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A. Based on policy review, clinical record review, and staff interview, it was determined that the Hospital failed to ensure compliance with A 2406.

Findings include:

1. The Hospital failed to document patient names on the ED central log and the care that was provided, and the disposition of the patient. See deficiency at A 2405.

2. The Hospital failed to provide a medical screening exam for patients presenting with emergency medical conditions. See deficiency at A 2406.

A. Based on review of Hospital Policy, Emergency Department (ED) central log, and staff interview, it was determined, that for 1 of 21 patient records reviewed (Pt. #1) of patients that presented to the Hospital's ED, the Hospital failed to ensure the ED central log included each patient who presented to the ED.

Findings include:

1. Hospital policy entitled, "Log Book," last reviewed on 2/09, reviewed on 2/29/12 at approximately 10:30 AM required, "Procedure: To identify procedure for recording every patient seen/or treated in the Emergency Room (ER)."

2. Pt #1 was a 63 year old female that presented to the Hospital ' s ED on 2/24/12 at 1:28 AM with complaints of Asthma and a history of Renal Failure on dialysis. Pt # 1 was treated and discharged home in stable condition on 2/24/12 at 4:50 AM.

3. On 2/29/12 at approximately 9:00 AM, the ED central log was reviewed. The log contained an entry for Pt #1 on 2/24/12 but lacked an entry on 2/25/12. Based on observation of the Hospital's security video and staff interview it was determined that Pt. # 1 did present to the Hospital for emergency services on 2/25/12.

4. On 2/29/12 at approximately 11:10 AM the ED physician (E #1) who was on duty on 2/25/12 was interviewed by phone. E #1, also the ED Medical Director, stated, "On 2/25/12 about 12:00 PM, Pt #1's husband came to the front desk and stated that he had brought his wife to the ED because she was not breathing. I went to the car, and the patient (Pt #1) was slumped over in the car and was not breathing. There is no stretcher or back board in the ED so I did not attempt to get Pt #1 out of the car, and I then instructed security to call 911. Since the Hospital's ED is only a Stand By ED and not a 911 facility I waited for the ambulance to arrive to take the patient out. I did not bring Pt #1 into the ED prior to transfer and did not attempt to stabilize Pt #1." Pt #1 was not entered into the ED central log on 2/25/12.

5. The findings were confirmed by the Chief Operating Officer, Director Of Nursing, Emergency Department Nurse Manager, and Director of Performance Improvement/Medical Staff Office during an interview on 3/1/12 at approximately 4:00 PM.

A. Based on review of Hospital's Security video, Chicago Fire Department run sheet, clinical record and staff interview, it was determined, that for 1 of 21(Pt. #1) patient records reviewed of patients that presented to the Hospital's Emergency Department, the Hospital failed to provide a medical screening exam.

Findings include:

1. On 2/29/12 at approximately 11:10 AM, the ED physician (E #1) on duty on 2/25/12 was interviewed by phone. E #1, also the ED Medical Director, stated, "On 2/25/12 about 12:00 PM, Pt #1's husband came to the front desk and stated that he had brought his wife to the ED because she was not breathing. I went to the car, and the patient (Pt #1) was slumped over in the car and was not breathing. There is no stretcher or back board in the ED so I did not attempt to get Pt #1 out of the car, and I then instructed security to call 911. Since the Hospital's ED is only a Stand By ED and not a 911 facility I waited for the ambulance to arrive to take Pt. #1 out. I did not bring Pt #1 into the ED prior to transfer and did not provide any care to the Pt. #1." There is no documentation that Pt #1 received a medical screening exam. The review of the hospital's security video and staff interview contradicted E#1's statement that E#1 went to the car to assess pt. #1's status.

2. On 2/29/12 at approximately 11:20 AM the ED nurse (E #2) was interviewed by phone. E #2 stated, " On 2/25/12 at approximately 11:30 AM to maybe 12:00 PM, security came into the ED and said a lady was in her car and was non-responsive and not breathing. I called E#1 and then went to Pt. #1. At that time E #1 arrived on the scene and told security to call 911 and I was told to return to the ED. Approximately 2 - 3 minutes later the paramedics arrived and got pt. #1 out of the car and left."

3. On 2/29/12 at approximately 1:30 PM the security guard on duty in the ED (E #3) was interviewed by phone. E #3 stated, "I was sitting at the desk at 11:30 AM and a guy drove his car up to the ED and said his wife was not breathing. I went to the ER and got the nurse and MD, I grabbed a wheelchair and headed outside to the car. The doctor (E#1) did not come outside with me. I told the nurse that the patient was not breathing. The MD(E#1) told the nurse (E#2) to come back inside because we do not go outside to treat patients. The doctor (E#1) told me to call 911. It took about 10 minutes to get here. The Chicago Fire Department Paramedics laid the patient on the ground and did CPR. "

5. The Hospital's ED security video dated 2/25/12 was reviewed at approximately 1:50 PM in the presence of the COO and DON. The tape included: At 11:47 AM a car pulled up to the Hospital ' s ED (front end of the care was visible) and a man entered the ED. The man was identified as only a male driver of Pt #1 by the COO and DON. At 11:48 AM the man entered the ED. At 12:03 and 10 sec the paramedics appeared at the car. At no time, in the video, was the ED physician observed exiting the ED or assessing the patient. The hospital staff did not provide any medical treatment to Pt. #1 for the 15 minutes that pt. # 1 was in the ED parking drive.

6. The Chicago Fire Department (CFD) run sheet for Pt. #1, was reviewed on 3/1/12 at approximately 10:AM. Pt #1 was a 63 year old female. The CFD run sheet, dated 2/25/12 indicated that the CFD was dispatched at 11:54 AM and arrived on the scene at 12:01 PM at hospital A. Documentation of the CFD run sheet included, "Upon arrival, patient found lying supine on ground on apron of hospital(A) ER entrance unresponsive, pulse less without spontaneous respirations and fixed an dilated pupils." CFD began CPR and followed ACLS protocol. CFD left the hospital A premises at 12:15 PM and arrived at Hospital B at 12:21 PM. The triage assessment at hospital B included information that Pt. #1 was unresponsive, pulse less and not breathing. Resuscitative measures were unsuccessful and the Pt. was pronounced dead at 12:33 PM on 2/25/12.

7. The findings were confirmed by the Chief Operating Officer, Director Of Nursing, Emergency Department Nurse Manager, and Director of Performance Improvement/Medical Staff Office during an interview on 3/1/12 at approximately 4:00 PM.