HospitalInspections.org

Based on record review and staff interview, the hospital failed to conduct a medical screening examination for a patient on hospital property (A2406).

Based on record review and staff interview, the hospital failed to ensure an emergency medical screening was conducted for one of 20 patients reviewed (Patient #1).

Findings include:

Review of the hospital's policy titled EMTALA policy, effective 03/01/19, revealed Attachment 1, Definitions which included the following information: "Comes to the emergency department means, with respect to an individual who is not a Patient, the individual - (2) Has presented on Hospital Property, other than the dedicated emergency department, and request examination or treatment for what my be an EMS, or has such a request made on his or her behalf." "(4) Is in a ground or air nonhospital-owned ambulance on hospital property for presentation for examination and treatment for a medical condition at a hospital's dedicated emergency department." "The hospital may direct the ambulance to another facility if it is in "diversionary status," that is, it does not have the staff or facilities to accept any additional emergency patients. If, however, the ambulance staff disregards the hospitals diversion instructions and transports the individual onto hospital property, the individual is considered to have come to the emergency department." "Medical Screening Examination or MSE. The screening process required to determine with reasonable clinical confidence whether an EMC does or does not exist.

On 05/22/19 at 11:38 AM, an interview with Staff E revealed that on 05/14/19 the facility received a call from a staff member who worked at Hospital B. That staff member informed Staff E there was a possible EMTALA violation based on a patient on the night shift who was not screened at Hospital C and that the squad employee was directed to take the patient to Hospital B.

Staff E stated further investigation on 05/14/19 revealed the Communication Center received a phone call in the early morning hours of that same day from an emergency squad employee to inform them a patient was enroute in the squad to this ED for evaluation of right arm and hand pain with nerve involvement status post gunshot wound six days prior.

Interview with Staff G on 05/20/19 at 1:40 PM revealed that while in the ED the morning of 05/14/19, he/she overhead Staff F speaking on the charge phone with the Communication Center and a squad member about a patient who had a gunshot wound and was enroute to this ED. During that phone call, Staff H had stated that they were familiar with this patient who recently received a gunshot wound and was enroute to this hospital, but was routed to Hospital B due to trauma. Staff G stated upon conclusion of the phone call, he/she thought it was a "done deal" for the squad to take the patient to Hospital B when two squad members arrived in the ED. The patient was in the squad at that time. Staff G overheard them telling Staff F "you do realize this is from last week don't you?" Staff G stated one of the two squad attendants appeared to be upset, turned around and quickly left the ED. Staff G stated he/she went to the ambulance entrance to tell the squad to bring the patient in for a medical screening exam as the ED staff needed to see the patient, but the squad was pulling away from the doors. Staff G informed Staff F to call the Communication Center employee to document something about this patient since the patient did not receive a MSE.

Interview with Staff F on 05/20/19 at at 2:36 PM revealed the ED was not a trauma center and when receiving a call from the Communication Center they had screening checklist that was used for screening by the Clinical Coordinator of the potential patient. Staff F stated he/she did not use this checklist for Patient #1 on 05/14/19. Further interview with Staff F revealed the following occurred during the three way phone call with the Communication Center and the squad employee: Staff F clarified with the squad employee the patient had experienced a gunshot wound a week ago and was experiencing pain and concerns with nerve involvement. Staff F stated he/she expressed concern to the squad employee that there were no resources at this site to care for the patient, and the patient would have to transfer to another facility for those services. Staff F stated he/she was concerned that the care for the patient would be delayed by bringing the patient to this site. Staff F stated the ED physician was involved in the conversation with Staff F and Staff H when they were discussing the patient coming to this site.

Staff F stated at the end of the conversation with the squad attendant and the Communication Center employee, the ambulance doors opened and two emergency medical technicians (EMTs) arrived. One EMT informed Staff F "I wanted to tell you it was a week ago, I wanted to make a point, and I was on the property the whole time (during phone conversation)." Staff F stated the squad attendants did not bring the patient into the ED and after leaving the ED, they left in the squad.

Staff F stated if the squad employee would have presented in the ED with the patient, staff would have conducted a MSE. Staff F admitted that on the phone he/she told the squad to take the patient to the other hospital and not to come to this ED. Staff F stated the ED was not busy at that time and was not in diversionary status. Staff F stated the ED had never been put on diversionary status.

Interview with Staff H on 05/20/19 at 3:05 PM revealed this employee was present in the ED when Staff F received the call from the Communication Center on 05/14/19. Staff H stated all calls were recorded. Staff H stated he/she overheard Staff F discussing the incoming patient's gunshot wound. Staff H recognized the patient from a few days before when they were transferred via Akron Children's Hospital transportation to the Level 1 trauma center at Hospital B for treatment of the gunshot wound. Staff H stated he/she overheard discussion between Staff F and Staff G that the patient needed to go to the other hospital due to the nature of the presenting complaint. Staff H then heard Staff F tell the squad employee to take the patient to the other hospital so as not to delay the care of the patient. Staff F confirmed two squad employees entered the ED to speak to ED staff stating "Do you realize the patient was shot a week ago?" One of the squad employees stated the squad was already in the parking lot, then threw his/her hands in the air and left. Staff F confirmed the incoming patient was not seen or examined at this ED.

On 05/22/19, review of a Communication Center Log entry dated 05/14/19 and titled Transfer Information revealed the following documentation: 16 year old patient had gunshot wound last week, has pain. Hospital C diverted to Hospital B. Sending facility was the name of the ambulance company, Receiving Facility was Hospital B. The call arrived on 05/14/19 at 5:02 AM.

On 05/22/19 at 12:33 PM, Staff B stated it was not within the nurses' scope of practice to make a decision to divert a patient from the ED. Staff D and J were present at that time. Staff B and Staff J then provided documentation of the job duties of RN Clinical Coordinators in the ED and confirmed this decision making was not a part of the scope of practice for the RN Clinical Care Coordinators.

On 05/20/19 beginning at 12:40 PM and in the presence of Staff A, C, D and E, both surveyors listened to the recorded audio calls and viewed the videos from this encounter involving Patient #1 on 05/14/19.

During the audio and video screening, Staff A, C, D and E confirmed the lack of a MSE per facility policy for Patient #1.

This deficiency substantiates Substantial Allegation OH00104434.