HospitalInspections.org

An unannounced EMTALA complaint investigation for complaint numbered MS00011752 was conducted on 09/04/13 through 09/05/13. The complaint was substantiated and the administrator was notified on December 12, 2013, via overnight mail, that Tishomingo Health Services is subject to termination of its provider agreement. Consequently, we plan to terminate Tishomingo Health Services participation in the Medicare program on March 12, 2013.

Based on complainant interview, staff interview, signed statement review, Emergency Department (ED) Register review and policy review, the facility failed to ensure ED medical staff is available to provide patient medical screening examinations. This affected two patients who registered in the hospital's ED during their Diversion Status, Patient #2 and #3 and the complainant's spouse, who never registered in the ED.



Findings include:


Cross Refer to A2406 for the hospital's failure to provide an ED physician to provide patient medical screening examinations from 6:00 p.m. on 9/02/13 until 6:00 a.m. on 9/03/13. This affected two (2) patients who registered in the hospital's ED during their Diversion Status, Patient #2 and #3, and the complainant's spouse, who never registered in the ED.

Based on complainant interview, staff interview, signed statement review, Emergency Department (ED) Register review, and policy review, the facility failed to ensure that medical staff was available to provide Medical Screening Examinations (MSE) for patients arriving at the ED from 6:00 p.m. on 9/02/13 until 6:00 a.m. on 09/03/13.This effected two patients who registered in the hospital's ED during their Diversion Status, Patient #2 and #3, and the complainant's spouse, who never registered in the ED.


Findings include:


A telephone interview with the complainant on 09/04/13 from 1:40 p.m. to 1:48 p.m. revealed that on 09/02/13, the complainant and her family were sick from a stomach virus, which lasted three (3) days. On 09/02/13 at approximately 7:00 p.m. the complainant took her spouse to the hospital's ED to be treated for projectile vomiting. After parking and getting out of her vehicle she went around the vehicle to assist her spouse out of the car and into the ED. As they approched the ED the complainant saw a sign posted on a sliding glass door at the ambulance entrance which stated, "No MD, Doctor or Nurse Practitioner from 6:00 p.m. to 6:00 a.m." After reading the sign they did not enter the building. The complainant stated that she assisted her spouse back to their car and drove to another hospital, which was approximately 30 minutes away.


An interview with the Director of Quality and Accreditation on 09/04/13 from 2:20 p.m. to 2:25 p.m. revealed that the facility did not have physician coverage for the ED on 09/02/12 for the 6:00 p.m. to 6:00 a.m. shift. The ED went into Diversion Status for that time frame. A sign was posted on one of the sliding glass doors in the ED to inform anyone coming to the ED that there was no Physician or Nurse Practitioner in the ED. The Director of Quality and Accreditation provided a photo of the sign posted in the ED. The sign stated "Attention: ER Patients There is NO physician or Nurse Practitioner on duty in the Emergency Dept."


Review of the ED Register revealed that two (2) patients arrived at the hospital's ED during their Diversion Status from 6:00 p.m. on 09/02/13 to 6:00 a.m. on 09/03/13. Patient #2 arrived on 09/02/13 at 7:19 p.m. and left by private vehicle at 7:30 p.m. Patient #3 arrived by ambulance on 09/02/13 at 10:58 p.m. and was transferred to another hospital by ambulance at 11:05 p.m. on 09/02/13. The complainant and spouse never entered the hospital's ED to register. As soon as they saw the sign posted on the ED door they returned to their car and left to drive to another hospital 30 minutes away.


An interview conducted with the Administrator on 09/05/13 from 9:00 a.m. to 9:10 a.m. confirmed that there was no ED physician available to work from 6:00 p.m. on 09/02/13 to 6:00 a.m. on 09/03/13. The ED went on Diversions Status at 6:00 p.m. on 09/02/13 and remained on Diversion Status until 6:00 a.m. on 09/03/13. The Administrator stated that medical staffing for the ED was routinely covered with contract physicians and with the facility's physicians. "The contract staffing agency is not providing ED physician coverage as it has previously done." The facility does not have a Nurse Practitioner to provide coverage for the ED.


The Director of Quality and Accreditation provided a signed statement on 09/05/13 which stated, "On or about the evening of Monday, September 2, 2013, the (Hospital ED) went on diversion status at approximately 1800 (6:00 p.m.) due to lack of emergency department physician coverage. As a result, (the Hospital ED) did not have the capability to provide a medical screening exam (examination) to determine whether a patient presenting had an emergency medical condition or not. The diversion period concluded at approximately 0600 (6:00 a.m.) the following morning, Tuesday, September 3, 2013, when the emergency department physician covering the following shift came on duty."


Review of the facility's "Medical Screening Exams Policy" revealed, "Procedure: Under EMTALA law, all patients who present to the Emergency Department (ED) who request an examination or treatment must receive an appropriate medical screening exam prior to discharge or transfer. Medical Screening exams (MSE) may be performed by a physician or nurse practitioner who has facility privileges... All individuals who present to the Emergency Department with a request for examination or treatment must receive an appropriate MSE within the capability of the ED, including ancillary services routinely available to the ED, to determine whether or not an emergency medical condition is determined to exist, provide any necessary stabilizing treatment or an appropriate transfer... Hospital property is also included under this regulation, including the parking lot, sidewalk, driveway, helicopter pad, and any other on-campus hospital site."