HospitalInspections.org

Based on document review, observation and interview, it was determined that in 1 (patient #25) of 23 medical records (MR) reviewed of patients who presented to the hospital requesting emergency services the hospital failed to ensure compliance with 489.24 in that the facility failed to provide a medical screening examination (MSE).

Findings include:

1. See findings cited at 42 CFR489.24(1), C2406.

Based on document review and interview, the hospital failed to ensure the central log of patients who presented to the Emergency Department (ED) seeking assistance included one (1) of 23 patients (patient #25).

Findings include:

1. Review of ED complaints/grievances indicated the hospital had recorded complaint/grievance Ticket ID VQY2602075, reported 5/13/21 from a family member with concerns of inability to gain access to the hospital for medical care after hours.

2. On 6/16/21, beginning at approximately 1:00 PM, review of video footage for 5/12/21 beginning at approximately 12:24:38 AM indicated 2 adult persons presented to the ED with a child, attempted entry to the Main/ED entrance and then the ambulance entrance.

3. Review of the hospital emergency department log for 1/1/21 through 6/15/21 lacked documentation/registration of patient #25.

4. On 6/16/21, beginning at approximately 1:30 PM, A1, Administrator/Chief Nursing Officer (CNO), verified the patient/individuals of the complaint were the same as those in the video and were not on the ED log/registration.

Based on document review, observation and interview the hospital failed to provide a medical screening examination (MSE) to one (1) individual (#25) who came to 1, the Hospital, emergency department (ED).

Findings include:

1. Review of the Medical Staff Bylaws, approved 6/24/2020, indicated the following: Any individual who presents to the Hospital shall receive an appropriate screening examination to determine whether he/she has an emergency medical condition.

2. Review of ED complaints/grievances indicated the hospital had recorded a complaint/grievance as follows: Ticket ID VQY2602075, reported 5/13/21: On 5/13/21, F1, family member of patient 25 called and requested a call back regarding trying to gain access to ED after 11 PM... The Note section of the report, entered 5/14/21 by A15, Clinical Manager, indicated the following: On 5/13/21 I contacted the complainant by telephone.... One of his/her main concerns was the inability to gain access to the hospital after hours, even when medical care was needed.

3. Beginning at approximately 1:00 PM, review of video footage, without audio, for 5/12/21 indicated the following: At approximately 12:24:38 AM an adult carrying a child entered via the Main/ED entrance and appeared ring the bell. At approximately 12:26 AM, another adult approached from the parking lot area, left the Main/ED entrance and the 2 adults, one still carrying the child, then walked around to the ambulance entrance, the three can be seen in the entry area of the ambulance entrance and the adult holding the child can be seen pushing the button on the wall. After a short time, the adult without the child, who appears to be holding soda type bottle(s) in his/her hands, uses his/her feet to knock/kick on the bottom of the door. At approximately 12:26: 57 AM, a staff member (identified by A1 as S1) appears to notice the persons outside the door as passing, turns around and stops in front of the glass. At approximately 12:26:57 AM, S1 can be seen conversing with one of the adults outside the ED door and then motioning, it appeared, for them to go around to the front of the building and leave the area in which they were. At approximately 12:26:59 AM, the adult with the child exited the building and as the other adult turned to leave, S1 can be seen waving in a good-bye type gesture, then the adult without the child turned and threw a plastic appearing soda type bottle at the door. No further video of the 3 requesting ED entrance was observed.

4. On 6/16/21, beginning at approximately 10:45 AM, A1, Administrator/Chief Nursing Officer (CNO), verified the hospital Main/ED entrance as well as the back ED entrance were locked after 11:00 PM. A1 indicated that both entrances had an intercom system... A1 indicated they recently had such a situation in which two (2) ambulances arrived shortly after midnight, the 2 nurses on duty were attending to those patients, the clerk was back in ED registering a patient, when another patient (adult with child) arrived at the front entrance, rang the bell and it was not answered. A1 indicated the individuals then presented at the ambulance entrance... A1 indicated that in a partial investigation, they found that the intercom volume at the ED nurse's station was not up. A1 verified the patient/individuals did not gain access to the ED and were not seen for a MSE.

5. Review of records from Hospital FS indicated patient #25 presented to their ED on 5/12/21 and was provided a MSE.