HospitalInspections.org

Based on documentation review and interview, the hospital failed to ensure compliance with the requirements of 42 CFR 489.24 as evidenced by the deficient practice cited in 489.24 (a) and (c).

The hospital failed to ensure all patients who presented to the Emergency Department (ED) received an appropriate medical screening examination (MSE).

Based on interview and document review, the hospital failed to ensure patients who presented to the emergency department (ED) received a medical screening examination to determine whether an emergency medical condition existed for 1 of 21 patients, P1, reviewed for emergency services.

Findings include:

A patient concern email dated 8/4/18, completed by another hospital (hospital #2) and forwarded to administrative nurse (AM)-B at hospital #1 was reviewed. The purpose of the e-mail was to inform the hospital P1 had presented at hospital #1's ED at approximately 3:00 a.m. on 8/4/18, due to severe postoperative left elbow pain. The patient was not registered at hospital #1, did not appear on the ED log, and did not receive a medical screening examination at hospital #1. Nurse-C told P1 to drive to hospital #2's ED (during the night and thirty miles away) because the patient's orthopedic physician provided care at hospital #2, and the nurse at hospital #1 stated they did not have the necessary equipment to provide an MRI if needed. P1 was not informed of the possible risks of leaving hospital #1's ED and was not asked to sign any papers related to his/her visit to hospital #1's ED. P1 arrived at hospital #2's ED at 6:42 a.m. on 8/4/18. The e-mail indicated that prior to P1 leaving hospital #1's ED, nurse-C called hospital #2's ED and informed staff that s/he was sending P1 to hospital #2's ED.

Review of P1's 8/4/18, ED record from hospital #2 indicated the patient arrived by car at hospital #2's ED on 8/4/18, at approximately 6:42 a.m. The record did not indicate that P1 was seen at hospital #1's ED prior to arriving at hospital #2's ED on 8/4/18. The patient stated s/he fell on 6/1/18, and fractured his/her left elbow. The patient complained of having left arm pain since having elbow surgery on 7/31/18. P1 stated s/he had been up all night due to severe pain and the current pain medications were not working. The patient received a supraclavicular nerve block for relief of pain while s/he was in hospital #2's ED. The ED record indicated the nerve block significantly reduced P1's pain, and the patient was discharged from hospital #2's ED at approximately 8:28 a.m. on 8/4/18.

When interviewed on August 20, 2018, at 11:45 a.m., nurse-C stated she knew P1 from the patients prior visits to hospital #1's ED. Nurse-C stated s/he was working in hospital #1's ED on 8/4/18, when the patient arrived at approximately 3:00 a.m. with his/her family member. P1 complained of having severe pain and screamed when nurse-C attempted to touch P1's arm. Nurse-C told P1 to go to hospital #2's ED and be seen by his/her orthopedic surgeon. Nurse-C told the patient that s/he would call ahead and inform hospital #2's ED that P 1 would be coming to the ED. Nurse-C stated s/he did not call hospital #1's on-call ED physician related to P1's arrival at the ED.

The hospital's EMTALA policy, dated January 2017, provided the following description of a Medical Screening Examination (MSE): "An examination within the capability of Avera Tyler's Emergency Department, including ancillary services routinely available to the Emergency Department, to determine with reasonable clinical confidence whether an EMC (Emergency Medical Condition) exists. The MSE shall be provided by Emergency Room physicians."