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Based on review of policies and procedures, review of information provided, review of Emergency Department logs, interviews with the patient and interviews with key staff on August 11, 18, 19 and September 1, 2010, it was determined that the hospital failed to meet the needs of a patient on April 22, 2010. (RECORD A)

Findings include:

1. Patient A ' s medical record was reviewed on August 18, 2010. The documentation revealed that the patient complained constantly of back pain. The medical record documentation revealed that the patient received Fentanyl 50 (fifty) micrograms for the pain at 10:44. It was documented that the patient got no relief from this medication and refused the next offer of Fentanyl 50 micrograms at 11:10.

2. Patient A ' s medical record additionally documented that the patient ' s pain level was between 6-10 all the time.

3. Patient A ' s medical record contained documentation that the patient requested pain medication at 11:10, 11:50, 12:15, and 12:30 and received none.

4. Patient A ' s medical record contained documentation by the Registered Nurse that the patient was told that the physician was notified several times that the patient was in pain and requested pain medication.

5. Patient A ' s medical record documented that the patient received Toradol 30 milligrams intravenously and Dilaudid 1 milligram intravenously with subsequent pain relief.

6. When the physician was interviewed on August 18, 2010 via telephone, the physician explained that if he/she had been aware sooner that the Patient A was in pain, that the pain medication would not have been delayed. He/she further stated that it may have been a communication problem with the Registered Nurse and him/her self. The physician additionally stated that none of the patients that followed the Patient A were complicated and therefore would not account for the delay in this patient receiving pain medication in a timely manner.

7. During an interview with the Registered Nurse on August 19, 2010, he/she stated that he/she told the physician several times that Patient A was requesting pain medication.

8. Another interview was conducted with the physician on September 1, 2010. During that interview, the physician stated that he/she had reviewed Patient A ' s medical record and stated that he/she did not understand why there had been a delay in the change of the narcotic analgesic. The physician also stated that he/she did not recall being particularly busy that day and also had no recollection of the nurse speaking with him.