HospitalInspections.org

Based on review of a sample of medical records, a review of hospital policies/procedures, and staff interviews, the hospital failed to provide a medical screening examination for 1 of 25 patients [see Tag A2406] and to initiate an appropriate transfer for 1 of 8 patients transferred to another acute care hospital [see Tag A2409].

Based on interviews and reviews of policies/procedures, the hospital failed to provide a MSE for 1 of 25 sampled patients who presented to the ED.

Findings include:

1. The hospital policy titled "EMTALA - MEDICAL SCREENING EXAM" states "PURPOSE: Patients presenting to (hospital) property or premises requesting emergency services will receive an appropriate Medical Screening Examination , as required by the Emergency Medical Treatment and Active Labor Act (EMTALA) 42 U>S>C>, Section 1394, and all Federal Regulations and interpretive guidelines. POLICY: 1. Any individual who comes to (hospital) property of premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by individuals qualified to perform such examination to determine whether or not an emergency medical condition (EMC)exists, regardless of the individual's ability to pay. 2. The EMTALA obligations are triggered when there has been a request for medical care by an individual within a dedicated Emergency Department (DED), or when an individual requests emergency care on hospital property other than a DED. If an EMC is determined to exist, the hospital must provide any necessary stabilizing treatment within the capabilities the staff and facilities at the hospital or an appropriate transfer."

The policy also states the components of when a medical screening examination is required in "PROCEDURE: I A. When a patient presents or is accompanied by another person to (hospital) property or premises (which includes off-campus departments) and requests emergency care, he/she must receive a MSE within the capabilities of the hospital.,. C. Hospital personnel are not prohibited from leaving the hospital to examine and/or treat an individual in need of emergency services on hospital property or premises., E. An individual in a non-hospital -owned ambulance, which is on (hospital) property or premises is considered to have come to the hospital's Emergency Department."

2. On March 19, 2010, the hospital's ED received a call from a non-hospital-owned ambulance and that they were transporting Patient #1 to the hospital for examination. When Patient #1 arrived onto hospital property, an EMT left the ambulance and entered the ED. The EMT informed the ED RN that the patient was refusing to be seen at the hospital and had requested to be taken to another hospital. The EMT left the ED and the ambulance drove off hospital property.

3. The RN involved in the incident was interviewed on April 14, 2010. The RN stated when the EMT told her Patient #1 refused to be seen at the hospital, she had replied "The patient is theoretically my patient." She stated the EMT then repeated the patient did not want to be seen and left the ED, reentered the ambulance, and the ambulance left hospital property.

The RN stated she did not enter the ambulance to observe, examine, or discuss the situation with the patient.

Based on medical record review and review of P&Ps, the hospital failed to provide an appropriate transfer for 1 of 8 patients transferred to other hospitals for continued care. The failure to provide an appropriate transfer resulted in the patient not being informed of the risks and benefits of the transfer and there was no documentation that ED records were sent to the receiving hospital.

Findings include:

1. The hospital P&P titled "PLAN FOR THE PROVISION OF CARE, TREATMENT, AND SERVICES" states "E. Criteria for Determining Eligibility for Care, Treatment, and Services, 2. Transferring Patients for Care. If (hospital) is unable to provide necessary care, the patient and/or their family will be informed of the risks and benefits of the examination, treatment, an/or transfer. With patient consent (if possible), arrangements will be made for transfer to a health care facility with the capacity to provide needed procedures or treatments. EMTALA procedures and requirements will be followed."

The P&P further states, "If the patient has an emergency medical condition which has not been stabilized, the patient cannot be transferred unless: a) the patient or his/her representative requests the transfer in writing; and/or b) a physician has determined the medical benefits of transfer to a higher level of care facility outweigh the increased risks from the transfer."

2. Patient #2 presented to the ED on 10/01/2009 at 0038 via EMS after a ground level fall at home one hour earlier. The MSE included a CT scan which revealed a subdural hematoma with some shift of the brain tissue as well as a right orbital floor fracture. Patient #2 had also sustained a laceration to the head in the fall. Following the CT scan, the physician documents that the patient and family were counseled regarding lab work, diagnosis, and need for follow-up.

Documentation of the Physician Assessment and Certification transfer form stated the patient's condition had not stabilized. There was no documentation of the risks and/or benefits of the transfer and no documentation that medical records related to the EMC were sent to the receiving facility.