HospitalInspections.org

Based on interview and record review the hospital's dedicated emergency department failed to comply with the requirements for the Emergency Medical Treatment and Labor Act (EMTALA) at §489.24.

Findings include:

The hospital failed to provide an appropriate medical screening examination to an individual who presented by ambulance to the parking lot of the emergency department (ED) for 1 of 21 patients presenting to the emergency department over the previous six months. (Patient #21). Refer to TAG: 2406.

The hospital failed to provide an appropriate transfer to 1 of 21 sampled patients (Patient #21). Refer to TAG: 2409.

Based on record review and interview, it was determined that the hospital failed to provide an appropriate medical screening examination to an individual who presented by ambulance to the parking lot of the emergency department (ED) for 1 of 21 sampled patients presenting to the emergency department over the previous six months. (Patient identifier is #21)

Findings include:

Review on 7/31/19 of the Emergency Medical Services (EMS) pre-hospital incident report for Patient #21, dated 7/12/19, revealed that Patient #21 arrived at the hospital's emergency department on 7/12/19. The above report revealed that after arrival the hospital requested that EMS transport Patient #21 to another hospital. The report also revealed that EMS did transport Patient #21 to another hospital without the patient first being seen for a medical screening.

Review on 7/31/19 of the hospital's medical control log, used to log all radio contact between the emergency department and ambulance services, revealed no evidence that the emergency department was contacted concerning Patient #21 on 7/12/19.

Review on 7/31/19 of the facility's policy and procedure titled "Emergency Medical Care/ EMTALA [Emergency Medical Treatment and Labor Act]", revised 11/2018, revealed the following procedure: "1. External Acute Transfers a. All patients presenting to [Hospital name omitted] for treatment shall have a medical screening examination appropriate to the individual's presenting signs and symptoms, by qualified personnel."

Interview on 7/31/19 at approximately 11:00 a.m. with Staff A (Vice President, Risk Management) and Staff B (Quality Improvement & Risk Assessment) confirmed the above findings. Staff A and B revealed they had initiated a root cause analysis. Staff A and Staff B revealed that prior to arriving at the hospital, the emergency room staff had consulted with the ambulance who was transporting Patient #21 and the hospital requested that the patient go directly to another hospital with a higher trauma rating. The ambulance relayed that they were not sure if they could. The hospital called the ambulance back approximately five minutes later and discovered that the ambulance had already arrived at the hospital and one of the emergency personnel from the ambulance had entered the hospital. After conversation between hospital staff and the ambulance staff, the patient was transported to another hospital with the higher trauma rating and the ambulance left without Patient #21 receiving a medical screening by qualified personnel.

Based on interview and record review, the hospital failed to provide an appropriate transfer to 1 of 21 sampled patients (Patient #21).

Findings include:

Review on 7/31/19 of the Emergency Medical Services (EMS) pre-hospital incident report for Patient #21, dated 7/12/19, revealed that Patient #21 arrived at the hospital's emergency department on 7/12/19. The above report revealed that after arrival the hospital requested that EMS transport Patient #21 to another hospital. The report also revealed that EMS did transport Patient #21 to another hospital without the patient first being seen for a medical screening.

Interview on 7/31/19 at approximately 11:00 a.m. with Staff A (Vice President, Risk Management) and Staff B (Quality Improvement & Risk Assessment) revealed the emergency room staff had consulted with the ambulance who was transporting Patient #21 prior to them arriving at the hospital and the hospital requested that the patient go directly to another hospital with a higher trauma rating. The ambulance relayed that they were not sure if they could. The hospital called the ambulance back approximately five minutes later and discovered that the ambulance had already arrived at the hospital and one of the emergency personnel from the ambulance had entered the hospital. After conversation between hospital staff and the ambulance staff, the patient was transported to another hospital with the higher trauma rating and the ambulance left without Patient #21 receiving a medical screening by qualified personnel to determined if an emergency medical condition existed.