HospitalInspections.org

Based on observation and interview, the facility did not post the Emergency Medical and Treatment Act (EMTALA) signage that specified the rights of patients to examination and treatment of emergency medical condition, and for women in labor .

Findings include:

During tour of the the facility's Emergency Department on 10/17/19 at approximately 11:00 AM, there was no EMTALA signage posted in the main Emergency waiting room, entrance to the Labor and Delivery Department, the Psychiatric emergency waiting room or in treatment areas.

During interview on 10/17/19 at approximately 11:15 AM, Staff R, Director of Nursing , Emergency Department, Staff L , Vice Chief of Psychiatry and Staff J, Senior Director of Nursing, Labor and Delivery, acknowledged the findings.

Based on medical record review, document review and interview, it was determined that a patient who presented to the Emergency Department (ED) after a suicide attempt, was not provided with a triage assessment or Medical Screening Examination. This was evident in one (1) of 29 medical records reviewed. (Patient #1).

Failure to evaluate the patient may have placed the patient at risk for harm.


Findings include:
Review of the medical record for Patient #1 identified: On 7/26/19 at 8:35 PM, Staff N, ED Psych Resident documented,"One hour ago patient was escorted by security from the psych ED after having been psychiatrically cleared. The patient returned and was spoken to in the waiting room. It was explained that she would not be admitted, and she began making conditional suicide statements "if you do not admit me, I will stand in the street." Pt has no history of suicide attempts and in the ED had no suicidal ideation (thinking about or planning suicide)."

At 10:45 PM on 7/26/19, an Attending Physician, Staff A documented that this patient returned to the ED with about six Police officers approximately half hour after she was discharged. The Police officers reported that passers had coaxed patient off the street where she was threatening to be hit by a vehicle. The physician documented that the patient was seen earlier at about 7:30 PM and was discharged from the Psych ED. The patient had been cleared by the psychiatrist and it was understood that her behavior was not an expression of a wish to die, but rather an expression of a wish to be admitted to the hospital. The physician documented that she did not speak to the patient at that time because the patient was in the waiting area and had not been registered. She spoke to the police to have the patient again register with Triage and patient would be re- assessed. The physician documented,... "apparently, she was taken instead to [another facility]." A physician called from another facility and reported "that patient remained very angry about not having been admitted at Mount Sinai and was currently in their ER."

There was no other documnetation in the medical record.

Review of the Security Log identified documentation on 7/26/19 stating, patient left the facility at 9:00 PM in the company of the police officer who took the patient to [another hospital].


During interview with Staff A on 10/21/19 at 11AM, she stated that she came into the building and she was called by a staff member from medical side of the ED to see a patient who came back requesting admission. She noted the patient was very angry and since the event was new, she requested that the patient re-register as the earlier visit had been closed out and any intervention with the patient could not be documented. During the meeting, the Vice Chair of Psychiatry, Staff L stated that the Attending could not see the patient unless the patient re-register as the psych ED was a locked unit and patients are not taken there without a consent.


A review of the facility policy titled "Triage Emergency Severity Index (ESI)", Reviewed 03/2016 states: "At the Mount Sinai Hospital ED (Main Campus) patients who arrive ambulatory or by EMS with a primary psychiatric complaint will receive a rapid triage screen, suicide risk assessment and provider evaluation . The patient will have a quick registration performed/will be logged into the ED central log and will be triaged and accompanied by a registered nurse and /or LIP to the Comprehensive Psychiatric Emergency Program (CPEP) for further medical screening examination and treatment."


A review of the facility policy, "Emergency Treatment, Stabilization, Transfer of Patients and EMTALA (Emergency Medical Treatment and Labor Act)", Effective July 2018 states: " Every individual who comes to MSHS Emergency Depart for examination or treatment or who presents anywhere on the premises as defined above (see III. scope- locations subject to this Policy), stating that s/he has an emergency, will be given an appropriate medical screening examination to determine whether an emergency condition exists....... The hospital may complete a full registration of the patient, including asking for insurance information, but only after triage, and only so long as the registration process does not delay the medical screening examination and stabilizing treatment".


The facility failed to triage the patient and perform a Medical Screening Exam (MSE) when the patient was brought to the ED by Police officers after she was noted actively trying to be hit in traffic.

These findings were brought to the attention of facility Medical Staff during a meeting on 10/21/19 at 11:00 AM. In attendance were, VP of Quality Assessment and Regulatory, Chief Medical Officer, Vice Chair of Psychiatry and the Attending Physician.