HospitalInspections.org

Based on record review, interview, and observation the facility staff failed to provide EMTALA (Emergency Medical Treatment and Active Labor Act) signs specifying the rights of individuals under EMTALA regulations in 1 of 4 areas: (main hospital entrance); failed to ensure all patients on hospital property with an emergency medical condition were documented on an Emergency Department (ED) central log (Pt #21); and failed to complete a medical screening exam (MSE) on 1 of 1 patients (Patient #21) presenting to the ED for medical care in a total of 20 medical records reviewed.

Findings Include:

The facility staff failed to provide EMTALA signs specifying the rights of individuals under EMTALA regulations in 1 area: (main hospital entrance). See Tag A-2402.

The facility staff failed to ensure a patient who presented on hospital property with an emergency medical condition was documented on an ED central log. See Tag A-2405.

The facility staff failed to complete a MSE on a patient who presented to the ED for medical care. See Tag A-2406.

Based on observation and interview facility staff failed to provide EMTALA (Emergency Medical Treatment and Active Labor Act) signs specifying the rights of individuals under EMTALA regulations in 1 of 4 areas: (main hospital entrance) in a total sample of 4 areas observed.

Findings Include:

During an observation on 04/25/2023 at 10:50 AM of the main hospital entrance, there were no signs posted specifying the rights of individuals under EMTALA regulations.

An interview on 04/25/2023 at 10:52 AM with Vice President (VP) of nursing services B confirmed that there were no signs posted in the main hospital entrance specifying the rights of individuals under EMTALA regulations. S/he stated that the hospital had recently gotten new entrance doors, and the EMTALA signage had not been re-posted.

An interview on 04/25/2023 at 11:30 AM with Director of Quality and Risk A confirmed that the facility does not have a policy that speaks to EMTALA signage posting.

Based on record review and interview facility staff failed to ensure all patients who presented on hospital property with an emergency medical condition are documented on an Emergency Department (ED) central log for 1 of 1 patients (Patient #21) in a total of 20 medical records reviewed.

Findings Include:

A review of the facility's investigation documents revealed, "... As a result of the patient not being brought into the ED, [his/her] information was never added to the central log..." Patient #21 did not have a medical record established for review.

A review of the facility's action plan "Recommendations to EMS (emergency medical services) revealed, "... If EMS arrives on site during the conversation, the patient has "presented for treatment" and must be registered and seen..."
During an interview on 04/25/2023 at 11:00 AM with ED Director C, s/he stated that Patient #21 was brought to the hospital via EMS and was in the hospital's ambulance bay when ED Physician E instructed EMS to divert Patient #21 to a different hospital for specialized care. Per ED Director C, Patient #21 was on hospital property and should have been registered in the ED and seen by a provider. ED Director C confirmed that Patient #21 was not on the ED log because Patient #21 was not registered in the ED.

An interview on 04/25/2023 at 11:40 AM with Vice President (VP) nursing services B revealed that Patient #21 was never documented on the facility's ED central log.

During an interview on 04/25/2023 at 1:28 PM with ED Physician E when asked about Patient #21, s/he stated that once Patient #21 presented on the hospital grounds via ambulance, s/he stated that the patient should have been registered into the ED central log.

Based on record review and interview the facility staff failed to complete a medical screening exam for 1 of 1 patients (Patient #21) who presented on the hospital premises via ambulance in a total sample of 20 medical records reviewed.

Findings Include:

A review of the facility's investigation documents revealed that the emergency medical service (EMS) contacted the facility on 03/13/2023 at 9:14 PM for a patient (Patient #21) who had trouble breathing and weakness. It was reported that Patient #21 missed a dialysis treatment that day (a process that helps the body remove extra waste products from the blood when the kidneys cannot function). ED Physician E communicated to EMS that s/he felt this patient would need dialysis, a service that the facility did not provide, and that the patient would need to be transported to another hospital. Further review of the RCA revealed that ED Physician E told EMS to bring the patient to another hospital, however EMS was already in the ambulance garage with Patient #21. Patient #21 was not provided an MSE, even though s/he was on hospital premises.

During an interview on 04/25/2023 at 1:28 PM with ED Physician E s/he confirmed Patient #21 did not receive a medical screening exam.

During an audio review of the EMS phone call to the facility on 03/13/2023 at 9:14 PM, it was revealed that ED Physician E directed EMS to transport Patient #21 to another facility even though the patient was in the ambulance garage.

A review of the facility's policy "EMTALA & Transfer Policy" last revised on 12/09/2022 revealed, "... Medical Screening Examination (MSE): A. All individuals who present to the hospital-based facilities on the hospital premises, such as Emergency Services... for examination or treatment for an emergency medical condition shall be provided with an appropriate MSE. B. An individual will be considered to have come to the Hospital if the individual is anywhere on the Hospital premises (including its parking lot, driveway, or sidewalk) and requests emergency care..."

A review of the facility's investigation documents revealed that the facility took corrective action immediately after the incident and prior to the investigation. The facility developed 7 corrective action items prior to the investigation. On 04/25/2023, through observation, record review, and interview, all 7 corrective action items have been implemented and/or completed with the final completion date of April 30th, 2023. The facility has been in compliance for 43 days since the violation occurred.