HospitalInspections.org

Based on document review and staff interview, it was determined that the hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24.

Findings include:

1. The hospital failed to track on a central log everyone who came to the hospital Emergency Department seeking care for an emergency medical condition. See deficiency at A-2405.

2. The hospital failed to ensure patients who did come to the Emergency Department were provided an appropriate medical screening examination within the capability of the hospital's emergency department. See deficiency at A-2406

Based on document review, patient interview, staff interview, and surveillance review it was determined that for 1 of 21 patients (Patient #21) the facility failed to log each individual who came to the emergency department for treatment. Findings include:

Hospital policy titled "Emergency Medical Treatment & Labor Act (EMTALA)" stated, " ...Central Log: Organizations are required to maintain a Central Log documenting the diagnosis, treatment and disposition of each individual who comes to a DED [dedicated emergency department]. Log details include whether an individual refused treatment, was refused treatment, or was transferred, admitted and treated, stabilized and transferred, or discharged ..."

In an interview with Employee #1 on 6/5/23 at 1:17 PM, they confirmed that the EMTALA policy applies to all emergency departments at the facility.

During a tour of the Main Emergency Department on 6/5/2023 from 11:52 AM - 12:28 PM, Employee #5 indicated there would be no reason for a person presenting to the emergency department not to be logged in with the exception of patients presenting for a scheduled appointment or people presenting to visit a patient.

Patient #21 was interviewed via phone on 6/9/23 at 10:40 AM. The patient indicated that she presented to the Pediatric ED to be seen for severe lower abdominal and back pain with a friend and a family member. Details were given that were able to identify the group in surveillance videos reviewed as part of the investigation (see below). The patient stated there were 3 staff members in scrubs behind the desk. When the patient presented to the window she was asked for her name, date of birth, and what the patient was there for. The patient stated she gave her name and date of birth and was asked to write her date of birth on a sticky note. Before the patient was able to say why she was there, the staff member informed the patient that she would be unable to be seen there because the patient was [18 years old or older]. The patient said the staff did not refer her to another area to be seen. The patient was crying as she left and went to a different acute care hospital.


Employee #2 reviewed the surveillance footage and was able to identify the staff in the video as Employee #3, RN, Employee #11, RN, and Employee #12, RN.

-at 8:21 PM Employee #11 and Employee #3 are seen in sitting behind the nurses' desk in the Pediatric ED waiting area. Employee #12 enters the nurses' area. There are no patients in the waiting area.
-at 8:29 PM three women enter the Pediatric ED waiting room (Patient #21, Woman #A, and Woman #B). Patient #21 approaches the right side window of the nurses' desk and Woman #A stands next to her. Woman #B stands behind them to the right. Employee #11 who was sitting behind the left side window stands up and hands Patient #21 a piece of paper. Patient #21 takes a pen from the cup on the desk and begins writing. When she is finished, she pushes the paper and pen toward the right side window. Employee #3, who was sitting behind the window on the right takes the paper.
-at 8:30 PM Woman #B sits in a chair while the other two women speak with the nurses at the window.
-at 8:31 PM Patient #21 turns away from the nurses' desk and begins to cry as she walks out. She is followed by Woman #B and Woman #A, who also appeared to be upset.
-During the time period from when the three women entered the Pediatric ED until the time they left, no other patients entered the waiting area.

The check-in log for the Pediatric ED for 5/23/23 showed a 3 month old patient checked in at 7:40 PM and the next patient to be checked in was a 3 year old patient at 8:52 PM. There is no evidence of an 18 year old patient being logged in at 8:30 PM.

Employee #3 was interviewed via phone call on 6/7/2023 at 1:29PM. In the interview the employee said she remembers people asking if this location [the Pediatric ED] is an emergency room. She said "yes, this is a pediatric ED" and asked the for the patient's age. The patient said [18 years old or older] and Employee #3 let the patient know they only see patients up to 18 years old and she would need to be seen in the main ED. Employee #3 said she made sure the patient didn't have any obvious signs of distress - bleeding, difficulty breathing, etc. If the patient did, they would have brought her back for a medical screening exam and taken her to main ED. Employee #3 said the patient responded by saying ok and left but did not demonstrate being upset to RN as she was leaving. Employee #3 did not remember the patient's name and says they did not take the name because they did not sign her in.

There is no evidence that Patient #21 who came to the Pediatric Emergency Department at 8:29 PM on 5/23/23 was logged.

The above findings were confirmed by Employee #1 on 6/7/23 at 12:43 PM.

Based on document review, patient interview, staff interview, and surveillance review it was determined that for 1 of 21 patients (Patient #21) the facility failed to provide a medical screening exam for each individual who came to the emergency department for treatment. Findings include:

Hospital policy titled "Emergency Medical Treatment & Labor Act (EMTALA)" stated, " ...A DED shall provide an MSE [medical screening exam] within its capabilities, including ancillary services routinely available to the DED, to any individual who comes to the DED, to determine if an EMC [emergency medical condition] exists, regardless of that individual's ability to pay, in the following instances: a) The individual requests medical care within the DED ...When an MSE is Not Required 1) An MSE is not required if an individual in the DED requests non-emergency tests or is there for a previously scheduled visit and does not appear to have an EMC. 2) The DED should document the reasons for concluding that no EMC exists ..."

In an interview with Employee #1 on 6/5/23 at 1:17 PM, they confirmed that the EMTALA policy applies to all emergency departments at the facility.

During a tour of the Pediatric Emergency Department on 6/5/2023 Employee #6 RN, was interviewed on 6/5/23 between 12:47 and 12:53 PM. Employee #6 stated the Pediatric Center ED will check in everyone that presents to their ED, no one is turned away. All patients will receive an ESI (emergency severity index) at check in, be triaged, and placed in a room if available. If a patient does not want to wait for a medical screening exam, the patient is asked to wait until "someone can look at you" and the physician is notified. If the patient leaves without being seen, the nurse will notate the information in the nursing/progress note. The Pediatric ED can stabilize and provide medical care to adults.

During a tour of the Pediatric ED on 6/5/2023 at 12:55 PM, Employee #4, PED ED Medical Director reported that all patients presenting to the Pediatric ED receive a medical screening exam, even if they are over 18 years old. If needed, a patient over 18 years would then be transferred internally. The only staff in the Pediatric ED qualified to perform medical screening exams are physicians.

Patient #21 was interviewed via phone on 6/9/23 at 10:40 AM. The patient indicated that she presented to the Pediatric ED to be seen for severe lower abdominal and back pain with a friend and a family member. Details were given that were able to identify the group in surveillance videos reviewed as part of the investigation (see below). The patient stated there were 3 staff members in scrubs behind the desk. When the patient presented to the window she was asked for her name, date of birth, and what the patient was there for. The patient stated she gave her name and date of birth and was asked to write her date of birth on a sticky note. Before the patient was able to say why she was there, the staff member informed the patient that she would be unable to be seen there because the patient was [18 years old or older]. The patient said the staff did not refer her to another area to be seen. The patient was crying as she left and went to a different acute care hospital.

Employee #2 reviewed the surveillance footage and was able to identify the staff in the video as Employee #3, RN, Employee #11, RN, and Employee #12, RN.
Surveillance review of the waiting room of the Pediatric Emergency Department on 5/23/23 revealed:
-at 8:21 PM Employee #11 and Employee #3 are seen in sitting behind the nurses' desk in the Pediatric ED waiting area. Employee #12 enters the nurses' area. There are no patients in the waiting area.
-at 8:29 PM three women enter the Pediatric ED waiting room (Patient #21, Woman #A, and Woman #B). Patient #21 approaches the right side window of the nurses' desk and Woman #A stands next to her. Woman #B stands behind them to the right. Employee #11 who was sitting behind the left side window stands up and hands Patient #21 a piece of paper. Patient #21 takes a pen from the cup on the desk and begins writing. When she is finished, she pushes the paper and pen toward the right side window. Employee #3, who was sitting behind the window on the right takes the paper.
-at 8:30 PM Woman #B sits in a chair while the other two women speak with the nurses at the window.
-at 8:31 PM Patient #21 turns away from the nurses' desk and begins to cry as she walks out. She is followed by Woman #B and Woman #A, who also appeared to be upset.
-During the time period from when the three women entered the Pediatric ED until the time they left, no other patients entered the waiting area.

Employee #3 was interviewed via phone call on 6/7/2023 at 1:29PM. In the interview the employee said she remembers people asking if this location [the Pediatric ED] is an emergency room. She said "yes, this is a pediatric ED" and asked the for the patient's age. The patient said [18 years old or older] and Employee #3 let the patient know they only see patients up to 18 years old and she would need to be seen in the main ED. Employee #3 said she made sure the patient didn't have any obvious signs of distress - bleeding, difficulty breathing, etc. If the patient did, they would have brought her back for a medical screening exam and taken her to main ED. Employee #3 said the patient responded by saying ok and left but did not demonstrate being upset to RN as she was leaving. Employee #3 did not remember the patient's name and says they did not take the name because they did not sign her in.

There is no evidence that Patient #21 who came to the Pediatric Emergency Department at 8:29 PM on 5/23/23 received a medical screening exam.

The above findings were confirmed by Employee #2 on 6/7/23 at 1:29 PM.