HospitalInspections.org

Based on staff interview, patient interview and policy review the facility failed to attempt to deescalate a patient's behavior or attempts to have them remain in the Emergency Department (ED) to be seen by a qualified medical professional and have a medical screening exam completed, instead the facility said they were calling the police which coerced the patient to leave the ED for one (1) of 20 patients: Patient #1.

Findings Include:

Cross Refer to A-2406/489.24(a)(l)(i) for the facility's failure to provide a medical screening examination for Patient #1.

During exit conference on 03/24/2022 with the Chief Nursing Officer survey findings were discussed. No further documentation was submitted for review.

Based on staff interview, patient interview and policy review the facility failed to complete a medical screening examination by a qualified medical professional for one (1) of 20 patients: Patient #1.

Findings Include:

An interview on 03/21/2022 at 3:10 p.m. with Triage Nurse #1 revealed that she was triaging during the incident involving Patient #1 on 02/17/2022 and stated, "we were extraordinary busy with very acutely ill patients when I noticed a clip board flying through an open window into the triage area. I was tending to a patient at that time. I did not really know where the clip board came from and was stunned." Triage Nurse #1 said there was a note on the clipboard that read "you are helping everyone else before me". Triage Nurse #1 stated, "When we called the next patient on our triage list, Patient #1 burst through the triage door just behind the entering patient and I instructed her to get out and that I was going to call the police." Triage Nurse #1 said Patient #1 left the triage room cursing and threatening us and the people in the waiting area. Triage Nurse #1 stated, "I contacted the police department because I was scared, felt threatened and I did not know what she was going to do to us or the patients waiting in the ED and the Patient in the triage area with me was terrified." Triage Nurse said "many of our patient population are on drugs and we don't know what kind and when they act out, we take it seriously. This woman was a lot bigger than we were."

An interview on 03/21/2022 at 3:40 p.m. with Nurse Practitioner (NP) revealed she was in triage the day of the incident, 02/17/2022, involving Patient #1. NP stated. "That day was a very busy day. A clip board came flying through the triage room." NP stated, "Another patient was called back for triage and suddenly a female came busting through the door just behind the called patient and she was asking why other people were being seen before her, calling Triage nurse names and was threatening us." NP said, "I have worked at a large psychiatric hospital for many years and on a chemical dependency unit and I was very scared of this patient." "We had another patient in the ED and neither one of us knew what this patient was going to do."

A telephone interview on 03/24/2022 at 2:33 p.m. with Patient #1 revealed she went to the emergency room at Facility #1 and waited an unspecified length of time before being called to Triage. Patient #1 said, she saw other patients called to Triage room that arrived after her. Patient #1 stated, "I did enter the Triage room and confronted the nurse to ask why I had been waiting to be seen." Patient #1 said the nurse had a patient present in the Triage room at the time she entered, and the nurse asked me to leave the triage room, the nurse said she is calling the police. Patient #1 said I left the room and walked to the window and the nurse closed the window blinds. Patient #1 said she used the security guard's telephone to call for a ride home and confirms she walked out of the Emergency Department to wait outside for her ride. Patient #1 confirmed she was not told to leave the ED and confirmed she was not escorted outside.

Review of the facility's policy, "Emergency Medical Treatment Active Labor Act (EMTALA)," version 4, last review date 02/05/2021, reveals, " ...II. Medical Screening Examination A. Triage and Registration of Patients Prior to Medical Screening Examination (MSE) ...If a patient informs the ED staff that he/she is leaving the hospital prior to receiving an MSE, staff should endeavor to persuade the patient to stay until he/she can be screened ..."

During exit conference on 03/24/2022. with the Chief Nursing Officer survey findings were discussed. No further documentation was submitted for review.