HospitalInspections.org

Based on review of ED (Emergency Department ) policies, tour of the hospital, and staff interviews by Surveyor #05409, the hospital failed to ensure compliance with EMTALA regulations 489.24. The hospital failed to provide a medical screening examination to 2 of 9 patients (Patients #1 and #2) who entered the ED door on 7/8/10.

Findings include:

The Emergency Department did not provide a medical screening for 2 of 9 patients (Patients #1 and #2) who presented for emergency care.

See findings for tag C2406.

Based on review of ED (Emergency Department ) policies, tour of the hospital, and staff interviews, the hospital failed to provide a medical screening examination to 2 of 9 patients (Patients #1 and #2) who entered the ED door on 7/8/10. The hospital has no records for #1 & #2. A total of 20 patient records were reviewed and all 20 were found to have had a medical screening exam.

Findings include:

Policy/Procedure # EMR 1626 states, "All patients who are in need of or are requesting emergency services will receive an appropriate Medical Screening Examination as by the Emergency Medical Treatment and Active Labor Act ("EMTALA").

Per interview with Ambulatory Clinical Director A from 11:00 a.m. to 12:00 p.m. on 7/15/10, A said that a family member (mother AA) brought 2 children (Patients #1 and #2) into the emergency entrance door of the hospital on 7/8/10 between 10:30 a.m. and 11:00 a.m. AA picked up the phone inside the door, said that her 2 children needed to be seen by a physician. RN (Registered Nurse) Unit Manager B answered the phone and told AA to go to the main front entrance to register. Receptionist C was at the registration desk at the time. A said that "somehow" AA and Patients #1 and #2 got referred to Essential Care (Urgent Care) and AA spoke with Registrar D. When D learned that the insurance carrier for Patients #1 and #2 was Medical Assistance from the state of Washington, D notified Supervisor E. Registrar D and Supervisor E informed AA that the facility could not accept the carrier from out of state.

The interview with A continued while the hospital was toured. The entrance labeled "Emergency" has an entrance door that is unlocked. There is a phone there and a buzzer with directions to either pick up the phone or use the buzzer upon entrance. The door to enter the emergency department is locked. Per Director A, staff should have offered ED services at the time because ED will except MA (Medical Assistance) from states other than Wisconsin and Minnesota, but staff did not do this.

Per interview with Unit Manager B from 12:30 p.m. to 12:39 p.m. on 7/15/10, B said that on 7/8/10 AA picked up the phone in the inside of the unlocked door at the emergency entrance, said that patients #1 and #2 needed to be seen. B asked AA if AA and Patients #1 and #2 were able to go around to the front (Main) entrance to register. Manager B said that AA did not say "No". Per Manager B if a patient says they are unable to go to the front entrance, then a staff member will go down to the ED to open the (locked) ED door and let the patient into the ED.

Receptionist C, Registrar D, and Supervisor E were not available for interview until 7/19/10.

Per interview with Registrar D from 8:45 a.m. to 8:56 a.m. on 7/19/10, D said that D was not aware that AA and Patients #1 and #2 had gone to the emergency entrance on 7/8/10. D said that AA reported that Patients #1 and #2 needed to be seen for sore throats and does not recall if ED services were offered. When D began entering information into the computer, at the insurance screen, D noted that AA had MA for the state of Washington. Per D, for the clinic (Urgent Care), the facility will not accept MA from states other than Wisconsin and Minnesota and D said D informed AA of this. Per D, AA became upset. Registrar D asked Supervisor E to speak with AA. During the conversation with E, AA said that "They" said that Patients #1 and #2 could be seen anywhere. Registrar D said that D did not know who "they" were. After speaking with Supervisor E, AA and Patients #1 and #2 began to exit the hospital. While exiting AA said, "We're going to go somewhere else."

Per interview with Supervisor E from 9:11 a.m. to 9:22 a.m. on 7/19/10, E said that E told AA that Patients #1 and #2 could be seen in the Urgent Care clinic, but to be seen there, it would be private pay. Supervisor E said that about a year and a half ago E was informed that the hospital would not accept MA from states other than Wisconsin or Minnesota for ED or the Urgent Care; therefore, E did not offer for Patients #1 and #2 to be seen in the ED as it would be more expensive than if #1 and #2 were seen in Urgent Care.

Per interview with Receptionist C from 9:30 a.m. to 9:40 a.m. on 7/15/10, C said C could not recall anything about the incident of 7/8/10 regarding Patients #1 and #2. Photos were shown of AA with Patients #1 and #2 from the security camera at the emergency entrance and at the receptionist desk at the main entrance to the hospital, but this did not aid in C's recollection of the 7/8/10 event. Receptionist C said that C was not aware until this morning, that ED will accept any out of state MA. Per C prior to the morning of 7/19/10, C was aware that the hospital would not accept MA from states other than Wisconsin and Minnesota.

At the exit conference from 10:30 a.m. to 11:00 a.m. on 7/19/10, Chief financial Officer F, CEO G, and Director A concurred that Patients #1 and #2 should have been screened in the ED on 7/8/10, but were not.