HospitalInspections.org

Based on video surveillance review, document review and interview, it was determined that the Hospital (Campus A) failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The Hospital failed to ensure that the patient seeking emergency services was registered in the emergency room log. See deficiency at A-2405

2. The Hospital failed to ensure that the medical screening examination (MSE) was done while the patient was in the emergency room as required. See deficiency at A-2406

Based on document review, video surveillance review, and interview, it was determined that for 1 of 20 (Pt. #2) sampled patients reviewed for seeking emergency services, the Hospital (Campus A) failed to maintain a central log of each individual who comes to the ED seeking assistance.

Findings include:

1. On 11/16/2021 at approximately 11:55 AM, the Hospital Campus A's document titled, "Ambulance Radio Report for 10/23/2021 written by E #7 (Emergency Communication Specialist) was reviewed. The document included clinical information for an unidentified patient (Pt. #2). The document indicated that on 10/23/2021 at 8:32 PM, E #7 received a report that an ambulance (Unit number M6) will be bringing a patient to the Hospital Campus A's ED. The report included patient's gender, age, and chief complaint of vomiting and dizziness.

2. On 11/16/2021 between 12:45 PM through 1:45 PM, the Hospital Campus A's ambulance bay area and ED entrance video surveillance footage on 10/23/2021 from 8:00 PM through 8:36: 57 PM (hour/minutes/seconds) was reviewed. At 8:36:14 PM, two paramedics were seen inside the Hospital ED's ambulance bay area. One of the two paramedics was wheeling a male patient sitting on the wheelchair wearing a mask. At 8:36:15 PM, the ED double door opened, and the two paramedics wheeled the male patient inside the Hospital's ED. The two paramedics were seen standing by the ED entrance door, while the male patient was sitting on the wheelchair. From 8:36:16 PM through 8:36:55 PM, one of the paramedics was seen speaking to someone by the wall inside the emergency room. At 8:36:56 PM, both the paramedics and the male patient on the wheelchair were seen leaving the ED.

3. On 11/16/2021 at approximately 2:30 PM, the Hospital's policy titled, "EMTALA Screening, Treatment, and Transfer of Patients" dated 02/06/2020 was reviewed and included, " ...Emergency Log: The Hospital will maintain the capacity to generate a central log of each individual who comes to the Hospital seeking emergency assistance. The log will indicate whether the individual refused treatment, was refused treatment, was transferred, was admitted to the Hospital and was treated, was stabilized and transferred, or was discharged ..."

4. On 11/16/2021 at approximately 4:13 PM, the ER Registered Nurse (E #1) was interviewed. E #1 stated that on 10/23/2021, she (E #1) was aware that a patient that needed to be seen in the ED was coming into the Hospital Campus A's ED by ambulance. E #1 stated that during the early part of her shift (7:00 PM through 7:00 AM), a male patient on a wheelchair was brought into the ED by the paramedics. According to E #1, the ED physician ordered the patient to be diverted to another Hospital because the CT scan (computerized tomography machine/creates a more detailed image of body parts) was not working. E #1 stated that she (E #1) told the paramedics to bring the patient to another Hospital because the patient needed a CT scan. E #1 stated that the patient was not document in the ED log.

5. On 11/17/2021 at approximately 9:45 AM, the Director of Nursing ED Services (E #9) was interviewed. E #9 stated that she is surprised that the patient was not registered in the ED log.

Based on video surveillance review, document review, and interview it was determined that for 1 of 20 (Pt. #2) patient reviewed for emergency medical services, the Hospital (Campus A) failed to provide an appropriate medical screening examination (MSE), as required, while the patient was in the emergency room.

Findings include:

1. On 11/16/2021 between 12:45 PM and 1:45 PM, the Hospital Campus A's ambulance's bay area and ED entrance video surveillance footage on 10/23/2021 from 8:00 PM and 8:36: 57 PM (hour/minutes/seconds) was reviewed. At 8:36:14 PM, two paramedics were seen inside the Hospital ED's ambulance bay area. One of the two paramedics was wheeling a male patient sitting on the wheelchair wearing a mask. At 8:36:15 PM, the ED double door opened and the two paramedics wheeled the male patient inside the Hospital's ED. The two paramedics were seen standing by the ED entrance door, while the male patient was sitting on the wheelchair. At 8:36:56 PM, both the paramedics and the male patient on the wheelchair were seen leaving the ED. The video footage did not show that an ED physician performed a medical screening exam of the male patient in the wheelchair.

2. On 11/16/2021 at approximately 2:30 PM, the Hospital's policy titled, "EMTALA Screening, Treatment, and Transfer of Patients" dated 02/06/2020 was reviewed and included, " ...Appropriate medical screening: When a patient comes to the Hospital seeking medical treatment, the Hospital must provide an appropriate MSE [medical screening examination] to determine whether the patient has an EMC [emergency medical condition] ...Basic Medical Screening Procedure: ...patients will be directed either to an examination room or to the ED triage room and then placed in a room ...iv. a physician or QMP (qualified medical professional) must perform an appropriate MSE... e... the following informaiton typically will be documented on the patient's record: i. Vital Signs ii. Allergies... iv. Mode of Admission... viii Clinical Tests and X-Rays Performed ix. Procedures Performed..."

3. On 11/16/2021 at approximately 3:15 PM, the ER Charge Nurse (E #6) was interviewed. E #6 stated that she was the charge nurse on the night shift (7:00 PM through 7:00 AM) on 10/23/2021. E #6 stated that since the ER physician advised paramedics to divert the patient to another hospital.

4. On 11/16/2021 at approximately 3:42 PM, the Emergency Communication Specialist (E #7) was interviewed. E #7 stated that she wrote the ambulance report for (Pt. #2) and informed (E #6) that a male with chief complaint of vomiting and dizziness will be arriving in the ED in 2 to 3 minutes.

5. On 11/16/2021 at approximately 4:13 PM, the ER Registered Nurse (E #1) was interviewed. E #1 stated that on 10/23/2021, she (E #1) was aware that a patient that needed to be seen in the ED was coming into the Hospital Campus A's ED by ambulance. E #1 stated that a male patient on a wheelchair was brought into the ED by the paramedics. According to E #1, the ED physician ordered the patient to be diverted to another Hospital because the CT scan was not working. E #1 stated that she (E #1) told the paramedics to bring the patient to another Hospital because the patient needed a CT scan. E #1 stated that she did not know if the male patient was sick because she did not perform an assessment. E #1 also said that a physician did not see nor examine the male patient.

6. On 11/17/2021 at approximately 9:15 AM, the ER Physician (MD #1) was interviewed. MD #1 stated that on 10/23/2021, she was told by the nursing staff to divert the patients to another hospital since the CT scanner was not working. MD #1 could not recall the decision regarding Pt. #2's diversion.

7. On 11/17/2021 at approximately 9:45 AM, the Director of Nursing ED Services (E #9) was interviewed. E #9 stated that from the video surveillance footages, she (E #9) did not see a medical screening exam done for Pt. #2.

8. On 11/17/2021 at approximately 1:00 PM, the ED Medical Director (MD #2) was interviewed. MD #2 stated that the medical screening should have been done while the patient was within the hospital premises.