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Based on interview and documentation review it was determined the Hospital failed to ensure policies and procedures were in place which clearly addressed the requirements for providing an appropriate medical screening examination to any individual who comes to the emergency department.

Findings included:


The Risk Manager said the Hospital did not have a specific ED EMTALA policy, but utilized a policy that address transferring patients with unstable medical conditions. She said this policy was utilized throughout the whole hospital for any patient requiring transfer to another health care facility.

The Hospital policy titled Interhospital Transfer of Patient with Unstable Emergency Medical Condition was reviewed. The Policy addressed the transfer of an unstable patient, the transfer documentation requirements, acceptance by the receiving facility, providing medical treatment to minimize the risk to the individual and providing qualified personnel/transportation equipment. The policy did not address the need to provide a medical screening examination to any individual who comes to the Ed requesting medical care.

Review of the Hospital's Rules and Regulations of the Medical Staff did not indicate the requirements for provision of an appropriate medical screening of any individual presenting to the ED was addressed.

Based on observation during a tour of the Hospital's Emergency Department (ED), it was determined the Hospital did not conspicuously post signage specifying the rights of individuals with respect to examination and treatment for emergency medical conditions, women in labor, and participation in the State Medicaid Program.

Findings included:

During the tours of the ED, conducted on 1/12/10, at 9:50 AM and 1/13/09 at 10:45 AM, it was observed the Hospital had not posted signage that contained the required EMTALA elements other than at the registration desk out side the waiting room, the waiting room and in the Express Care treatment area. The signage in the the waiting room consisted of one sign that was posted on the far wall of the area and was of a size and placement that was not observable to all areas in the waiting room. No signage was posted in the main ED treatment rooms or the ambulance entrance bay.

Based on documentation review it was determined the Hospital did not have written policies and procedures in place that clearly addressed the expected in-person response time for specialty physicians who were on call for the ED.

Findings included:

The Hospital's Rules and Regulations of the Medical Staff were reviewed. The Rules and Regulations state when a staff physician or his designee is not available to respond to the emergency situation in the Hospital the designated physician on call for that department or service will assume responsibility for the emergency treatment and continuing hospital care. The Rules and Regulations did not specifically address on call physician's responsibility related to the ED nor did it specify any expected response time /appearance requirements after a request had been by an ED physician for an in person appearance to evaluate and treat a patient.

The Risk Manager said the Hospital did not have a specific ED EMTALA policy, but utilized a policy that address transferring patients with unstable medical conditions.

The Hospital policy titled Interhospital Transfer of Patient with Unstable Emergency Medical Condition was reviewed. The policy did not indicate the on call physician's responsibility related to the ED.

Based on interview it was determined the Hospital failed to ensure the ED conducted an appropriate medical screening examination to determine if one of one applicable Patient who had presented to the ED, requesting treatment, had an emergency medical condition.

Findings included:

The Medical Director/Chief of Emergency Medicine said he was on duty in the ED when the Patient had arrived by ambulance but he had been treating two critically ill patients and was unaware, until a couple of days after the incident, that the Patient was turned away and not provided with a medical screening examination.

The ED Staff Registered Nurse (RN) who had been assigned as the Charge Nurse said as Charge Nurse one of her duties was to triage patient who arrived by ambulance. As the Patient was wheeled into the ED on a stretcher one of the ED nurses stated that the Patient could not be in the Hospital because she had a restraint order against him for punching her in the face while a patient in the ED in the past. She said when she was told there was a restraint order in effect related to assault of a staff member she was concerned that if the Patient did become agitated/assaultive the ED would be unsafe for other patients and staff members. She also thought because of the restraint order the Patient could not receive care at the Hospital; therefore in an effort to keep the ED safe she instructed the emergency medical technicians to take the Patient to another hospital.

The ED Staff Nurse, who had reported she had a " Stay Away " court order against the Patient, said when she heard the Patient name she had stated to the Charge Nurse that she thought she had a " Stay Away " order against the Patient. She said she had overhear the Charge Nurse instructing the ambulance crew to take the Patient to another Hospital.