HospitalInspections.org

Based on document review, video tape review, and interview, it was determined the hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24 as evidenced by:

Findings include:

1. The hospital failed to ensure a patient who presented to the emergency department (ED) was entered in the ED log. Refer to A 2405.

2. The hospital failed to ensure a patient who presented to the ED for emergency services was provided a medical screening examination. Refer to A-2406 (A)

3. The hospital failed to ensure the Medical Staff Bylaws/ Rules and Regulations identified the person/s qualified to conduct a medical screening exam. Refer to A-2406 (B)

Based on document review, video tape review, and interview, it was determined for 1 of 1 patient (Pt. #1) who was denied examination in the emergency department (ED), the hospital failed to ensure a patient who presented to the ED for examination was included in a central ED log.

Findings include:

1. Hospital policy I-A-1, titled, "EMTALA Compliance Policy", reviewed 2/14, was reviewed on 7/21/14 at 10:20 AM. The policy did not provide instruction on a central ED log.

2. On 7/21/14 at 9:55 AM, a video recording of Pt. #1 was reviewed in the security office. Pt. #1 walked through the ED ambulance entrance corridor on 7/16/14 at 1:03 AM, in wrist restraints and ankle shackles, accompanied by 2 Chicago police officers. Pt #1 exited the ED at 1:08 AM, 5 minutes after arrival with the two officers.

3. On 7/21/14 at 10:20 AM, the ED log for 7/15/14 and 7/16/14 was reviewed. Pt. #1's name was not in the hospital's ED log.

4. On 7/21/14 at 3:40 PM, Pt. #1 clinical record from the receiving hospital was reviewed. Pt. #1 was a 36 year old male, assessed on 7/16/14 at 1:29 AM, with a complaint of suicidal ideation. Pt. #1's medical screening exam, completed at the receiving hospital, dated 7/16/14 at 1:51 AM, included, "Per police, patient was originally brought to outside hospital [transferring], but patient was not evaluated due to history of violent behavior at that facility and was sent to [receiving hospital] instead..."

5. On 7/22/14 at 8:45 AM, an interview was conducted with the Registered Nurse (E #5) who denied Pt. #1's entrance into the ED. E #5 stated that Pt. #1 arrived on 7/16/14, close to 1:00 AM, with 2 police escorts, yelling, screaming, and making threats. Another nurse, who recognized Pt. #1, told E #5 that Pt. #1 "was not supposed to be here" and a security alert was posted about Pt. #1. E #5 went to the security office to see the notice in the security alert binder and the "directive" (notice) stated Pt. #1 was not to be treated. E #5 returned and told the Chicago police, Pt. #1 could not be treated at the hospital. The Chicago police said "Okay, we'll take him to [the receiving] hospital." E #5 stated he did not include Pt. #1's ED visit information in the ED log.

A. Based on document review, video tape review, and interview, it was determined for 1 of 1 patient (Pt. #1) who was denied examination in the emergency department (ED), the hospital failed to ensure a patient who presented to the ED was provided a medical screening exam.

Findings include:

1. Hospital policy I-A-1, titled, "EMTALA Compliance Policy", reviewed 2/14, was reviewed on 7/21/14 at 10:20 AM. The policy required, "Mercy provides medical evaluations... to all persons presenting to the emergency department..."

2. On 7/21/14 at 9:55 AM, a video recording of Pt. #1 was reviewed in the security office. Pt. #1 walked through the ED ambulance entrance corridor on 7/16/14 at 1:03 AM, in wrist restraints and ankle shackles, accompanied by 2 Chicago police officers. Pt. #1 left the ED at 1:08 AM, 5 minutes after arrival, with the officers and without receiving a medical screening exam. Pt. #1 was taken to another hospital for services.

3. On 7/21/14 at 3:40 PM, Pt. #1 clinical record from the receiving hospital was reviewed. Pt. #1 was a 36 year old male, assessed on 7/16/14 at 1:29 AM, with a complaint of suicidal ideation. Pt. #1 had medical screening exam completed at the receiving hospital on 7/16/14 at 1:51 AM, and included, "Per police, patient was originally brought to outside hospital [transferring], but patient was not evaluated due to history of violent behavior at that facility and was sent to [receiving hospital] instead..." Pt. #1 was treated at the receiving hospital and was waiting for transfer to a psychiatric hospital with a diagnosis of Psychosis.

4. On 7/22/14 at 8:45 AM, an interview was conducted with the Registered Nurse (E #5) who prevented Pt. #1's medical screening exam. E #5 stated that Pt. #1 came in on 7/16/14 close to 1:00 AM, with 2 police escorts. Pt #1 was yelling, screaming, and making threats. Another nurse, who recognized Pt. #1, told E #5 that Pt. #1 "was not supposed to be here". A security alert was posted about Pt. #1 indicated Pt. #1 was not to be treated in the ED. E #5 told the Chicago police officers, Pt. #1 could not be treated at the hospital.

B. Based on document review and interview, it was determined, the hospital failed to ensure the Medical Staff Bylaws/ Rules and Regulations identified who was deemed qualified to conduct medical screening exams.

Findings include:

1. On 7/21/14 at 10:10 AM, the "Bylaws of the Medical Staff", and "Rules and Regulations", dated January 2013, were reviewed. Page 10 of the "Rules and Regulations" included, "6. If any individual presents to the Emergency Department and/or a request is made on the individual's behalf for examination or treatment for a medical condition, a qualified medical professional shall provide an appropriate medical screening examination within their capabilities, including ancillary services routinely available to the Emergency Department, to determine whether or not an emergency medical condition exists." The Rules and Regulations did not specify which medical professionals were approved to provide medical screening exams.

2. On 7/21/14 at 10:15 AM, an interview was conducted with the Director of Quality and Compliance (E #4). E #4 stated the Rules and Regulation language was not clear and a revision would be done.