HospitalInspections.org

Based on record review and interview, the facility failed to ensure the medical staff or governing body designated the qualified medical personnel in either the hospital bylaws and/or the rules and regulations, and failed to provide a medical screening examination (MSE) for 1 of 25 sampled patients (#14). Refer to Tag A-2406.

Based on record review and interview, the facility failed to ensure the medical staff or governing body designated the qualified medical personnel in either the hospital bylaws and/or the rules and regulations, and failed to provide a medical screening examination (MSE) for 1 of 25 sampled patients (#14).
Findings included:
1. Patient #14's emergency department (ED) medical record documented the following events. He was triaged at 4:03 p.m. on 5/03/11 with a chief complaint of "out of insulin". The ED record read, "In the triage waiting pt (patient) states he is here for insulin and can not afford to see his pcp (primary care physician). Informed pt that ED will not just give him insulin." Pt. stated "no, you're going to admit me and you can't refuse because I will go into DKA (diabetic keto-acidosis)." The case manager and director were notified.

At 4:37 p.m., his blood sugar was documented as 310 (norm 60-110).

At 4:45 p.m., ED staff went in to talk to the patient who stated he is out of insulin and does not have money to get insulin pump filled. He said, "I am going to be admitted so they can give me my insulin. Until last year, Health First was filling my insulin pump at no cost and now they want 20% and I am not going to pay that because I don't have any money". The ED physician walked into the room and the patient told him the same thing as above.

The ED physician asked the patient when he was discharged from the hospital last month if he had followed up with anyone medically. At 4:46 p.m., the patient stated he could not afford to follow up with anyone and the community medical clinic will not see him because he has Medicare.

The ED physician asked the patient what he was expecting to be done in the ED. The patient stated he came to the ED to be admitted for insulin refill. The patient was informed by ED staff that they would run a test and then the patient would have to follow up with his PCP. The patient stated to the ED physician, "if you don't admit me I will assault you and sue you . . . .and if you are a good doctor you will admit me and not get assaulted." At 4:47 p.m., hospital security was called to escort the patient out of the ED. The patient was escorted out of the ED without giving the patient any insulin and without performing a medical screening examination.

2. Review of the hospital bylaws and the rules and regulations, dated as revised 03/2011, failed to show who is determined to be qualified to perform emergency medical examinations.
During an interview on 06/15/2011 at 8:50 a.m., the Vice President of Medical Affairs said all physicians credentialed to practice in the hospital have the capability to assess patients, but there is no specific definition of qualified medical personnel designated to perform medical screening examinations in either the hospital bylaws and/or the rules and regulations.