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Based on review of Hospital #1 and Hospital #2's Emergency Department (ED) medical records, document review, staff interviews, family interview, review of the bylaws, rules, and regulations of the medical staff, review of the ED policies and procedure manuals, and review of hospital policies and procedures, Hospital #2 failed to comply with 42 CFR §489.24 by failing to report that Hospital #1 failed to ensure Patient #1 was triaged, received a Medical Screening Exam (MSE) and Stabilizing Treatment for an Emergency Medical Condition (EMC) within that hospital's capabilities (staff and facilities) that minimized the health risks of Patient #1 while he was present in their ED.



Findings include:


Cross Refer to A-2410 / 489.24 for Hospital #2's failure to report Hospital #1 for not ensuring that Patient #1 was provided a MSE and necessary Stabilizing Treatment for an EMC within the capabilities of the staff and facilities available at Hospital #1.


This EMTALA complaint was SUBSTANTIATED and there were DEFICIENCIES CITED.
A2400 Failure to Comply with 489.20
A2410 / 489.24 (e) (3) Whistleblower Protections

Based on review of Hospital #1 and Hospital #2's Emergency Department (ED) medical records, document review, staff interviews, family interview, review of the bylaws, rules, and regulations of the medical staff, review of the ED policies and procedure manuals, and review of hospital policies and procedures, Hospital #2 failed to report Hospital #1 for not ensuring the provision of a Medical Screening Exam (MSE) and failing to provide any stabilizing treatment while Patient #1 was in their ED with an Emergency Medical Condition (EMC).


Findings include:


Mississippi State Department of Health received a written complaint from Patient #1's wife. The complaint stated that on 02/09/2018 at 11:00 p.m. she, her husband (Patient #1), and their son arrived at Hospital #1's ED. She told staff there that her husband was having a stroke, that his blood pressure was elevated and he had been having signs/symptoms of weakness. She was told by staff that they could not take him straight back, that they had a lot of patients already and to just take him somewhere else. She stated that her husband was able to function somewhat with his right side at that point, but was extremely weak and getting weaker. They left Hospital #1 and took him to Hospital #2 where he was diagnosed with a left side stroke. She stated that his stroke had caused him to have paralysis on the right side and speech impairment.



Hospital #2 failed to report to the State Agency that they received Patient #1 in their ED and had been told by his wife that he had just come 30 miles from Hospital #1's ED approximately 30 minutes prior, where he had not received any services for signs and symptoms of a Cardio Vascular Accident (CVA). Hospital #1 had failed to triage Patient #1, failed to provide him a MSE and failed to provide any stabilizing treatment while he was in their ED.


On 2/28/18 at 11:30 a.m. the distance from Hospital #1 to Hospital #2 was driven in a car. The distance was 27 miles and took approximately 30 minutes.


On 2/28/18 from 12:01 to 12:13 p.m. a telephone interview was held with Patient #1's wife. She stated that on the night they went to Hospital #1 her son was parking the van and she took her husband inside and told the woman in the front that her husband was having a stroke. "His eyes looked funny and he was dizzy. The woman told me she needed his drivers' license and insurance card. I told her he was dizzy and his blood pressure at home was 180/90 and can't someone see him. She checked in two more people behind us before she would get the nurse. The nurse came out and told me that there were seven or eight people ahead of us and he just needed to go sit down. I remember saying, 'Can you not just look at him? Oh my God you're not going to see him?' She wouldn't even look at him and take his vital signs. We left and took him to (Hospital #2). When we got there his blood pressure was 225/100. They said he had a blood clot in his brain, but it was too late to use the clot buster. They also said this has happened before to others and they were not surprised." She confirmed that she told staff at Hospital #2 that she and her husband had just been at Hospital #1 and did not receive any assistance with his EMC. When asked how her husband was doing now she stated, "He is getting Physical Therapy, Speech Therapy, and Home Health is coming to the house to help." At this point she began to cry and we ended the conversation.

On 2/28/18 at 12:30 p.m. the surveyors entered Hospital #2. An interview was held with the hospital's Registered Nurse (RN)/Assistant Administrator. She was told the reason for the survey and was given a list of items surveyors needed to conduct the survey. She began submitting documents, policies and procedures, and schedules as requested.

On 3/1/18 at 11:15 a.m. the ED was toured with the Assistant Administrator and the RN/ED Manager. Observation revealed 38 beds, four (4) trauma rooms, EMTALA signs in the waiting area, in front of triage and in the registration area. The ED was noted to be extremely big with 19 rooms going down one side and 19 rooms going down the other side. It was stated that the left side is closed from 1:00 a.m. to 8:00 a.m. every day.


On 3/1/18 at 11:36 a.m. the RN/ED Manager was asked what their protocol was if they received a patientin their ED that says that they just came from another hospital and got no treatment at the other hospital. Who would they notify? She stated, "We don't usually get a lot of that. We would just treat them. We wouldn't notify the other hospital unless they had some type of lab work done. That usually doesn't happen."


On 3/1/18 at 12:11 p.m. the Assistant Administrator was told that the surveyors needed to interview the RNs who were on duty in the ED on the evening Patient #1 presented to their ED (12/11/17). She stated understanding and that she would have them contact the surveyors by telephone.

On 3/1/18 at 1:26 p.m. Patient #1's electronic file was reviewed. The review showed nothing was in the nurses' notes or the physician's notes that revealed this patient or family told anyone at this facility that they had just come from Hospital #1 and did not receive the required services for his EMC.

On 3/1/18 at 1:40 p.m. ED Physician #1 was interviewed in the nurse's station of the ED. He stated that he had reviewed Patient #1's chart and did not remember being told by anyone that this patient had come from Hospital #1 prior to presenting at their ED on 2/11/18.


On 3/2/18 at 8:05 a.m. a telephone interview was done with ED RN #1. When asked if she remembered Patient #1 when he came into their ED on 12/11/17, she stated yes she did. "I remember that during check-in they did say they came from (Hospital #1). They said they sat in the lobby for a bit. There was a delay and they couldn't get back right away." She did not remember if they told her that the nurse at the other facility told them to go somewhere else.

On 3/2/18 at 8:13 a.m. a telephone interview was held with ED RN #2. She stated that she did remember Patient #1 coming into their ED on 12/11/17. "I just remember that we got him back pretty fast. I don't recall (Hospital #1) being mentioned. We were trying to get the patient stable."


Hospital #1 record review for Patient #1 revealed this 59 year old male presented via private vehicle to the ED with his wife and son on Sunday 2/11/18 at 12:07 a.m. (not 2/9/18 at 11:00 p.m. as the complaint stated) with a complaint of slurred speech and dizzy. The patient's wife told staff he was having a stroke and became upset because the staff did not take him straight to the back. At 12:23 a.m. the wife and patient walked out of the ED area without being triaged, without a Medical Screening Exam (MSE), and with no Stabilizing Treatment provided.



Hospital #2 record review for Patient #1 revealed this 59 year old male presented to the ED ambulatory with wife and son on 2/11/18 at 12:40 a.m. He was triaged at 12:47 a.m. as a Level 2 with complaints of dizziness, high blood pressure, slurred speech, and other signs and symptoms of a Cardio Vascular Accident (CVA) X3 hours. A MSE was performed at 12:41 a.m. and he was diagnosed with Cerebral Infarction, facial weakness and loss of motor function to lower extremities. While in the ED he received labwork, an EKG, a CT of head and a Magnetic Resonance Imagining (MRI) and he was given Aspirin, Norco and Lipitor by mouth. He was admitted to the hospital and was discharged on 2/13/18 at 12:30 p.m. in stable condition to home with spouse. He was scheduled with home health, Speech Therapy, and Physical Therapy in the home.

The following materials were obtained from the hospital and reviewed:
EMTALA Policies and Procedures
Transfer Consent Form
ED Staffing Schedule X6 months for Physicians/Nurse Practitioners, On-Call Physicians, On-Call Nurse Practitioners, and for Nurses
Medical Staff Bylaws, Rules and Regulations
Medical Staff Meeting minutes X12 months
Current Medical Staff Roster
In-Service training program records, schedules, reports, etc as they relate to EMTALA
Quality Assessment and Performance Improvement (QAPI) - EMTALA
QAPI Meeting Minutes
List of Contracted Services
List/Number of emergency patients seen per month for last 6 months
List/Number of emergency patients transferred to other hospitals in last 6 months
20 ED Medical Records




This EMTALA complaint was SUBSTANTIATED and there were DEFICIENCIES CITED.
A2400 Failure to Comply with 489.20
A2410 / 489.24 (e) (3) Whistleblower Protections