HospitalInspections.org

Based on observation and interview the facility failed to post EMTALA signs in areas likely to be noticed by all individuals that visit the emergency department (ED). Findings include:

On 11/27/2012 at approximately 1100 during a tour of the ED it was observed that EMTALA signs were not posted anywhere in the ED.

On 11/27/2012 at approximately 1100 during an interview with staff C this surveyor asked "Where are the EMTALA signs posted?" Staff C stated "I knew you were going to ask that. We have not moved them over from the old ED. We are getting new ones made, but they do not have them finished yet." This surveyor asked "When did you move here?" Staff C stated "We moved on November 14, 2012."

Based on interview and document review the facility failed to provide a functioning on call system for specialty physicians resulting in a delay in care for 1 of 22 patients (#5). Findings include:

On 11/27/2012 at approximately 1500 during review of the policy titled EMTALA Guidelines in the section titled "On-Call Issues" it is stated "The hospital maintains an on-call list of physicians that best mets the needs of hospital patients receiving required EMTALA services.
1. It is the responsibility of the on-call physician to appear, when requested, within a reasonable amount of time after notification."

On 11/27/2012 at approximately 1400 during review of patient #5 it was revealed that the patient came to the ED on 5/8/2012, after falling on her face in her garden. She was an 89 year old woman who had sustained multiple facial fractures and right orbital blow-out fractures with herniation and comminuted nasal fractures. She had a history of pulmonary and cardiovascular disease and was on blood thinners. A consult for ophthalmology, staff C was ordered on 5/9/12 at 1502. On 5/10/2012 it was documented in a progress note by staff L that the patient ' s daughter was very upset that her mother had not yet received surgery for the facial fractures. Staff L goes on to say in the progress note " We had originally consulted optho [staff K] on May 9th, 2012. I called his office today [May 10th] which stated he could not come to evaluate the patient today. I was given the number of [staff M] and told to ask if he could do a favor for [staff K] and see the patient today. I spoke with [staff M] directly who was apologetic but he was unable to evaluate the patient today. I was given [staff N]'s number by staff M. I spoke to the receptionist at staff N's office who spoke with him. She stated [staff N] was unable to come in as well. " It was also documented that surgery was pending ophthalmology ok. The patient had surgery on 5/12/2012 and no evidence of an ophthalmologist seeing the patient prior to surgery could be found. The above documentation from the medical record was confirmed with staff B, staff C and staff J on 11/27/2012.

On 11/27/2012 at approximately 1215 during review of the on call physicians list, it was revealed there was an organized list of physicians on call. Staff K was the ophthalmologist on call on May 9, 2012, and was unavailable to see patients. Based on the above facts for patient #5, ophthalmology physicians were not available when on call; revealing that the list was not a functional tool.

Based on observation, interview and record review the facility failed to medically screen a patient prior to requesting insurance information for 21 out of 22 patients reviewed (#1-#20) resulting in the potential to miss a medical emergency. Findings include:

On 11/27/2012 at approximately 1125 during an interview with staff F regarding the registration process, it was stated "We ask for the following information in this order Name, DOB, Sex, Race, SS#, Phone, Arrival date and time, ethnicity, language, primary care physician, insurance card and ID, chief complaint." Staff F then provided a "Triage Registration" format that confirmed the order of information collection. This surveyor then asked "Do you collect their ID and insurance card before you ask about their chief complaint?" Staff F stated "Yes, unless they have been here before." This surveyor asked "Are you the first person the patient encounters when they walk into the ED?" Staff F stated "Most of the time."

On 11/27/2012 at approximately 1145 during an interview with staff I this surveyor asked "When do you see the patient, and do you have to wait for certain staff to first see the patients, before you can speak with them." Staff I stated " We go in when we can get in the rooms. We do not have to wait for the doctors or nurses to first see them, we just leave and come back if a doctor or nurse comes in. "

On 11/27/2012 at approximately 1230 during an interview with patient #21 stated he had walked into the ED with an infected foot. The patient stated that among other things he was asked for insurance information at the information desk before being seen by a doctor or nurse; he informed them that he had no insurance information. The patient stated "No one has asked for it again, or asked about payment. But, I have seen the doctor and he said I would be staying overnight for IV antibiotics."

On 11/27/2012 at approximately 1150 during an interview with staff G it was asked by this surveyor if physicians know the insurance a patient has before caring for the patient. "I am an ED physician, when I walk in the room; I have no idea what insurance the patient has. Nor do I know after seeing the patient, unless it is to order medications covered by the patient's insurance." Staff H was asked the same question and responded "No. And, I'm pretty sure it's the same for the other doctors as well."

On 11/27/2012 at approximately 1300 - 1500 during medical record review for patients #1-#20 it was revealed that insurance information was collected in every case before a medical screening exam was completed. Staff C reviewed medical records with this surveyor and confirmed the times indicating that registration was completed before each medical screening exam was completed.