HospitalInspections.org

Based on review of facility policies, quality data, a tour and staff interviews, it was determined that the facility failed to ensure compliance with 42 CFR 489.24, Special Responsibilities of Medicare Participating Hospitals in Emergency Cases.

Findings were:
Cross refer to A2403 as it relates to the facility's failure to maintain a medical record for an individual who presented to the Emergency Department (ED).

Cross refer to A2405 as it relates to the facility's failure to include an individual on the facility's Central Log who presented to the ED.

Cross refer to A2406 as it relates to the facility's failure to provide a medical screening examination (MSE) for an individual who presented to the ED.

Cross refers to A2407 as it relates to the facility's failure to provide stabilizing treatment for an individual who presented to the ED.

Cross refer to A2409 as it relates to the facility failure to ensure an appropriate transfer for an individual who presented to the ED.

Based on review of facility policy and procedure, quality data, and an interview, it was determined that the facility failed to maintain a medical record for the individual who presented to the ED on 05/17/12.

Findings were:

Review of the facility's policy entitled "EMTALA Guidelines", revised 09/2011 under #1 indicated the procedure was for "All patients presenting to the ED to be entered into the hospital's registration system".

During review of the facility's quality data central log list with the Quality Director, the Director indicated that all patients that presented to the ED were entered into the hospital's data system. The system generated a log list that contained the patient's name, date of service, chief complaint and disposition. The director indicated the individual was not listed on the facility's central log on 05/17/12 and did not have a medical record.

An interview was conducted at 2:00 p.m. on 05/30/12 in the Board Room with the nurse (employee file #4) who was familiar with the individual (patient #21). The nurse stated the individual had an altercation in the ED with the security officer and was not a patient at the facility. The nurse explained he/she assessed the individual and felt he/she did not need treatment but was acting out because the individual did not want to go to jail.

Based on review of policy and procedure, quality assurance data, and staff interviews, it was determined that the facility failed to enter the individual who presented to the ED on the facility's central log.

Findings were:

Review of the facility's policy entitled "EMTALA Guidelines", revised 09/2011 under #1 indicated the procedure was that "All patients presenting to the ED will be entered into the hospital's registration system".

During review of the facility's quality data log list with the Quality Director, the Director indicated that all patients that presented to the ED were entered into the hospital's data system. The system generated a log list that contained the patient's name, date of service, chief complaint and disposition. The individual (patient #21) was not listed on the facility's log on 05/17/12.

An interview was conducted at 2:00 p.m. on 05/30/12 in the Board Room with the nurse (employee file #4). The nurse stated the individual was in the ED having an altercation with the security was not a patient at the facility. The nurse stated he/she assessed the individual and asked him/her multiple times if he/she needed assistance but, the individual stated he/she did not. The nurse felt that this occurrence was a security issue and felt the individual did not need a medical screening or psychiatric screening.

An interview was conducted on 05/30/12 at 1:35 p.m. in the Board Room with the Senior Security Officer (SSO-employee file #2) ). The SSO stated he/she was on duty the time of the incident. The SSO stated he/she was called about 9:15 p.m. to assist in the ED. The SSO explained the individual's behavior was erratic but seemed to be in control and knew what he/she was saying and doing but was non-compliant. The SSO stated the police officer asked if a doctor could come to the waiting room to 1013 (involuntary) the individual. The SSO stated he/she had not notified the nursing staff or medical staff that the police officer had asked for the individual to get a 1013.

Base on review of policy and procedure, quality assurance data, and staff interviews, it was determined the facility failed to provide an appropriate medical screening examination (MSE) within the capability's of the hospital's ED, to determine whether or not an EMC existed for the individual that presented to the ED.

Findings were:

Review of the facility policy entitled, "EMTALA (Emergency Medical Treatment and Labor Act Guidelines", revised 09/2011, revealed that all patients presenting to the emergency room would receive a medical screening examination that included providing all necessary testing and on-call services within the hospitals capabilities. Further review of the policy indicated that all necessary definitive treatment would be given to the patient and only maintenance care can be referred to a physician office or clinic.


Review of the hospital's quality data revealed that an individual with psychiatric signs/symptoms presented to the ED waiting area on 05/17/12. The report indicated the staff on duty (employee files #1, #2, #4 and #5 ) was unaware the individual (patient #21) was in the waiting area until another person in the waiting area reported to the security officer (employee file #1) that an individual was acting inappropriately in the waiting area. The officer approached the individual and asked if he/she was a patient or wanted to be seen. The individual replied he/she was not a patient and did not want to be seen. After the individual indicated he/she did not want to be seen, the officer requested the individual to leave. The individual then became aggressive and hit the officer. Security officers were called for back up assistance. The individual removed his/her clothing and urinated on the floor. The nurse was notified and came to the area and gave the security officer a gown for the individual.

Review of the police report on 05/17/12 revealed the police were called to assist the facility's security officer. The police officer arrived at the facility and placed the individual in hand cuffs. The report indicated the security officer (employee #1) filed assault charges against the individual. The police officers completed a report of the incident and asked the facility supervisor security officer (employee #2) to have the physician see the individual to evaluate for a 1013 (involuntary) status. The report indicated the police officer was present in the ED approximately 30-40 minutes after the request for a physician evaluation. The report indicated the individual was placed in the police car and the police officer left the facility with the individual.

Review of the security officer's report dated 05/17/12 indicated that police officers were called to the facility because an individual hit and assaulted a security officer. The report indicated the individual was uncontrollable and was placed in handcuffs. While the individual was waiting to be seen by a physician, he/she became irritate and was taken outside, placed in the police car, and taken away. The staff (employee file #1, #2, #4 and #5) thought the officers took the individual out to the police car to make sure the individual was safe and would not injure anyone. When the physician attempted to see the individual, the facility staff realized the police officers had left the facility with the individual.

An interview was conducted on 05/30/12 at 1:10 p.m. in the Board Room with the security officer (employee #1). The officer stated a visitor approached him/her in the ED and told him/her that an individual was making him/her feel uncomfortable. The officer stated he/she approached the individual. The officer asked the individual if he/she was a patient and needed help. The individual stated he/she did not need any help and was going to leave. When the officer was escorting the individual out the door, the individual changed his/her mind and refused to leave the ED. The security officer verbalized he/she called the supervisor for assistance. The individual became non-compliant and came towards the officer and hit and scratched him/her. The officer explained that the individual continued to swing at the officer. The police was called and the people in the waiting area moved out of the area. The individual took his/her clothes off and urinated on the floor. The officer verbalized that the nurse brought the individual a hospital gown to wear. The officer put the gown on the individual. The security officer verbalized he/she came to work at 8:30 p.m. and at approximately 9:20 p.m. the police officers arrived at the facility. The police officers talked to the individual and then placed handcuffs on him/her. The individual sat in the chair cussing and hollering at anybody who asked him/her a question. The officer was standing there with the individual during this time while the police officers talked among themselves for about an hour and decided what was to be done. After the security officer returned from having the scratched on his/her arm examined by the nurse, the individual had been taken to the police car outside the ED.

An interview was conducted on 05/30/12 at 1:35 p.m. in the Board Room with the Senior Security Officer (SSO-employee file #2). The SSO stated he/she was on duty the time of the incident. The SSO stated he/she was called about 9:15 p.m. to assist in the ED. The SSO explained the individual's behavior was erratic but he/she seemed to be in control and knew what he/she was saying and doing but was non-compliant. The SSO stated the police officer asked if a doctor could come to the waiting room to 1013 (involuntary) the individual. The SSO explained the police officer did not discuss with him/her why he/she was requesting a 1013. The SSO responded to the police officer and stated that in order for the individual to see the physician, the individual needed to get registered first. The SSO stated he/she had not notified the nursing staff or medical staff that the police officer had asked for the individual to get a 1013. The SSO explained after having given the police officer that information he/she basically had no other conversation with the police. The SSO explained the police officers remained on the scene for a while and around 10:00 p.m. the police officers escorted the individual out to the police car. The SSO stated he/she asked the police what they were going to do with the individual and they advised him/her they were going to take him/her to another acute care hospital. The supervisor stated that he/she did not notify the ED staff of the police plan to take the individual to another hospital but gave no explanation. The SSO explained after the police officers took the individual in the police car, the staff did not inquire about the individual.

An interview was conducted on 05/30/12 at 2:00 p.m. in the Board Room with the nurse (employee file #4) who was on duty on 05/17/12. The nurse stated that he/she was the triage ED nurse the day the individual was at the facility. The nurse explained he/she heard the person shouting and heard a thump and saw the security officer (employee file #1) dealing with an individual in the ED waiting area. The nurse asked the registration clerk to call police. The nurse verbalized by this time the individual had taken off his/her clothes and threw them at the security officer and had urinated on the floor. The nurse explained he/she had informed the individual and security officers that the police were on their way. The nurse stated after the individual had taken his/her clothes off he/she placed the clothes in a bag and gave the security officer a gown. The police came in and told the individual to stand up and the police officer put the handcuffs on the individual . The nurse stated he/she assessed the individual and asked the individual multiple times if he/she needed assistance but the individual stated he/she did not need any help. The nurse felt that this occurrence was a security issue and felt the individual did not need a medical screening or psychiatric screening. The nurse explained he/she was familiar with the individual and was aware of his/her aggressive behavior. The nurse explained the individual was treated at the facility before and had a mental health history and felt the individual did not necessarily need psychiatric treatment at that time but was acting out trying to keep from going to jail. The nurse stated he/she was not aware that anyone had requested a 1013 for the individual.

An interview was conducted at 3:05 p.m. on 05/30/12 in the Board Room with the Clinical Team Leader nurse (employee fie #5) who worked in the ER. The nurse stated he/she had not seen the individual but was notified afterwards that the individual was taken to another hospital ED. The nurse explained that the physician at the other facility wanted to know why the individual was transferred inappropriately and not treated. The nurse explained to the physician that the individual was not at the facility to be seen but was a perpetrator and had assaulted someone. The nurse explained that the nurse practitioner and/or physician assistant on duty was not aware the individual was present or needed a 1013.

An interview was conducted on 05/30/12 at 1:30 p.m. in the conference room with the Chief Executive Officer (CEO). The CEO stated he/she was familiar with the incident and received a call from another facility concerning a patient that was not treated and inappropriately transferred to their facility. The CEO stated the case was reviewed and he/she felt that the individual was not at the facility to be seen and that the facility would never turn any one away if they wanted to be seen or needed medical treatment.

Based on review of the facility's policy and procedure, quality assurance data, and staff interviews, it was determined that the facility failed to provide stabilizing treatment for the individual who presented to the ED.

Findings were:

Review of the facility policy, entitled, "EMTALA (Emergency Medical Treatment and Labor Act Guidelines", revised 09/2011, revealed that all patients presenting to the ED requesting examination or treatment for an emergency medical condition will have a medical screening examination and stabilization treatment, regardless of their ability to pay. Further review of the policy indicated that hospitals are then required to provide stabilizing treatment for patients with emergency medical conditions. If the hospital is unable to stabilize a patient within its capability, or if the patient request, an appropriate transfer should be implemented.

Review of the hospital's quality data revealed that an individual with psychiatric signs/symptoms presented to the ED waiting area on 05/17/12. The report indicated the staff on duty (employee files #1, #2, #4 and #5 ) was unaware the individual (patient #21) was in the waiting area until another person in the waiting area reported to the security officer (employee file #1) that an individual was acting inappropriately in the waiting area. The officer approached the individual and asked if he/she was a patient or wanted to be seen. The individual replied he/she was not a patient and did not want to be seen. After the individual indicated he/she did not want to be seen, the officer requested the individual to leave. The individual then became aggressive and hit the officer. Security officers were called for back up assistance. The individual removed his/her clothing and urinated on the floor. The nurse was notified and came to the area and gave the security officer a gown for the individual.

Review of the police report on 05/17/12 revealed the police were called to assist the facility's security officer. The police officer arrived at the facility and placed the individual in hand cuffs. The report indicated the security officer (employee #1) filed assault charges against the individual. The police officers completed a report of the incident and asked the facility supervisor security officer (employee #2) to have the physician see the individual to evaluate for a 1013 (involuntary) status. The report indicated the police officer was present in the ED approximately 30-40 minutes after the request for a physician evaluation. The report indicated the individual was placed in the police car and the police officer left the facility with the individual.

Review of the security officer's report dated 05/17/12 indicated that police officers were called to the facility because an individual hit and assaulted a security officer. The report indicated the individual was uncontrollable and was placed in handcuffs. While the individual was waiting to be seen by a physician, he/she became irritate and was taken outside, placed in the police car, and taken away. The staff (employee file #1, #2, #4 and #5) thought the officers took the individual out to the police car to make sure the individual was safe and would not injure anyone. When the physician attempted to see the individual, the facility staff realized the police officers had left the facility with the individual.

An interview was conducted on 05/30/12 at 1:10 p.m. in the Board Room with the security officer (employee #1). The officer stated a visitor approached him/her in the ED and told him/her that an individual was making him/her feel uncomfortable. The officer stated he/she approached the individual. The officer asked the individual if he/she was a patient and needed help. The individual stated he/she did not need any help and was going to leave. When the officer was escorting the individual out the door, the individual changed his/her mind and refused to leave the ED. The security officer verbalized he/she called the supervisor for assistance. The individual became non-compliant and came towards the officer and hit and scratched him/her. The officer explained that the individual continued to swing at the officer. The police was called and the people in the waiting area moved out of the area. The individual took his/her clothes off and urinated on the floor. The officer verbalized that the nurse brought the individual a hospital gown to wear. The officer put the gown on the individual. The security officer verbalized he/she came to work at 8:30 p.m. and at approximately 9:20 p.m. the police officers arrived at the facility. The police officers talked to the individual and then placed handcuffs on him/her. The individual sat in the chair cussing and hollering at anybody who asked him/her a question. The officer was standing there with the individual during this time while the police officers talked among themselves for about an hour and decided what was to be done. After the security officer returned from having the scratched on his/her arm examined by the nurse, the individual had been taken to the police car outside the ED.

An interview was conducted on 05/30/12 at 1:35 p.m. in the Board Room with the Senior Security Officer (SSO-employee file #2) ). The SOS stated he/she was on duty the time of the incident. The SSO stated he/she was called about 9:15 p.m. to assist in the ED. The SSO explained the individual's behavior was erratic but seemed to be in control and knew what he/she was saying and doing, but was non-compliant. The SSO stated the police officer asked if a doctor could come to the waiting room to 1013 (involuntary) the individual. The SSO explained that the police officer did not discuss with him/her why he/she was requesting a 1013. The SSO responded to the police officer and stated that in order for the individual to see the physician, the individual needed to get registered first. The SSO stated he/she had not notified the nursing staff or medical staff that the police officer had asked for the individual to get a 1013. The SSO explained, after having given the police officer that information, he/she basically had no other conversation with the police. The SSO explained the police officers remained on the scene for a while and around 10:00 p.m. the police officers escorted the individual out to the police car. The SSO stated he/she asked the police what they were going to do with the individual and they advised him/her they were going to take the individual to another acute care hospital. The supervisor stated that he/she did not notify the ED staff of the police plans to take the individual to another hospital, but gave no explanation. The SSO explained after the police officers took the individual in the police car, the staff did not inquire about the individual.

An interview was conducted on 05/30/12 at 2:00 p.m. in the Board Room with the nurse (employee file #4) who was on duty on 05/17/12. The nurse stated that he/she was the triage ED nurse the day the individual was at the facility. The nurse explained he/she heard the person shouting and heard a thump and saw the security officer (employee file #1) dealing with an individual in the ED waiting area. The nurse asked the registration clerk to call police. The nurse verbalized by this time the individual had taken off his/her clothes and threw them at the security officer and had urinated on the floor. The nurse explained he/she had informed the individual and security officers that the police were on their way. The nurse stated after the individual had taken his/her clothes off he/she placed the clothes in a bag and gave the security officer a gown. The police came in and told the individual to stand up and the police officer put the handcuffs on the individual . The nurse stated he/she assessed the individual and asked the individual multiple times if he/she needed assistance but the individual stated he/she did not need any help. The nurse felt that this occurrence was a security issue and felt the individual did not need a medical screening or psychiatric screening. The nurse explained he/she was familiar with the individual and was aware of his/her aggressive behavior. The nurse explained the individual was treated at the facility before and had a mental health history and felt the individual did not necessarily need psychiatric treatment at that time, but was acting out trying to keep from going to jail. The nurse stated he/she was not aware that anyone had requested a 1013 for the individual.

An interview was conducted at 3:05 p.m. on 05/30/12 in the Board Room with the Clinical Team Leader nurse (employee file #5) who worked in the ER. The nurse stated he/she had not seen the individual but was notified afterwards that the individual was taken to another hospital ED. The nurse explained the physician from the other hospital wanted to know why the individual was transferred inappropriately and not treated. The nurse explained to the physician that the individual was not at the facility to be seen, but was a perpetrator and had assaulted someone. The nurse explained the nurse practitioner and/or physician assistant on duty was not aware the individual was present or needed a 1013.

An interview was conducted on 05/30/12 at 1:30 p.m. in the conference room with the Chief Executive Officer (CEO). The CEO stated he/she was familiar with the incident and received a call from another facility concerning a patient that was not treated and inappropriately transferred to their facility. The CEO stated the case was reviewed and he/she felt that the individual was not at the facility to be seen and that the facility would never turn any one away if they wanted to be seen or needed medical treatment.

Base on review of the facility's policy and procedure, quality assurance data, and staff interviews, it was determined that the facility failed to effect an appropriate transfer for the individual who presented to the ED.

Findings were:

Review of the facility policy, entitled, "EMTALA (Emergency Medical Treatment and Labor Act Guidelines", revised 09/11 under #9, revealed that the hospital may not transfer patients who are potentially unstable as long as the hospital has the capabilities to provide treatment and care to the patient. Transfer of a patient to another facility may only be for reason of medical necessity.

Review of the facility's central log lacked evidence that the individual was registered, received a medical screening, was treated, was stabilized or was transferred from the facility on 05/17/12 to another hospital.

Review of the county police report on 05/17/12 indicated that the police were called to assist the facility's security officer. The police officer #1 arrived at the facility and placed the individual in hand cuffs who had reportedly assaulted a security officer. The report indicated the security officer (employee #1) was filing assault charges against the individual. The police officers wrote the report of the incident and asked the facility security officer (employee #2) to have the physician see the individual to evaluate for a 1013 (involuntary) status. The report indicated the police officer #1 was present in the ED approximately 30-40 minutes after the request for a physician evaluation. The report indicated the individual was placed in the police car and the police officer left the facility with the individual.

Review of the security officer's report dated 05/17/12 indicated that police officers were called to the facility because an individual hit and assaulted a security officer. The report indicated the police took custody of the patient. The police requested to the security officer that an evaluation for a 1013 be done and was instructed by security that the individual needed to be registered first. The report indicated after approximately 40 minutes the individual was transported to another hospital for treatment. The police advised that the jail would turn the individual away due to his/her current state. The report indicated that the police transported the individual to another hospital and that the other hospital notified the facility and wanted to know why the patient was not treated at their facility.

.An interview was conducted on 05/30/12 at 1:35 p.m. in the Board Room with the Senior Security Officer (SSO-employeefile #2). The SSO stated he/she was on duty the time of the incident. The SSO stated he/she was called about 9:15 p.m. to assist in the ED. The SSO explained the individual's behavior was erratic but he/she seemed to be in control and knew what he/she was saying and doing but was non-compliant. The SSO stated the police officer asked if a doctor could come to the waiting room to 1013 (involuntary) the individual. The SSO explained the police officer did not discuss with him/her why he/she was requesting a 1013. The SSO responded to the police officer and stated that in order for the individual to see the physician, the individual needed to get registered first. The SSO stated he/she had not notified the nursing staff or medical staff that the police officer had asked for the individual to get a 1013. The SSO explained after having given the police officer that information he/she basically had no other conversation with the police. The SSO explained the police officers remained on the scene for a while and around 10:00 p.m. the police officers escorted the individual out to the police car. The SSO stated he/she asked the police what they were going to do with the individual and they advised him/her they were going to take him/her to another acute care hospital. The supervisor stated that he/she did not notify the ED staff of the police plan to take the individual to another hospital but gave no explanation. The SSO explained after the police officers took the individual in the police car, the staff did not inquire about the individual.

An interview was conducted on 05/30/12 at 2:00 p.m. in the Board Room with the nurse (employee file #4) who was on duty on 05/17/12. The nurse stated that he/she was the triage ED nurse the day the individual was at the facility. The nurse explained he/she heard the person shouting and heard a thump and saw the security officer (employee file #1) dealing with an individual in the ED waiting area. The nurse asked the registration clerk to call police. The nurse verbalized by this time the individual had taken off his/her clothes and threw them at the security officer and had urinated on the floor. The nurse explained he/she had informed the individual and security officers that the police were on their way. The nurse stated after the individual had taken his/her clothes off he/she placed the clothes in a bag and gave the security officer a gown. The police came in and told the individual to stand up and the police officer put the handcuffs on the individual . The nurse stated he/she assessed the individual and asked the individual multiple times if he/she needed assistance but the individual stated he/she did not need any help. The nurse felt that this occurrence was a security issue and felt the individual did not need a medical screening or psychiatric screening. The nurse explained he/she was familiar with the individual and was aware of his/her aggressive behavior. The nurse explained the individual was treated at the facility before and had a mental health history and felt the individual did not necessarily need psychiatric treatment at that time but was acting out trying to keep from going to jail. The nurse stated he/she was not aware that anyone had requested a 1013 for the individual.

An interview was conducted at 3:05 p.m. on 05/30/12 in the Board Room with the Clinical Team Leader nurse (employee fie #5) who worked in the ER. The nurse stated he/she had not seen the individual but was notified afterwards that the individual was taken to another hospital ED. The nurse explained that the physician at the other facility wanted to know why the individual was transferred inappropriately and not treated. The nurse explained to the physician that the individual was not at the facility to be seen but was a perpetrator and had assaulted someone. The nurse explained that the nurse practitioner and/or physician assistant on duty was not aware the individual was present or needed a 1013.

An interview was conducted on 05/30/12 at 1:30 p.m. in the conference room with the Chief Executive Officer (CEO). The CEO stated he/she was familiar with the incident and received a call from another facility concerning a patient that was not treated and inappropriately transferred to their facility. The CEO stated the case was reviewed and he/she felt that the individual was not at the facility to be seen and that the facility would never turn any one away if they wanted to be seen or needed medical treatment.







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