HospitalInspections.org

Based on interview and document review, the hospital failed to ensure compliance with the requirements of 42 CFR 489.24 as evidenced by the deficient practice cited at 42 CFR 489.24(a) and 489.24(c).

Based on a review of the central log maintained by the hospital's Emergency Department (ED), the hospital failed to ensure that every patient that presented to the ED was entered on the log for 1 of 21 (P21) patients reviewed.

Findings include:

The ED log for the hospital was reviewed from 3/1/2015 through 8/31/ 2015. Review of the log revealed no information on P21 who on 8/28/2015, had been transported by law enforcement to the main entrance admission desk of the ED.

Interview with RN-A on 9/21/2015, 12:08 p.m. established RN-A in an attempt to triage P21, was provided a court ordered revocation of a provisional discharge paper by law enforcement for P21. The court order was given to physician-B who determined the hospital did not provide inpatient mental health hospital services for P21. Physician-B told RN-A to have P21 transported by law enforcement to a hospital that provided that service.
Interview with RN-C emergency services director on 9/21/2015, at 11:00 a.m. confirmed P21 had not been entered in to the ED central log. RN-C stated all patients presenting to the ED must be entered on the ED central log including P21.

Based on documentation review and interview, the hospital failed to ensure that each patient who presented to the emergency department (ED) received a medical screening examination for 1 of 21 (P21) patients reviewed.

Findings include:

The ED provided no medical record related to P21's presentation to the ED on 8/28/2015.

The hospital provided P21's court document dated 8/28/2015, at 4:18 p.m. titled the Matter of Civil Commitment with the subject matter of order for hold pending revocation of provisional discharge. The document established a hold order for P21 and consent for transportation provided by the local sheriff for admission to a secured inpatient mental health hospital/unit.

Interview with RN-A on 9/21/2015, 12:08 p.m. established P21 presented to the ED's admission desk the evening of 8/28/2015. P21 apparently had been transported by law enforcement to the hospital. RN-A in an attempt to triage P21, was provided P21's court ordered revocation of a provisional discharge paper by law enforcement. P21 required inpatient admission to a mental health hospital. The court order was given to physician-B who determined the hospital could not provide inpatient mental health hospital services for P21. Physician-B told RN-A to have P21 transported by law enforcement to a hospital that provided that service. P21 left the hospital ED escorted by law enforcement. No triage or medical screening examination (MSE) was provided by the ED for P21.Interview with physician-B on 8/21/2014, at 12:48 p.m. revealed after reading the court order for P21 she thought law enforcement had transported P21 to the wrong hospital. The hospital did not provide inpatient mental health services. Physician -B confirmed all patients that present to the ED were provided an MSE. P21 should have been triaged and received an appropriate MSE.

Review of P21's ED medical record from the second hospital revealed on 8/28/2015, at 8:56 p.m. P21 presented to their ED. P21 was 21 years old and previously resided in a foster home. The judge revoked P21's provisional discharge due to the patient's alleged overdose 22 hours prior to the ED visit. P21 said s/he overdosed on 50 to 60 tablets of Mucinex, an over the counter expectorant. P21 said s/he just wanted to get high and denied suicidal and/or homicidal thoughts. The MSE was normal; P21 exhibited a depressed mood, and was withdrawn but alert and oriented. The ED ordered blood work, a urine screen, and EKG. P21's test results were normal except the urine tested positive for cannabis. The ED completed a psychiatric evaluation and held P21 in the ED until 8/30/2015, when a mental health bed became available.

Review of the hospital's policy and procedure titled Emergency Room EMTALA Compliance Policy with an approval date of 8/11/2014, revealed the hospital would provide every patient who came to the hospital knowingly presenting for a medical screening, with an appropriate MSE to determine whether the patient had an emergency condition.