HospitalInspections.org

Review of the facility policy "Emergency Medical Treatment and Labor Act (EMTALA) Policy" reviewed March 2013 revealed, "Policy: Any individual who comes to The Uniontown Hospital requesting emergency services is entitled to and will receive a Medical Screening Exam performed by individuals qualified to perform such exam to determine whether an Emergency Medical Condition exists...All individuals requesting or requiring a Transfer for further medical care will be transferred according to the requirements under EMTALA...Definitions...6. Come(s) to the Emergency Department means that the individual either presents to the ED requesting examination or treatment for a Medical Condition or presents elsewhere on hospital property requesting examination or treatment for an Emergency Medical Condition...10. Hospital Property or Premises includes the entire main Hospital campus, including the parking lot, sidewalk, driveway and the physical area immediately adjacent to the provider ' s main building, other areas and structures that are strictly contiguous to the main building, but are located within 250 yards of the main building. EMTALA obligations exclude other areas or structures of the hospital's main building that are not part of the hospital, such as physician offices, rural health clinics, skilled nursing facilities, or other entities that participate separately in Medicare, or restaurants, shops, or other non-medical facilities...IV...A. Hospitals are obligated to perform the Medical Screening Examination to determine if an Emergency Medical Condition exists. B. The Hospital must provide a Medical Screening Examination to any individual regardless of diagnosis (i.e., Labor, AIDS), financial status (i.e., uninsured, Medicare/Medicaid), race, color, national origin, handicapped, etc. C. Individuals who come to the Emergency Department must be provided a Medical Screening Examination beyond initial triage."

1) Review of EMS trip sheet to receiving hospital dated January 14, 2014, revealed the following:
Chief Complaint...voices in head are telling patient to kill himself. History of Present Illness...patient reported an extensive history of psych problems and hearing voices in head that are telling patient to kill himself. Patient explains wanting help...01:25 patient was met outside of patient's house. CAOx4 ABCs intact. Primary and secondary survey noted and completed. Patient assisted to truck secured to stretcher in typical fashion...Vital signs stable, patient transferred to Uniontown Hospital...BLS notification alert sent by [EMS OTH1]. Report given to Uniontown Hospital because it was the nearest hospital. Was advised to standby then was advised by Uniontown ER that they would not accept the patient because they did not have a psych unit. At that time we transported the patient to Highlands Hospital...Transportation Factors affecting care: Diversion.

2) Telephone interview with EMS OTH1 January 27, 2014, at approximately 10:00 AM, "We responded to the call. We called the hospital when we were about five minutes out from the hospital. We were told to stand by. We called them to tell them we were knocking at back door. We were told they we were not accepting the patient because they do not have psych services. We were turning into the hospital when we got the call. Normally, they know we are close when we say we are at your back door."
3) Telephone interview with EMS OTH2 January 27, 2014, at approximately 2:00 PM, "We were transporting the patient for a psych eval. I was driving. When we got the call to divert, we were driving through the [Uniontown Hospital] parking lot."

4) Telephone interview with EMP24, (Uniontown ED) January 27, 2014, at approximately 2:20 PM, "They [EMS] called in, they had a patient that was hearing voices. I told them we did not have psych services here anymore. I did not tell them we were refusing the patient. They called back and said they were diverting to [other hospital]. They say they were in the parking lot when they got the call from us. I didn't see them. I couldn't see outside from where I was." Additionally, during the telephone interview EMP24 was asked if an EMS would report "we are knocking on your door" what that would mean. EMP24 responded, "I would think they are backing into the ambulance bay."

5) Telephone interview with EMP25, (Uniontown Hospital ED), January 28, 2014, at approximately 7:45 AM, "I was charge nurse on that night. I was walking past the radio, EMP24 was on the radio. EMS called; they were 5 to 7 minutes out with a psych patient. I asked [emergency department physician], if I should have then go directly to the nearest facility that has a psych unit? [Physician] agreed. I told EMP24 to ask them if they would be able to go the nearest mental health facility. They responded... we are diverting. I never heard them say, we are knocking on you door. Some EMS does not have a fob to open the bay doors, so they have to knock. There was no one backing up on our bays or driving in the parking lot that anyone could see."

6) A review of EMS radio transmission tapes from January 14, 2014 is as follows:
1:40.57: "(from EMS) we are knocking on your door right now."
1:41.12: "(from facility) be advised, we do not have psych services here anymore."
1:41.24: "(from EMS) Received, we are going to divert to [other facility] then."

Based on a review of facility documents and staff interviews (EMP), it was determined that the facility failed to ensure complete and appropriate transfer for one of eight medical records reviewed (MR4).

Findings include:

Review of the facility policy "Emergency Medical Treatment and Labor Act (EMTALA) Policy" reviewed March 2013 revealed, "...Policy: Any individual who comes to The Uniontown Hospital requesting emergency services is entitled to and will receive a Medical Screening Exam performed by individuals qualified to perform such exam to determine whether an Emergency Medical Condition exists...All individuals requesting or requiring a Transfer for further medical care will be transferred according to the requirements under EMTALA...VIII Appropriate Transfers:...E. For a patient who has not been Stabilized and a Transfer is recommended, a Physician must sign a certification that certifies, based on the information available at the time of Transfer, the medical benefits reasonable expected from the provision of the appropriate medical treatment at another medical facility outweigh the increased risks to the individual...1. The certification must be signed by the patient or a legally responsible person acting on behalf of the patient and contain a summary of the risks and benefits upon which it is based..."

Findings include:

1. Review of MR4 on January 27, 2014 at approximately 11:45 AM revealed a document (dated December 6, 2013 and timed 10:25 PM) which indicated, "A. The patient has been stabilized such that, within reasonable medical probability, no medical deterioration of the patient's condition is likely to result from transfer...Consent: I have had the opportunity to ask questions and have had those questions answered to my satisfaction. I hereby authorize and consent to this transfer. I also consent to the release of medical records including mental health, drug and alcohol, HIV related illness or AIDS information...Patient's Name...Patient Signature..."

Continued review of MR4 revealed that the consent was not signed by the patient.

2. On January 27, 2014, at approximately 11:45 AM, EMP6 confirmed that there was no documentation as to why the consent form was not signed by the patient.