a MSE to determine an EMC has the potential to cause harm or death due to a delay in treatment. According to the facility provided information the ED sees an average of 103 patients per month.

Findings are:

See also 2406

A. Review of the facility policy: Examination and Transfer of Emergency Patients Procedure (Reviewed: 10/01/2021) revealed;
- Any individual who is not otherwise a patient of Hospital shall be provided an appropriate medical screening examination with in the capabilities of the Emergency Department (including ancillary services routinely available to the Emergency Department as follows: a.) Presentation in a dedicated Emergency Department (the traditional Emergency Department or the OB Department). Upon presentation at a dedicated Emergency Department of the Hospital, and upon request for examination or treatment of ANY medical condition. Such a request will be considered to exist if a prudent layperson observer would believe, based on the individual's appearance or behavior that the individual needs examination or treatment for a medical condition.

B. The hospital failed to follow their EMTALA policy "Examination and Transfer of Emergency Patients Procedure" (Reviewed 10/01/2021) and did not provide Patient 21 with a medical screening exam when the patient presented to the Emergency Department on 7/10/2022 at unknown time and requested to see a medical provider for a food bolus lodged in his throat.

C. In an interview on 8/17/2022 at 2:42 PM, RN-A confirmed that when Patient 21 presented to the facility on 7/10/2022 and that the patient was not provided any medical care. RN-A confirmed that she did not enter the patient into the Emergency Department log.

Based on staff interviews and review of facility EMTALA policy and procedures, the hospital failed to ensure 1 (Patient 21) of 21 sampled patients was provided a Medical Screening Examination (MSE) to determine with in the hospital's capabilities the presence of an Emergency Medical Condition (EMC) existed. Patient 21 presented to the Emergency Department (ED) seeking medical care for a food bolus lodged in his throat and the staff failed to provide a MSE. The total sample of 21 patients were reviewed. This failure has the potential for all patients presenting to the ED to have an untreated EMC which could result in harm or death due to delay in treatment. According to the facility provided information the ED sees an average of 103 patients per month.

Findings are:

A. In an interview on 8/17/2022 at 2:42 PM, RN-A confirmed while she was on duty on 7/10/2022 (unknown time, in morning), Patient 21 presented to the front door of the hospital and told RN-A that he had food get stuck in throat since through the night (works nightshift at a factory in town) and wanted to see a doctor. RN-A stated, "I told the patient we could see him but the endoscope equipment (the equipment a doctor would use to locate and remove the food bolus) was down." RN-A indicated that the patient stated he would just go to Hospital B (25 miles away) where he could be treated then. Patient then turned around and left. When asked if RN-A put patient in the ED log or notified the provider that the patient presented for care, RN-A stated "no I did not." Inquired if RN-A contacted Facility B to notify them that the patient was coming to their facility for treatment RN-A stated "no I did not."

B. In an interview on 8/17/2022 at 3:15PM with the Chief Executive Officer (CEO) and the Director of Nurses (DON) both confirmed that Patient 21 should have been checked into the ED and had a MSE. The CEO stated that the endoscopic equipment being down did not change anything from any other weekend. The CEO stated that the facility should of still seen the patient in the ED and transferred him if he needed to have it removed by endoscope, because the facility does not have a surgeon on call and the provider on call does not provide that service.

C. In an interview on 8/24/2022 at 9:30AM with Hospital B's ED Nurse Practitioner (NP-B) revealed, that she was working on 7/10/2022 when Patient 21 presented to Hospital B's ED. ED NP-B recalled Patient 21's case, and indicated that Patient 21 did mention that he had stopped at Hospital A prior to coming to Hospital B. ED NP-B stated "(Patient 21) was in no acute distress, he was able to speak, and he was able to manage his own secretions. When he tried to take a drink of water, he could not swallow it and vomited it right back up." ED NP-B indicated that they did attempt a dose of IV Glucagon (medication that can be used to relax the smooth muscles of the esophagus and stomach), but it was unsuccessful in removing the food bolus. ED NP-B then contacted the General Surgeon (MD-C) on call for a consult. MD-C consulted with the patient and the decision was made to perform a surgical procedure to remove the food bolus lodged in his throat.

D. Review of Patient 21's Hospital B medical record for the 7/10/2022 ED visit revealed, Patient 21 arrived at 9:53AM to Hospital B's ED. Nurses documentation noted giving the patient a sip of water with immediate emesis after arrival. The 7/10/22 ED NP-B Emergency room note revealed, Patient 21's had an esophagram (a live video of x-rays of esophagus after swallowing a contrast dye) with showed a Midesophageal obstruction (a complete blockage of the middle of the esophagus). The ED NP-B then ordered a dose of Glucagon (medication that can be used to relax the smooth muscles of the esophagus and stomach to allow the blockage to move to the stomach) which was unsuccessful in removing the food bolus. The surgeon was consulted and admitted the Patient to the Same Day Surgery Department for an Upper Gastrointestinal (GI) endoscope (a procedure used to visually examine the upper digestive system with a tiny camera on the end of a long flexible tube) to remove the food bolus. The procedure was intiated at 12:22 PM and concluded at 1:32 PM. The patient was discharged from Hospital B at 4:35 PM on 7/10/2022.

E. Review of the policy and procedure titled, Examination and Transfer of Emergency Patients Procedure (Reviewed 10/01/2021) revealed:
Any individual who is not otherwise a patient of Hospital shall be provided an appropriate medical screening examination with in the capabilities of the Emergency Department (including ancillary services routinely available to the Emergency Department as follows: a.) Presentation in a dedicated Emergency Department (the traditional Emergency Department or the OB Department). Upon presentation at a dedicated Emergency Department of the Hospital, and upon request for examination or treatment of ANY medical condition. Such a request will be considered to exist if a prudent layperson observer would believe, based on the individual's appearance or behavior that the individual needs examination or treatment for a medical condition.