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Tag No.: A2400
Based on staff interview and review of medical records and hospital policies, it was determined the hospital failed to comply with the provisions at CFR 489.24(a). The hospital failed to provide an appropriate MSE to 1 of 21 patients (# 21), who came to the ED seeking services on 01/05/2010. The findings include:
1. Refer to A2406 as it relates to the lack of an MSE provided to a patient.
Tag No.: A2406
Based on staff interview and review of clinical records, it was determined the hospital failed to provide an MSE to 1 of 21 patients (#21) who came to the ED seeking treatment. This resulted in delayed assessment, stabilization, and treatment of this patient. The findings include:
An ambulance report, dated 1/05/10 but not specifically timed, stated Patient #21 was a 71 year old male who complained of chest pain and pressure and left arm pain at approximately 3:00 AM that day. The report stated Patient #21 requested and was brought to the Emergency Department at MMH by ambulance on the morning of 1/05/10. The time of arrival was not specified in the ambulance report. The report stated that, upon arrival to the Emergency Department, an RN came out of the hospital and "...explained to pt wife the need for transport to [another hospital approximately 30 miles away.] Pt wife informed pt need for [other hospital.] We were in ambulance bay when MMH didn't want pt. ER MD [Physician A] spoken with on phone advised us he couldn't do anything major for pt and we should go to [other hospital.] Informed [Physician A] we were in ambulance bay and we will divert to [other hospital.] Per [Physician A] MS04 PRN for pt. MMH refused pt in Paramedic's opinion. Pt appears rather upset [due to] diversion."
The face sheet from the hospital that eventually accepted the patient stated Patient #21 arrived there at 6:09 AM on 1/05/10. The "EMERGENCY ROOM REPORT'" dated 1/05/10, stated he was admitted to the receiving hospital's Cardiac Care Unit for treatment.
The MMH RN who met with the ambulance, Nurse B, was interviewed on 1/09/10 at 10:45 AM. She stated Patient #21 came by ambulance to the ED. She stated the patient became more stable in the ambulance before reaching the hospital. She said Physician A told her since Patient #21 was stable, he should be taken to another hospital. She stated she went to the ambulance bay and spoke with the patient's wife. She said she told the wife the patient could be seen at MMH but the patient would be better served at the other hospital. Nurse B stated she spoke with the ambulance driver but did not remember what she told him. Nurse B said she did not see or talk with Patient #21. Nurse B stated the ED physician did not see the patient. Nurse B stated no medical record was generated at MMH and Patient #21 was not entered into the Emergency Room Log.
Physician A, an MMH ED physician, was interviewed on 1/14/10 at 3:05 PM. He stated he was on duty on 1/05/09. He said the nurse informed him a patient was in transit by ambulance to the ED on the morning of 1/05/09. He said the patient had a history of blood clots. He stated a patient came by ambulance to the hospital. Physician A said he was not aware the patient had come to the hospital and was in the ambulance bay. He said he did not see the patient. He said the patient did not receive a medical screening examination.
Patient #21's wife was interviewed on 1/11/10 at 9:15 AM. She stated she had followed the ambulance in her car to MMH on the morning of 1/05/10. She stated the ambulance pulled into the ambulance bay and she walked up to it. She stated she thought her husband was having a heart attack. She said a team of people came out of the hospital and went to the ambulance. She said a nurse told her it would be quicker for Patient #21 to receive treatment if he went to the other hospital. She said hospital staff did not see or examine the patient. She said Patient #21 was oriented and capable of making decisions but she did not think MMH staff spoke with him. She said she went into the ambulance and informed Patient #21 of the decision to go to the other hospital. She stated the physician was not in the group of people from MMH and she did not speak with him.
Patient #21 was interviewed on 1/11/10 at 9:30 AM. He stated he had severe chest pain radiating down his left arm early in the morning on 1/05/10. He said his cardiologist practiced at MMH so he requested the ambulance take him there. He said the ambulance backed into the garage at the hospital. He said MMH staff talked to his wife and the medics. He said he was not examined by MMH staff and he was not asked if he wanted to be seen at the hospital.
The hospital did not conduct an MSE on this emergent patient.