HospitalInspections.org

Based on document reviews and staff interviews, the facility failed to meet the EMTALA requirements for participating hospitals by:

a. Failure to maintain a current central log of all patients that present to the emergency room seeking treatment for 1 (#1) of 16 patients that presented to the emergency room. (See tag C2405);

b. Failure to provide an appropriate medical screening examination for 3 (#s 1, 12, and 13) of 16 reviewed patients presenting to the emergency room. (See tag C2406);

c. Failure to provide stabilizing treatment for 4 (#s 1, 12, 13 and 16) of 16 reviewed patients presenting to the emergency room. (See tag C2407)

Based on document review and staff interviews, the facility failed to document in the central log each individual who comes to the emergency department seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for 1 (#1) of 16 selected records. Findings include:

On 5/30/12 at approximately 6:30 a.m., an unnamed individual came to the emergency room desk at the facility. The individual spoke with the nurse on duty about his daughter and concerns about her mental health. The individual was informed that if he wanted his daughter to be seen, he would have to bring her into the emergency department. The gentleman then left the facility. At approximately 8:30 a.m., the individual returned with his daughter. They spoke with provider C at the desk and the individual and his daughter left the facility without being seen. Facility staff observed the individual and his daughter speaking to provider C, but did not hear the interaction between the provider and the individual.

The facility log was not updated with information that included the name of the person seeking treatment, chief complaint, information about acceptance or refusal of treatment, and admission, transfer, or discharge status.

In an interview with staff member AA on 7/10/12 at 2:30 p.m., staff member AA stated that two staff had informed her of the episode and both of the staff members verified the event and that the patient was never registered as a patient or entered into the emergency room log.

In an interview with staff member DD on 7/10/12 beginning at 9:10 p.m., staff member DD stated that she had spoken with the individual at 6:30 a.m. when he presented to the emergency room desk. He discussed his concerns about his daughter (#1) with the staff member. He left the facility and returned with his daughter to the facility. Staff member DD stated that she informed provider C of the potential for the individual to return with his daughter to be seen after the individual had left the facility. Staff member DD stated that she had seen the individual and patient #1 return to the facility, speak with provider C and leave.

The staff member did not register the patient into the log despite the fact that the individual left the facility and returned with patient #1 with the apparent intent of the patient being seen in the emergency room.

Based on record review and staff interviews, the facility failed to ensure that an appropriate Medical Screening Examination (MSE) was completed for 3 (#s 1, 12, and 13) of 16 sampled patients. Findings include:

1. An unnamed individual, came to the emergency room desk at the facility on 5/30/12 at 6:00 a.m. The individual spoke with the nurse on duty about his daughter and concerns about her mental health. The father was informed that if he wanted his daughter to be seen, he would have to bring her into the emergency department. The gentleman then left the facility. At approximately 8:30 a.m., the individual returned with his daughter, patient #1. They spoke with provider C at the desk and left the facility without being seen. Facility staff observed the individual and his daughter speaking with provider C, but did not hear the interaction between the provider and the individual. No medical screening examination was initiated or completed.

2. Patient #12, a 16 year old female, presented to the emergency room on 4/28/12 with the chief complaint of abdominal pain. The patient was taken to a bed in the emergency room and an initial examination was conducted by the nurse on duty. The nurse contacted the on-duty provider by phone and initial orders were received. The nurse made 2 attempts to start an intravenous line, but was unsuccessful on both attempts. The patient refused further treatment and left the facility against medical advice (AMA) The facility AMA form was signed by the parent of the patient. The patient was not seen by the provider prior to leaving the facility. The nurse that examined the patient had not been trained to complete medical screening examinations in the emergency room.

3. Patient #13, a 19 year old female, presented to the emergency room on 5/27/12 at 15:17 (3:17 p.m.) with complaints of vaginal bleeding and cramps. The patient was signed into the emergency room and initial vital signs and a pertinent medical history was obtained by the nurse on duty. The nurse contacted the provider on-call and gave the information about the patient. The provider advised that the patient proceed on to a facility in another city for evaluation. The patient was not seen by the provider. The nurse on duty, who had been trained to do MSEs and granted approval to perform those examinations by the governing board, did not complete a medical screening examination to establish the present or absence of an emergency condition.

During an interview with staff member AA on 7/11/12 at 7:30 a.m., staff member AA stated that there were 4 nurses that had been trained and certified to complete medical screening examinations at the facility. She stated that the providers had changed and were doing the majority of the screening examinations themselves.

During an interview with staff member EE on 7/11/12 at 8:55 a.m., the emergency room record for patient #13 was presented. Staff member EE reviewed the record and stated that no screening examination was documented on the facility form. When asked if vaginal bleeding and the passage of clots by a patient was an emergent situation staff member EE stated that is could be.

During an interview with staff members AA, BB, and II on 7/11/12 at 11:30 a.m., the surveyor identified the three patients that did not receive screening examinations when they came to the emergency room. None of the staff members were aware of the omission of the examinations for patients #12 and #13.

This STANDARD is not met as evidenced by:
Based on document review and staff interviews, the facility failed to ensure that further medical examination and treatment as required to stabilize the medical condition was provided for 4 (#s 1, 12, 13, and 16) of 16 reviewed patients.
Findings include:

1. On 5/30/12 at 6:00 a.m., an unnamed individual came to the emergency room desk at the facility. The individual spoke with the nurse on duty about his daughter and concerns about her mental health. The individual was informed that if he wanted his daughter to be seen, he would have to bring her into the emergency department. The individual then left the facility. At approximately 8:30 a.m. the individual returned with his daughter (Patient #1). The father and daughter spoke with provider C at the desk and then left the facility without being seen. Facility staff observed the individual and his daughter speaking with provider C, but did not hear the interaction between the provider and the individual. No medical screening examination was initiated or completed. No treatment was provided to the patient.

2. Patient #12, a 16 year old female, presented to the emergency room on 4/28/12 with the chief complaint of abdominal pain. The patient was taken to a bed in the emergency room and an initial examination was conducted by the nurse on duty. The nurse contacted the on-duty provider by phone and initial orders were received. The nurse made 2 attempts to start an intravenous line, but was unsuccessful on both attempts. The patient refused further treatment and left the facility against medical advice (AMA). The facility AMA form was signed by the parent of the patient. The patient was not seen by the provider prior to leaving the facility. The nurse that examined the patient had not been trained to complete medical screening examinations in the emergency room. No treatment was provided to the patient to address the presenting symptoms.

3. Patient #13, a 19 year old female, presented to the emergency room on 5/27/12 at 15:17 (3:17 p.m.) with complaints of vaginal bleeding and cramps. The patient was signed into the emergency room and initial vital signs and a pertinent medical history was obtained by a qualified nurse on duty. The nurse contacted the provider on-call and gave the information about the patient. The provider advised that the patient proceed to a facility in another city for evaluation. The patient was not seen by the provider. The qualified nurse on duty did not complete a medical screening examination to establish the presence or absence of an emergency condition. No stabilizing treatment was provided to the patient prior to her exiting the facility.

4. Patient #16, a 5 year old female, was brought to the emergency room by her mother on 3/10/12 with complaints of a cough. The patient was signed into the emergency room and received a medical screening examination by a qualified nurse. The results of the examination were communicated to the practitioner on duty. The parent of the patient refused laboratory and radiology tests ordered and decided to wait until the clinic opened later in the morning to have the child examined. No determination of the seriousness of the patient's condition was documented. No stabilizing treatment was documented as offered or delivered. The patient left with her mother. No facility AMA form was initiated or completed.

In an interview with staff members AA, BB and II on 7/11/12 at 11:30 a.m., the issue of no stabilizing treatment was discussed. The staff members were not aware of treatment not being provided to the patients.