HospitalInspections.org

On March 24, 2011, an unannounced on-site EMTALA (Emergency Medical Treatment and Labor Act) complaint investigation survey authorized by the Centers for Medicare and Medicaid Services (CMS) was conducted at Billings Clinic Hospital. One deficiency was cited as a result of this investigation. The facility is not in compliance with CFR ?489.24.

Based on record review, staff and physician interviews, the facility failed to ensure that 1 (#1) of 15 sampled patients of the emergency department (ED) had an appropriate medical screening exam (MSE). Findings include:

According to the initial report from hospital B, dated March 11, 2011, patient #1 was transferred from a medical clinic and accepted at hospital A on March 2, 2011. The patient was inadvertently brought to hospital B by the ambulance service. The ambulance called the ED at hospital B, by radio, and was told by the charge nurse, after checking with the ED physician, that they had not accepted the patient. During this process, the patient arrived via a stretcher to the ED at hospital B and was taken into an exam room. The charge nurse was then able to make contact with the clinic and was informed that a physician at hospital A had accepted the patient. The charge nurse instructed the ambulance crew to transport the patient to hospital A where he had been accepted.

Staff member C, RN, ED Director, was interviewed on 3/24/11. He stated when he heard of the incident, he informed Risk Management, as he felt it was a possible EMTALA violation. The patient's medical record was requested, and staff member C stated the patient was only in the ED for a few minutes and had not been logged in.

Staff member D, RN, ED charge nurse, was interviewed on 3/25/11 via telephone. She stated she had received a call from the ambulance service stating they were transporting a patient. She told them she was not aware of any patient arriving via ambulance. Upon questioning 2 ED physicians and 2 hospitalists, none of these physicians were aware of a patient coming in. Because the ED was always aware of a patient coming via ambulance prior to their arrival, she called the clinic. While on the phone with the clinic, patient #1 arrived via stretcher. The ambulance crew had brought the patient into the corridor and she directed them to take the patient into an exam room. She then spoke with the physician assistant at the clinic, who stated it was his mistake and that the patient was to be taken to hospital A, where the physician was awaiting his arrival. Staff member D then went into the exam room and instructed the paramedics to take the patient to hospital A.

Patient #1 was interviewed on 3/25/11 via telephone. He stated that he remembered the clinic staff telling him that the hospitals take turns accepting patients through the ED. He was told the ambulance would be taking him to hospital B. When he was brought into the ED at hospital B, he remembered the nurse stating they had not received a phone call and he would not be admitted. He further stated that he told the nurse he heard the clinic physician say he was to go to hospital B. The nurse then responded, "not here, didn't get a call". She told the paramedics to take him into the exam room as she was on the phone. The paramedics assisted him to the exam table. The nurse came in and told the paramedics that they were to take him to hospital A, as they had accepted him. The paramedics then assisted him back to the stretcher and took him to hospital A.

The Information Communication Form, written by staff member I, paramedic, documented, "Transported a 66 y/o [year old] male pt [patient] to (hospital B) as instructed by (clinic) staff. While talking with (charge nurse name) at (hospital B) by giving report it sounded as if they had not heard from the (clinic). I immediately called (hospital A) and spoke to (staff name) to see if they had a report on a pt from the (clinic) and I was told no they had not got a report. I then proceeded to transport the pt to (hospital B). After arriving to (hospital B) the pt was taken to room A-1 in the ED. We had the pt move off the cot onto the ED bed. (Charge nurse) then came in and demanded the pt be taken to (hospital A) because (physician name) already accepted the pt. The pt then moved back onto the cot and we transported to (hospital A)".

Review of the ambulance trip log showed the patient arrived at hospital B at 12:14 p.m. on 3/2/11. The patient arrived at hospital A at 12:24 p.m.

In summary, patient #1 was brought to the ED at hospital B and was told he had not been accepted at the facility. The paramedics were instructed to take patient #1 to another hospital. The patient did not receive a medical screening exam while in the ED at hospital B, as required by EMTALA.