HospitalInspections.org

Based on observations, record review and interview the facility failed to meet the Emergency Medical Treatment and Labor Act (EMTALA) of conspicuously posting the appropriate EMTALA sign failed to provide an adequate Medical screening exam and failed to have a process in place for patients that choose to transfer via private vehicle. This deficient practice could lead to unfavorable outcomes while patient is en route to accepting hospital.

The findings are:

A. Failed to post signs informing patients of their rights to seek medical care. Refer to tag A-2402.

B. Failed to provide a medical screening exam. Refer to tag A-2406

C. Failed to have a process in place for patients that choose to transfer via private vehicle. Refer to tag A-2409.

Based on observation and interview the facility failed to post appropriate EMTALA (Emergency Medical Treatment and Labor Act) signs in English for the population served by the hospital informing patients of their rights presenting to the emergency department (ED). This deficient practice can lead to all patients not being aware of their rights as a patient in the emergency department.

The findings are:

A. During an observation on 04/02/2024, at 10:00 AM, in the ambulance bay where patients are brought in to the ED there was not an English sign posted that explained patients right to be seen for any emergency condition and stated whether the facility participated in the Medicaid program.

B. During an interview on 04/02/2024 at 10:50 AM with Staff (S)4, Emergency Department Director confirmed that an English sign should be posted in the ambulance bay.

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Based on record review and interview the facility failed to provide an appropriate medical screening exam for 1 (P[patient]1) out of 20 (P1-P20) patients reviewed for seeking emergency care. This deficient practice could possibly lead to patient's medical conditions being untreated, resulting in harm.

The findings are:

A. Record review of P1's medical record revealed the following:

1. Under "ED (Emergency Department) events," P1 arrived to the ED on 01/12/24 at 12:56 PM and P1 was discharged from the emergency department on 01/12/24 at 10:17 PM.

2. Under "Provider Notes", at 9:30 PM, P1 was assessed by S(staff)11 for a chief complaint of leg swelling, a thorough review of systems (an assessment of patient that includes each body organ system) was not done by the provider. S11 did not assess P1's pedal pulses (pulse felt in foot, used to determine the blood flow to the extremity).

3. Under "Clinical Lab Results", P1 had an elevated D-dimer of 732 at 7:52 PM (Normal range is 0-500; a blood test used to measure the level of D-dimer protein which is released when clots dissolve in the body).

4. Under "Imaging Results", P1 had a left lower extremity ultrasound at 3:50 PM that revealed no acute deep or superficial clot. There was no evidence that an ultrasound was done for the right lower extremity.

5. There was no evidence that a Chest CT Angiogram (computed tomography, x-ray scan that shows the blood vessels in the chest) was done to check for a pulmonary embolism (Blood clot in the lung).

6. Under vital sign flow sheets, P1 had initial vital signs on 01/12/24 at 1:32 PM with an oxygen saturation level of 96% respirations (Number of breathes per minute) 18 (Normal respirations in adults is 12-20), blood pressure (Measure of pressure or force of blood inside arteries) 175/85 . The final vital signs taken prior to discharge at 10:00 PM revealed an oxygen saturation that was trending downward. P1 was discharged with an oxygen level of 93%, respirations 22, and blood pressure of 174/98. The decreased oxygen level, increased respirations and elevated blood pressure were not addressed in the provider's note.

7. Under the section "Flowsheets", in the pain assessment section, P1 reported a pain level of 7.5 on a rating scale of 1-10 at 9:03 PM. P1's pain remained untreated when discharged from the emergency department.

8. Under the section "Imaging Results," P1 had a chest X-ray (a scan that produces images of your internal organs), that revealed "air distention of the bowel suggesting ileus [The inability of the intestine to contract normally]". The ileus was not mentioned on the providers note or assessment and was not addressed in the emergency department.

B. During an interview on 04/03/2024 at 5:45 PM with S11, when asked how she completes a review of systems, S11 explained that they no longer have to chart a full review of systems, but the way she assesses a patient is dependent on the complaint. S11 explained that if a patient presented with a concern for DVT (deep vein thrombosis or blood clot) she would look for leg swelling, leg pain, and pitting edema (swelling). S11 did not mention doing a chest CT Angiogram (computed tomography, x-ray scan that shows the blood vessels in the chest).

Based on record review and interview the facility failed to have a process in place for patients that choose to transfer by a private vehicle for 1 (P [Patient] 20) of 20 (P1-P20) patients reviewed for seeking emergency medical care. The deficient practice could lead to patients not being monitored and not receiving medical care while they are en route to accepting hospital.

The findings are:

A. Record review of facility's policy titled, "EMTALA Transfer" dated 03/05/2021, on page 4, number 9 stated; "A transfer to another facility will be appropriate only in those cases in which: . . . The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer."

B. Record review of P20's emergency department note for visit on 11/15/2023, under "Medical Decision Making" stated, "[Patient] presents for approximately 24 hours of right lower quadrant abdominal [right lower area of the abdomen] pain. With nausea [the feeling of needing to vomit] and vomiting. And decreased urine output. No fevers. CT [computed tomography, an imaging procedure] shows distal ureteral stone on the right [kidney stone that has moved out of the kidney and is in the tube connecting the kidney to the bladder], 7 to 8 mm [millimeters]. White blood cell count 13.8 [value high and can reflect various medical issues such as inflammation or infection]. urinAlysis [sic] shows trace blood [urine sample that is showing blood in the urine, an abnormal finding]. Urology [medical service that deals with issues related to the urinary system] consulted to see if admission is warranted. Patient aware and willing to do what is ever necessary. Pain currently controlled after 1 dose of morphine [medication given for pain management]. Urology [doctor's name] recommends transfer to [name of facility]. [doctor's name] is the admitting doctor. Stable for transfer."

C. Record review of P20's transfer paperwork under "RN [Registered Nurse] Documentation" dated 11/17/2023, stated, "Transport by - Car", "Ambulance Company [blank]", and "Transported by (If not by Ambulance) - Spouse." There was no evidence that patient was offered an ambulance and no evidence of the reason why patient was transported by private vehicle.

D. During an interview on 04/03/2024 at 2:30 PM, with Staff (S)10, MD (Medical Doctor), it was asked what the risks are associated with a patient transferring to another hospital by private vehicle. S10 explained that patients are not monitored, medical professionals are not available, and if an ambulance gets a flat tire or there is a car accident they already have a network setup to assist the patient.