HospitalInspections.org

Based on observations, review of Medical Staff Bylaws and Rules and Regulations, facility policies and procedures, medical records (MR), Emergency Department (ED) Central Patient Log, Emergency Medical Services (EMS) Patient Care Reports (PCR), facility video surveillance footage, Hospital B (Piedmont Columbus Regional Midtown) and Hospital C (Piedmont Columbus Regional Northside) medical records, and interviews it was determined Jack Hughston Memorial Hospital (JHMH) failed to:

1. Identify and approve individual(s) qualified to perform the medical screening examination (MSE) for the ED in the facility medical staff bylaws or rules and regulations. This had the potential to affect all patients presenting to the ED.

2. Receive patients presenting on hospital grounds for treatment, and not have the patient wait in the ambulance until COVID-19 tests results were obtained, to provide a MSE and stabilizing treatment. This affected 6 of 9 records reviewed who arrived via ambulance and 2 of 16 records reviewed who arrived by car, including:

a. Patient Identifier (PI) # 20 who presented on 8/17/21 at 12:40 PM via EMS and waited in the ambulance 59 minutes before being taken into the ED.

b. PI # 16 who presented on 8/4/21 at 1:12 PM via EMS and waited in the ambulance 59 minutes before being taken into the ED.

c. PI # 17, an unstable patient who presented on 8/11/21 at 8:03 PM via ambulance and waited in the ambulance 18 minutes before being taken into the ED.

d. PI # 14 who presented on 7/28/21 at 2:36 PM via EMS and waited in the ambulance 45 minutes before being transported to Hospital B.

e. PI # 23, a motor vehicle accident victim, who was taken to JHMH via ambulance as requested by the patient on 7/16/21. EMS personnel were informed en route by the ED physician the ambulance personnel could not bring the patient into the ED but the patient could walk in and would be seen. PI # 23 was dropped off by EMS at the hospital entrance.

f. PI # 21, who presented via ambulance on 8/24/21 at 11:04 AM and waited in the ambulance 44 minutes, as observed by the surveyor, before being taken into the ED.

g. PI # 24, a patient who was dropped off at the ED by a friend for treatment of flu-like symptoms on 8/11/21 at 7:50 PM. Signage at the ED entrance directs patients with symptoms to return to the car and call a posted number to be seen in the ED. PI # 24 was denied access to the facility and had no car available to return to. PI # 24 called 911 and was transported to Hospital C for treatment.

h. PI # 25, who was brought to the facility by two police officers for psychiatric care on 8/13/21 at 10:48 PM. PI # 25 was not registered on the Central Log and not provided a MSE. EMS arrived at JHMH at 11:04 PM and transported PI # 25 to Hospital B for treatment.

3. Provide a MSE and stabilizing treatment for 1 of 1 MR for a patient presenting with suicidal thoughts. PI # 6 presented to the ED on 5/12/21 at 1:15 PM with chief complaint of suicidal thoughts. PI # 6 left prior to triage and a MSE. This had the potential to affect all patients presenting to the ED with suicidal thoughts.

4. Inform patients leaving the ED before receiving a MSE of the risks and benefits of the examination, make and document efforts to obtain a written refusal and reason for leaving. This effected PI # 23, PI # 6 and had the potential to affect all patients who leave the ED before being seen by the physician.

5. Ensure registered patients waiting in cars were monitored and triaged promptly. This affected PI # 22 and had the potential to affect all patients assigned to wait in the car for triage.
PI # 22 presented to the ED on 8/24/21 and was registered at 11:45 AM and instructed to wait in the car for triage. At 2:09 PM PI # 22 called registration to question why the nurse had not contacted him/her. PI # 22 waited in the car 3 hours and 39 minutes without being monitored or contacted by ED staff.

Refer to A 2406 and A 2407 for findings.

Based on review of facility policies and procedures and Emergency Department (ED) central patient log, EMS (Emergency Medical Services) Patient Care Reports (PCR), facility video surveillance footage and interviews it was determined the facility failed to ensure all patients presenting for treatment on hospital property were entered on the ED central log.

This deficient practice affected 3 of 3 medical records (MR) reviewed who presented on hospital property including Patient Identifier (PI) # 23, PI # 24, PI # 25, and had the potential to affect all patients presenting to this ED.

Findings include:

Facility Policy Name: Emergency Medical Treatment and Labor Act (EMTALA) Central Log
Policy Number: 760.204
Reviewed Date: 11/30/2020

Policy:

The hospital will maintain a central log to include information for each individual that presents to the Emergency Department or is on hospital property seeking treatment for a potential emergency medical condition.

Purpose:

To identify and document each individual who either 1) comes to the Emergency Department seeking treatment for a medical condition, or 2) is present on the hospital property seeking care for an emergency medical condition.

Procedure:

1) The log must contain:
The name of the individual who comes to the emergency department
seeking assistance, and whether the individual:
Refused treatment
Was refused treatment
Was transferred
Was admitted and treated
Was stabilized and transferred, or
Was discharged.

2) A log entry should be made at the initial point of contact. This should occur prior to or at the time of triage and then finalized after the medical screening and/or any necessary treatment...

Facility Policy Name: EMTALA-Medical Screening Examination and Stabilization Policy
Policy Number: 760.203
Reviewed Date: 11/30/2020

IV. Procedure

D. Registration and Log

a. Each patient that presents to the hospital...must be listed in the Central Log.

1. Review of the EMS PCRs, video surveillance footage, and still shots provided by the facility revealed the following patients presented on the hospital premises seeking treatment;

a. PI # 23 was transported to the facility via ambulance on 7/16/21 at 8:48 AM. Review of the EMS PCR number 64334 for PI # 23 revealed documentation EMS called in to the facility to make them aware of PI # 23, a motor vehicle accident victim, who requested to be taken to Jack Hughston Memorial Hospital (JHMH). EMS personnel were informed en route by the ED physician, the ambulance personnel could not bring the patient into the ED but the patient could walk in and would be seen. PI # 23 was dropped off by EMS at the hospital entrance as verified by video surveillance.

b. PI # 24 dropped off at the ED via private vehicle on 8/11/21 at 7:50 PM per hospital video surveillance and still shots. PI # 24 was denied entrance and was observed on video walking around talking on the phone outside the ED. PI # 24 was observed being picked up by EMS on hospital property and being transported away from JHMH.

c. PI # 25 presented to the ED via police transport on 8/13/21 at 10:48 PM per hospital video surveillance and still shots. Video surveillance revealed EMS arrived on hospital property, picked up PI # 25 at 11:12 PM and transported away from JHMH.

The ED central log was requested for the time period of 2/22/21 to 8/22/21. Review of the ED central log revealed no documentation PI # 23, PI # 24, or PI # 25 was registered.

The surveyor requested facility documentation, including the medical record (MR) and registration log for PI # 23 for date of service (DOS) 7/16/21, PI # 24 for DOS 8/11/21, and PI # 25 for DOS 8/13/21. No documentation was provided.

The facility failed to follow their policy and list each individual on the central log that presented to the Emergency Department or was on hospital property seeking treatment for a potential emergency medical condition.

In an interview conducted on 8/24/21 at 10:40 AM, Employee Identifier # 3, Chief Nursing Officer, confirmed there were no MR's for the requested patients and that the requested patients were not on the ED central log.

Based on review of facility policies and procedures, Medical Staff Bylaws and Rules and Regulations, medical record (MR) reviews, Leaving Against Medical Advice Log, Diversion Log, EMS (Emergency Medical Services) Patient Care Reports (PCR), Hospital B (Piedmont Columbus Regional Midtown) MR reviews, Hospital C (Piedmont Columbus Regional Northside) MR reviews, and interviews, it was determined Jack Hughston Memorial Hospital (JHMH), (Hospital A), failed to:

1. Identify and approve individual(s) qualified to perform the medical screening examination (MSE) for the Emergency Department (ED) in the medical staff bylaws or rules and regulations.

2. Ensure all patients presenting to the ED were triaged and received a MSE including 6 that arrived by ambulance and 4 who arrived by car.

3. Provide a MSE and stabilizing treatment for 1 of 1 MR for a patient presenting with suicidal thoughts. Patient Identifier (PI) # 6 presented to the ED on 5/12/21 at 1:15 PM with chief complaint of suicidal thoughts. PI # 6 left prior to triage and a MSE. This had the potential to affect all patients presenting to the ED with suicidal thoughts.

4. Ensure registered patients waiting in cars were monitored and triaged promptly.

This deficient practice affected 10 of 25 MRs reviewed including PI # 23, PI # 24, PI # 17, PI # 21, PI # 6, PI # 14, PI # 20, PI # 25, PI # 16, PI # 22 and had the potential to affect all patients served by this ED.

Findings include:

Facility Policy Name: Emergency Medical Treatment and Labor Act (EMTALA)-Medical Screening Examination and Stabilization Policy
Policy Number: 760.203
Reviewed Date: 11/30/2020

I. Policy

It is the policy of JHMH to provide an appropriate Medical Screening Examination to any person requesting treatment or an examination, by a physician to determine whether an Emergency Medical Condition exists or not....

IV. Procedure

A. Medical Screening Examination (MSE)

1. Any individual who comes to the ED and makes a request or a request has been made on the individual's behalf, who comes onto the hospital premises or has been brought in by ambulance, for examination or treatment of a medical condition will be screened.

3. In the event that an EMS provider presents to the hospital with an individual and the hospital does not have the capacity or capability to provide an immediate MSE....the hospital must still assess the individual upon arrival ...

B. Triage

The patient will be triaged promptly by a Registered Nurse (RN)....Triage establishes the order in which an individual will be evaluated and is not considered an emergency MSE....

C. Patient Care

The MSE will be conducted by the ED physician...

E. Consent or Refusal of Screening Examination

2. If the patient refuses the medical screening exam, then the patient is informed of the risks and benefits to such an examination, and the emergency department personnel shall make every attempt to obtain the informed refusal in writing by having the patient sign the, "Release for Leaving the Hospital Against Medical Advice" form. This form shall become a permanent part of the patient's hospital record. In the event that a written refusal cannot be obtained, the hospital personnel must document the steps taken to secure written refusal and the reason it was not obtained.

Facility Policy Name: Suicidal-Homicidal Patient
Policy Number: 760.182
Revised Date: 10/12/2020

I. Policy

A suicide/homicide risk screen will be completed for all patients presenting to Jack Hughston Memorial Hospital Emergency Department at the time of triage...Patients under suicide precautions will be continuously monitored, kept free from harm, and will receive education regarding suicide prevention.

II. Purpose

Guidelines will be used to identify and provide care to patients at risk for suicide.

IV. Procedure

During triage, the RN will perform suicide risk screening in the Self Harm section of the triage screen on all patients.


1. The facility medical staff Bylaws and Rules and Regulations were received from Employee Identifier (EI) # 1, Vice President of Operations, on 8/23/21.

Review of the facility medical staff bylaws and rules and regulations revealed no documentation to identify and approve the individual(s) qualified to perform the MSE in the ED.

An interview was conducted with EI # 1 on 8/26/21 at 9:45 AM, who confirmed there was no documentation to identify and approve the individual(s) qualified to perform the MSE in the facility Medical Staff Bylaws and Rules and Regulations.

2. PI # 23 was transported via ambulance from the scene of a motor vehicle accident (MVA) to JHMH on 7/16/21. Per review of the EMS PCR number 64334 narrative, PI # 23 was ambulatory on scene and stated he/she had been running over 70 miles per hour (MPH) at the time of the accident, and requested EMS transport him/her to JHMH. Further review of the PCR narrative revealed when EMS called report to JHMH, EI # 6, ED Medical Director, refused to accept the patient and stated EMS needed to divert to another facility. After being informed by EMS of JHMH refusal, PI # 23 refused to go to any other hospital. EMS called back to JHMH, again spoke with EI # 6, gave EI # 6 full report and that PI # 23 refused to go elsewhere. Per the PCR narrative, EI # 6 still refused to accept the patient, but stated if PI # 23 walked into the ED, he/she would have to take her, but EMS could not bring him/her into the ED.

The surveyor requested documentation of communications between EMS and ED staff during transport. EI # 2, ED Director, stated the ED staff was supposed to document the communication in the electronic medical record but have not been doing it. No documentation was provided.

Review of video surveillance and still shots provided by the facility, with content confirmed by EI # 1, of the hospital's main parking lot and entrance on 7/16/21 revealed PI # 23 arrived to the front (main) entrance of the hospital via ambulance at 8:48 AM, and then PI # 23 walked around to the ED walk in entrance at 8:51 AM. Further review of video surveillance and still shots revealed PI # 23 walking away from the ED walk in entrance at 9:10 AM.

Review of the ED log dated 7/16/21 revealed PI # 23 was not listed on the log. The surveyor requested the MR for PI # 23. None was provided.

The facility failed to perform prompt triage per policy and provide a MSE for PI # 23 that presented on the hospital property via ambulance on 7/16/21.

In an interview conducted on 8/24/21 at 10:40 AM, EI # 3, Chief Nursing Officer, confirmed there was no MR for PI # 23, and PI # 23 was not on the ED central log.

An interview was conducted on 8/25/21 at 12:30 PM with EI # 6, Medical Director. EI # 6 was asked if he/she remembered being called by EMS for PI # 23 on 7/16/21. EI # 6 stated, "it sounded familiar. It was reported to me by EMS as a high speed trauma and was beyond the scope of our facility." "We have no trauma back up or surgeons on the weekends. No way to do surgery if having internal bleeding."

Review of the diversion log provided by the facility revealed JHMH was not on diversion on 7/16/21.

3. Review of the EMS PCR number 73323 revealed EMS was dispatched to JHMH after PI # 24 called 911 from the hospital parking lot with a chief complaint of flu like symptoms, nature of call; breathing difficulty.

EMS arrived on scene at 7:14 PM CT (central time) and PI # 24 was placed in the ambulance. Vital Signs (VS) were assessed at 7:45 PM CT: BP 140/98, Pulse 99, strong and regular, Respirations 16 and normal, Oxygen (O2) saturation 96% on room air.

Review of the PCR narrative documentation revealed the patient went to JHMH and the doors were shut with a number to call to be seen in the ED, and when staff came to the door PI # 24 was told they could not see him/her, PI # 24 called 911. The PCR narrative also documented once contact was made with PI # 24, EMS called the hospital and was told they were full. Further review of the PCR narrative revealed EMS walked to the EMS door entrance (ambulance bay), and was approached by an ED nurse who stated PI # 24 would need to return to his/her vehicle and wait until they had a room or they would place a chair under the awning for PI # 24 to sit on until they were able to see him/her. The PCR narrative documented by this time, PI # 24 had laid down on the ground, and EMS decided to transport, priority non-emergency, to another facility.

The surveyor requested documentation of communications between EMS and ED staff. EI # 2 stated the staff failed to document the communication with EMS and none was provided.
Review of video surveillance and still shots provided by the facility, with content confirmed by EI # 1, revealed PI # 24 presented to the ED walk in entrance via private vehicle on 8/11/21 at 7:50 PM. Still shot at 8:18 PM revealed PI # 24 had walked away from the facility ED, and was on the paved hospital entrance drive where he/she was picked up by EMS. EMS pulled up to the facility ambulance bay at 8:24 PM, and PI # 24 and both EMS were noted standing at the facility ambulance bay entrance, talking to ED staff at 8:25 PM. The next still shot revealed PI # 24 talking on cell phone, walking towards the ambulance at 8:28 PM. A still shot at 8:32 PM revealed the ambulance on the paved hospital entrance drive leaving the facility.

Review of the ED log dated 8/11/21 revealed PI # 24 was not listed on the log. The surveyor requested the MR for PI # 24. None was provided.

JHMH failed to perform prompt triage per policy and provide a MSE for PI # 24 that presented on the hospital premises on 8/11/21.

In an interview conducted on 8/24/21 at 10:40 AM, EI # 3 confirmed there was no MR for PI # 24, and PI # 24 was not on the ED central log.

Review of Hospital C's MR for PI # 24 revealed PI # 24 arrived via EMS transport on 8/11/21 at 8:45 PM with a chief complaint of shortness of breath (SOB) and possible COVID exposure. PI # 24 was treated and discharged home in stable condition with a diagnosis of Cough, Upper Respiratory Tract Infection, Unspecified Type, SOB with Exposure to COVID.

4. Review of EMS PCR number 73308 dated 8/11/21 for PI # 17 revealed a chief complaint of flu type symptoms, nature of call; breathing difficulty, with a history of Diabetes Type 2, Hypertension, Chronic Respiratory Bronchitis, and Cardiac Disease. EMS arrived on scene at 6:29 PM CT and PI # 17 was sitting on the couch with family who stated the spouse of PI # 17 was diagnosed with COVID 19 the week prior, and PI # 17 started feeling sick and became very weak with shortness of breath within a few days. The daughter of PI # 17 also stated that PI # 17 was only responding to pain.

VS and EMS Assessment and Treatment 6:54 PM CT: BP 88/50, Pulse 74, weak and regularly irregular, Respirations 12 and shallow, O2 saturation 69% on room air, Blood Glucose 236. Skin Color, Pale, Skin Moisture, Clammy, Lung Sounds Left and Right, Diminished. LOC (Level of Consciousness) Painful with spontaneous movement, ECG (electro-cardiogram) Atrial Fibrillation. PI # 17 was placed on a non-rebreather oxygen mask with 15 liters per minute (L/M) oxygen flow. IV (intravenous) access was obtained with a 20 gauge in left forearm and bolus of 500 milliliters (ML) 0.9% Normal Saline begun with improved response.

VS at 7:01 PM CT: BP 112/65. Pulse 78, weak, regularly irregular, Respirations 12 and shallow, O2 95% on oxygen 15 L/M. LOC and rest of assessment remained unchanged.

PI # 17 was transported emergency priority to JHMH per family request and arrived at the facility at 7:03 PM CT. Review of PCR narrative documentation revealed upon arrival, EMS were met in the ambulance bay by EI # 8, RN, who stated that PI # 17 had to be tested for COVID before being allowed to be brought in to be treated. PCR documents EMS waited approximately 15-20 minutes outside in the ambulance with PI # 17 being unstable, still only responsive to painful stimulus. PI # 17 tested positive for COVID 19 and was placed in ED room number 8 where care was turned over to ED staff.

Review of the ED records revealed PI # 17 was registered on 8/11/21 at 8:17 PM. A COVID 19 swab sample was obtained at 8:15 PM while PI # 17 was in the ambulance. PI # 17 was brought into the ED and placed in a treatment room at 8:35 PM and received triage assessment by EI # 8, with an assigned acuity level of 2. The triage assessment documented a chief complaint of Fever, Shortness of Breath, Chills, Altered Mental Status, and known COVID 19 Exposure with VS: BP 96/42, HR (heart rate) 84, RR (respiratory rate) 20, O2 Saturation 80% on room air, Temp 100.5 F axillary.

Further review of the MR revealed PI # 17 received his/her MSE on 8/11/21 at 8:43 PM where the Physical Exam documented by the physician stated: VS have been reviewed as abnormal, hypotensive, oxygen saturation low...Appearance lethargic, patient in moderate distress....Respiratory, moderate respiratory distress.

PI # 17 was admitted as an inpatient from the ED.

Review of video surveillance and still shots provided by the facility, with content confirmed by EI # 1, revealed PI # 17 arrived via ambulance on 8/11/21 at 8:08 PM, and ED staff member was seen approaching the ambulance. Still shot at 8:13 PM revealed ED staff walking towards ambulance to perform COVID 19 swab, then returning towards the ED ambulance entrance at 8:15 PM holding the swab. Further review of still shots revealed PI # 17 being unloaded from the ambulance at 8:26 PM.

The facility had PI # 17 wait in the ambulance and did not allow PI # 17 to enter the facility for 18 minutes to receive triage and a MSE.

In an interview conducted on 8/25/21 at 2:34 PM, EI # 2 confirmed PI # 17 received COVID swab in the ambulance at 8:15 PM, and was not brought inside the ED until 8:35 PM, waiting 20 minutes to receive the MSE.

5. PI # 21 was observed by the surveyor at the facility ED ambulance bay still inside the ambulance with EMS on 8/24/21 at 11:04 AM. EI # 9, RN, was present and obtaining VS, asking COVID screening questions, and beginning triage assessment. EI # 9 obtained a COVID swab sample at 11:08 AM while PI # 21 remained in the ambulance.

PI # 21 was observed being brought into the ED and placed in treatment room number 6 at 11:45 AM.

Review of the ED record revealed PI # 21 was registered at 11:09 AM, and had Triage assessment at 11:03 AM with an assigned acuity level of 3.

VS at 11:14 AM: BP 141/86, HR 90, RR 18, O2 saturation 96%, Temp 98.7, Pain level 7/10. PI # 21 had a history of Chronic Lower Extremity Pain, Hypertension, AFib (Atrial Fibrillation), Intervertebral Disc Disease, Coronary Artery Disease, Depression, Diabetes Mellitus, and Congestive Heart Failure.

PI # 21 received the MSE by the physician at 11:53 AM.

PI # 21 waited inside the ambulance for 44 minutes waiting for the COVID test results, which resulted at 11:51 AM.

An interview was conducted on 8/25/21 at 2:37 PM with EI # 2, who was asked if a room was available for PI # 21 at the time of arrival by EMS? EI # 2 stated, "yes." The surveyor then asked why was PI # 21 not placed in a room? EI # 2 stated "it was pending the COVID test."

6. PI # 6 presented to the ED and was registered on 5/12/21 at 1:15 PM with a Chief Complaint of Suicidal Thoughts/Mental Health Issues.

Review of the facility Leaving Against Medical Advice Log provided by the facility revealed PI # 6 left prior to triage.

Review of the MR revealed PI # 6 signed the General Consent for Treatment and Tests at 1:16 PM. There was no documentation PI # 6 was triaged, including a Suicide Risk Assessment, or had a MSE to determine if PI # 6 had an emergency medical condition. Further, there was no documentation hospital staff implemented steps to prevent PI # 6 from leaving the ED prior to receiving a Suicide Risk Assessment and MSE.

An interview conducted on 8/25/21 at 2:17 PM with EI # 2 confirmed PI # 6 left prior to triage and there was no documentation the staff implemented steps to prevent PI # 6 from leaving the ED.



36271

7. Review of the EMS PCR # 68397 dated 7/28/21 for PI # 14 revealed:

Chief complaint of Malaise/General Weakness with a history of Hypertension, Schizophrenia and Seizure Disorder. EMS arrived on scene at 12:52 PM CT (Central Time) and PI # 14 was sitting on the porch, reported he/she ran out of seizure med's and had been vomiting for 3 days.

VS at 1:14 PM (CT): BP 182/115, Pulse 89 and regular, Respirations 18 and Oxygen (O2)saturation 99% on room air.

VS at 1:23 PM (CT): BP 169/107, Pulse 91, Respirations 18 and O2 99% on room air.

IV access obtained with 18 gauge in right AC (antecubital). Temp 97.7 (forehead). Alert/oriented. Transported non emergency to JHMH. Report called with 5 minute ETA (estimated time of arrival). Mask placed on patient and started to get patient out of ambulance but staff met crew at door and advised to keep patient in ambulance for now...patient was registered....COVID tested at back door of ambulance...staff stated did not have a room...after approximately 40 minutes of not being allowed inside the ER, patient wanted to go somewhere else...transported to (Hospital B).

Review of the ED records revealed PI # 14 was registered on 7/28/21 at 2:44 PM. A COVID 19 swab was obtained at 2:44 PM while the patient was in the ambulance. PI # 14 left the ED at 3:11 PM before triage, "the patient appears to be alert, oriented x 4, coherent and in no acute distress. He/she stated leaving with EMS going to another facility. Notified the ED physician of patient departure. Patient left without signing form prior to leaving...the COVID 19 test was resulted negative at 3:27 PM.

There was no documentation the hospital staff performed a triage/nursing assessment including vital signs and a medical screening examination (MSE).

Further review of the ED records revealed a single page: "Milestones: Arrival 2:44 PM, Triage 3:20 PM, Registration 2:44 PM, To Treatment Room 2:49 PM, and Seen by Nurse 2:51 PM."

Questions were submitted to EI # 2 to validate the Milestone times documented above which conflicted with other documentation in the ED record. EI # 2 confirmed the entries in "Milestones" were not accurate.

Review of the hospital video surveillance dated 7/28/21 revealed the ambulance arrived in the ED bay at 2:36 PM, EMS personnel approached the ED door at 2:38 PM, hospital employee completed COVID swab 2:49 PM, and the ambulance left the bay at 3:12 PM transporting PI # 14 away from JHMH. Still photos were provided and verified as PI # 14 by EI # 1, VP of Operations on 8/26/21 at 2:00 PM.

PI # 14 waited in the ambulance on hospital property from 2:36 PM to 3:11 PM, a total of 35 minutes prior to being transported to another facility (Hospital B).

The surveyor requested documentation of the communication report by EMS prior to PI # 14 arriving at the ED. EI # 2 stated the staff failed to document the EMS communication. No documentation was provided.

The facility failed to receive a patient with elevated BP, who arrived via ambulance, and provide a MSE until after COVID test results.

An interview conducted 8/24/21 at 1:55 PM ET (eastern time) with EI # 2, ED Director, confirmed PI # 14 was held in the ambulance pending results of a COVID 19 test, no triage assessment was performed, no MSE was performed and PI # 14 was transported to another facility prior to signing forms. EI # 2, further stated the staff failed to document the communication from the EMS staff when en route, and there was no way to identify what ED beds were available

Review of the ED records from Hospital B revealed PI # 14 arrived via ambulance on 7/28/21 at 3:32 PM. BP at 3:46 PM was 168/125. PI # 14 was treated and discharged home at 4:10 PM.

8. Review of the EMS PCR # 2108-2696 dated 8/17/21 for PI # 20 revealed:

Responded to scene with patient sitting in driver's seat of vehicle on roadside. Patient stated began having severe migraine, was driving to the hospital, began vomiting, pulled to roadside and called EMS, pain 10/10, pain increases with bright light. Patient requested transport to JHMH.

From scene to JHMH without incident, at destination staff would not let EMS unload patient until they could get nasal swab for COVID 19 and get results back.

Arrived at JHMH at 11:40 PM CT.

Review of the ED records revealed a rapid COVID 19 swab was obtained at 12:55 AM ET (8/18/21) and resulted as negative at 1:28 AM ET.

Further review of the PCR revealed IV access was obtained at 12:05 AM (1:05 ET) and Ondansetron 4 milligrams IV was administered to PI # 20 by EMS (PI # 10 Paramedic) while waiting in the ambulance. PI # 20 was transported into the ED at 12:39 AM (1:39 ET).

Review of the facility video surveillance and still shots provided by the facility confirmed PI # 20 arrived by ambulance at 12:45 AM on 8/18/21 and was taken from the ambulance into the ED at 1:36 AM. Still photos were provided and verified as PI # 20 by EI # 1, on 8/26/21 at 2:00 PM.

The facility failed to receive a patient arriving via ambulance upon arrival and provide a MSE until after COVID test results.

PI # 20 waited in the ambulance 59 minutes prior to having a MSE performed.

An interview conducted 8/26/21 at 12:25 PM with EI # 10, Paramedic, confirmed PI # 20 was not allowed to enter the facility ED until after a COVID 19 test was obtained and resulted. EI # 10 further confirmed PI # 20 required IV medication administration while waiting in the ambulance on hospital property, and stated "they were not treating (him/her) so I did."

9. Review of the EMS PCR # 74053 dated 8/13/21 for PI # 25 revealed:

Chief complaint Psychotic/psychosis

Dispatched emergency to parking lot of Jack Hughston Memorial Hospital in reference to an AMS (altered mental status) patient. On arrival..PD (police department) advised they picked pt up elsewhere and brought to Jack Hughston because the pt told them "people were out to kill him and people are following him."..." just wants to be taken back to the hospital so (he/she) can be safe."

VS at 10:16 PM CT: BP 131/89, Pulse 125 strong, O2 96% on room air, refused temp.

Pt walked without assistance to ambulance...tx (transported) to (Hospital B)...care turned over to nurse at 10:54.

Review of the facility video surveillance and still shots provided confirmed PI # 25 was brought to the ED entrance accompanied by 2 police officers at 10:48 PM on 8/13/21 and was escorted out of the ED with the police officers at 10:51 PM. The ambulance arrived on hospital property at 11:04 PM and departed at 11:12 PM transporting PI # 25 away from JHMH. Still photos were provided and verified as PI # 25 by EI # 1 on 8/26/21 at 2:00 PM.

Review of the ED log revealed PI # 25 was not registered as having come to the ED. The surveyor requested ED records for PI # 25 dated 8/13/21 and none were provided.

The facility failed to provide a MSE and stabilizing treatment for a patient brought to the ED by the police, who stated people were trying to kill him/her and he/she wanted to be safe.

An interview was conducted on 8/25/21 at 3:26 PM with EI # 8, Registered Nurse ED, who works evening shift. EI # 8 confirmed he/she remembered a time when a patient was brought in to the ED with police, "2 police cars came up - when they called me I was just asked where they could seek psych services. We don't have psych here."

Review of the ED records from Hospital B revealed PI # 25 arrived via ambulance on 8/13/21 at 11:21 PM. PI # 25 was stabilized and transferred for inpatient psychiatric treatment.

10. Review of the EMS PCR # 2108-0436 dated 8/4/21 for PI # 16 revealed:

Chief complaint: flu symptoms.

Responded to location...patient supine in bed complaining of flu like symptoms including chills, body aches, cough, nausea and weakness. Temp 98.4...IV access attempted but unsuccessful...transported to JHMH...report called in to nurse who informed crew to wait outside with patient in truck...upon arrival nurse was notified...nurse came out at 12:29 PM CT and performed COVID swab...nurse stated patient not allowed in hospital until results were returned from lab...at 12:50 PM CT nurse came out and stated patient was COVID positive...at 1:09 PM CT pt got room assignment.

Review of the ED records revealed PI # 16 was registered at 1:12 PM. A COVID 19 swab was obtained at 1:24 PM and resulted at 1:48 PM. The patient was taken to ED room at 2:11 PM.

Review of the hospital video surveillance dated 8/4/21 revealed the ambulance arrived in the ED bay at 1:09 PM, the nurse went out to the ambulance at 1:14 PM and PI # 16 was taken from the ambulance into the ED at 2:10 PM. Still photos were provided and verified as PI # 16 by EI # 1 on 8/26/21 at 2:00 PM.

The surveyor requested documentation of the EMS communication report to the ED staff prior to arrival. EI #2 stated the staff failed to document the EMS communication. No documentation was provided.

PI # 16 waited in the ambulance 59 minutes prior to having a MSE performed.

An interview conducted 8/25/21 at 1:37 PM with EI # 2 confirmed PI # 16 waited in the ambulance until the COVID 19 test results were received and stated "all closed door rooms were full."

11. An interview was conducted 8/25/21 at 10:52 AM with EI # 7, Patient Access One (ED patient registration) to determine the facility process for registering patients coming to the ED. EI # 7 described the "car registration" process for patients with cold/flu like symptoms. A sign outside the ED entrance directs patients with a list of symptoms to call a listed phone number to be seen in the emergency room. EI # 7 stated the patients will return to the car and call the number, which rings to the ED registration, and a "car registration" is completed. When the patient is registered in the electronic system, the ED staff will see there is a patient waiting for triage and will call the patient and instruct them to drive to the ambulance bay entrance where triage will take place and a COVID 19 swab will be obtained. The patient is then instructed to park in ED parking lot to wait for the COVID 19 test results.

The surveyor asked EI # 7 if anyone ever left or had a long wait time. EI # 7 related an example of a patient the day before who was registered at 11:45 AM. The spouse called registration back at 2:09 PM, asking why no one had contacted them. EI # 7 stated she saw in the electronic system the patient had been "discharged Left Prior to Triage at 12:00 PM." The patient's spouse told EI # 7 they had been in the parking lot all this time and neither of their phones rang. EI # 7 stated she registered the patient again at 2:09 PM. EI # 7 stated sometimes the cell service was not great in the parking lot.

The surveyor requested both the ED records for this patient (PI # 22) dated 8/24/21.

Review of the MR revealed PI # 22 presented to the ED and was car registered on 8/24/21 at 11:45 AM with chief complaint of Neck Swelling and Runny Nose. There was no triage documentation or documentation of phone contact by the ED staff after registration.

The surveyor requested documentation the ED staff made contact with PI # 22 any time from 11:45 AM to 2:09 PM when he/she contacted the registration desk. No documentation was provided.

Review of the second ED record for PI # 22 dated 8/24/21 at 2:09 PM revealed he/she was triaged at 2:22 PM, rapid COVID 19 test was obtained at 2:23 PM, patient remained in vehicle pending COVID results at 2:37 PM. The COVID 19 test was resulted as negative at 2:58 PM. The nursing documentation revealed "in bed ready for evaluation - ED physician notified" at 3:19 PM.

The physician saw the patient for the MSE at 3:18 PM and PI # 22 was discharged home at 3:41 PM.

PI # 22 waited in the vehicle from 11:45 AM to 3:19 PM (3 hours and 39 minutes) prior to being triaged and brought into the ED for a MSE.

The facility failed to monitor a patient who presented to the ED for care with a complaint of neck swelling, and was told to wait in the car and the nurse would contact them by phone.

An interview conducted 8/26/21 at 11:07 AM with EI # 2 confirmed there was no documentation the triage nurse attempted to call PI # 22 for car triage from registration at 11:45 AM and was discharged as left prior to triage at 12:00 PM. EI # 2 further confirmed there was no process for monitoring patients waiting in their cars, but when patients are waiting in the lobby vital sign are checked every hour.

Based on review of the facility policies and procedure, Leaving Against Medical Advice Log, EMS (Emergency Medical Services) Patient Care Reports (PCR), medical record (MR) reviews and staff interviews, it was determined Jack Hughston Memorial Hospital (JHMH) failed to ensure:

1. Stabilizing treatment was provided for all patients presenting to the Emergency Department (ED) for treatment.

2. The staff implemented steps to prevent a patient presenting with suicidal thoughts from leaving the ED prior to receiving a Medical Screening Examination (MSE).

3. Staff informed patients of the risk and benefit of refusal of the MSE and further treatment prior to leaving the ED and document steps taken to secure a written refusal and the reason it was not obtained.

This deficient practice affected 7 of 25 MRs reviewed, including Patient Identifier (PI) # 17, PI # 6, PI # 21, PI # 23, PI # 14, PI # 20, and PI # 25, and had the potential to affect all patients served by the facility ED.

Findings include:

Facility Policy Name: Emergency Medical Treatment and Labor Act (EMTALA)-Medical Screening Examination and Stabilization Policy
Policy Number: 760.203
Reviewed Date: 11/30/2020

I. Policy

It is the policy of JHMH to provide an appropriate Medical Screening Examination to any person requesting treatment or an examination, by a physician to determine whether an Emergency Medical Condition (EMC) exists or not. If an EMC is determined to exist, the hospital will...provide: stabilizing treatment within the capabilities of the hospital and its staff...


IV. Procedure

E. Consent or Refusal of Screening Examination

2. If the patient refuses the medical screening exam, then the patient is informed of the risks and benefits to such an examination, and the emergency department personnel shall make every attempt to obtain the informed refusal in writing by having the patient sign the, "Release for Leaving the Hospital Against Medical Advice" form. This form shall become a permanent part of the patient's hospital record. In the event that a written refusal cannot be obtained, the hospital personnel must document the steps taken to secure written refusal and the reason it was not obtained.

H. Stabilization Procedure

1. Stabilizing treatment consists of providing medically appropriate treatment within the capabilities of the hospital's medical staff and services.

2. Service capability is also dependent upon the number and availability of staff, beds, services, and appropriate equipment.

Facility Policy Name: Suicidal-Homicidal Patient
Policy Number: 760.182
Revised Date: 10/12/2020

I. Policy

A suicide/homicide risk screen will be completed for all patients presenting to Jack Hughston Memorial Hospital Emergency Department at the time of triage. The ED physician will be immediately notified of positive suicide/homicide risk screening...Patients under suicide precautions will be continuously monitored, kept free from harm, and will receive education regarding suicide prevention.

II. Purpose

Guidelines will be used to identify and provide care to patients at risk for suicide.

1. Review of EMS PCR number 73308 dated 8/11/21 for PI # 17 revealed a chief complaint of flu type symptoms, nature of call; breathing difficulty, with a history of Diabetes Type 2, Hypertension, Chronic Respiratory Bronchitis, and Cardiac Disease. EMS arrived on scene at 6:29 PM Central Time (CT) and PI # 17 was sitting on the couch with family who stated to EMS the spouse of PI # 17 was diagnosed with COVID 19 the week prior, and PI # 17 started feeling sick and became very weak with shortness of breath within a few days. The daughter of PI # 17 also stated that PI # 17 was only responding to pain.

Vital Signs (VS) and EMS Assessment and Treatment 6:54 PM CT: BP 88/50, Pulse 74, weak and regularly irregular, Respirations 12 and shallow, O2 (oxygen) saturation 69% on room air, Blood Glucose 236. Skin Color, Pale, Skin Moisture, Clammy, Lung Sounds Left and Right, Diminished. LOC (level of consciousness) Painful with spontaneous movement, ECG (electro-cardiogram) Atrial Fibrillation. PI # 17 was placed on a non-rebreather oxygen mask with 15 liters per minute (L/M) oxygen flow. IV (intravenous) access was obtained with a 20 gauge in left forearm and bolus of 500 milliliters (ML) 0.9% Normal Saline begun with improved response.

VS at 7:01 PM CT: BP 112/65. Pulse 78, weak, regularly irregular, Respirations 12 and shallow, O2 95% on oxygen 15 L/M. LOC and rest of assessment remained unchanged.

PI # 17 was transported emergency priority to JHMH per family request
and arrived at the facility at 7:03 PM CT. Review of the PCR narrative documentation revealed upon arrival, EMS were met in the ambulance bay by Employee Identifier (EI) # 8, RN (Registered Nurse), who stated that PI # 17 had to be tested for COVID before being allowed to be brought in to be treated. The PCR documents EMS waited approximately 15-20 minutes outside in the ambulance with PI # 17 being unstable, still only responsive to painful stimulus. PI # 17 tested positive for COVID 19 and was placed in ED room number 8 where care was turned over to ED staff.

Review of the ED records revealed PI # 17 was registered on 8/11/21 at 8:17 PM. A COVID 19 swab sample was obtained at 8:15 PM while PI # 17 was in the ambulance. PI # 17 was brought into the ED and placed in a treatment room at 8:35 PM and received triage assessment by EI # 8, with an assigned acuity level of 2. The triage assessment documented a chief complaint of Fever, Shortness of Breath, Chills, Altered Mental Status, and known COVID 19 Exposure with VS: BP 96/42, HR (heart rate) 84, RR (respiratory rate) 20, O2 Saturation 80% on room air, Temp 100.5 F axillary.

Review of video surveillance and still shots provided by the facility, with content confirmed by EI # 1, Vice President of Operations, revealed PI # 17 arrived via ambulance on 8/11/21 at 8:08 PM, and ED staff was seen approaching the ambulance. Still shot at 8:13 PM revealed ED staff walking towards ambulance to perform COVID 19 swab, then returning towards the ED ambulance entrance at 8:15 PM holding the swab. Further review of still shots revealed PI # 17 being unloaded from the ambulance at 8:26 PM.

Per the facility video surveillance footage, JHMH delayed PI # 17 from receiving MSE and stabilizing treatment for 18 minutes after EMS arrival by not allowing PI # 17 to enter the facility until COVID 19 testing had resulted.

The MSE was performed on 8/11/21 at 8:43 PM where the Physical Exam documented by the physician stated: VS have been reviewed as abnormal, hypotensive, oxygen saturation low...Appearance lethargic, patient in moderate distress....Respiratory, moderate respiratory distress.

During the course of stabilizing treatment while in the ED, PI # 17 had multiple labs performed, arterial blood gases (ABG's), chest x-ray, CT (Cat Scan) of the Chest, Abdomen and Pelvis, and received Oxygen at 10 L/M, Dexamethason 6 MG (milligrams) IVP (intravenous push), Rocephin 1 gram and Azithromycin 500 MG IVPB (intravenous piggy back), and Acetaminophen 650 MG per rectum.

PI # 17 was admitted as an inpatient from the ED once a bed was available on 8/12/21 at 3:00 AM with an ED discharge diagnosis of Moderate Acute Renal Failure, COVID 19 with Pneumonia, and Hypoxia.

In an interview conducted on 8/25/21 at 2:34 PM, EI # 2, ED Director confirmed PI # 17 received COVID swab in the ambulance at 8:15 PM, and PI # 17 was not brought inside the ED until 8:35 PM, waiting 20 minutes to receive the MSE and stabilizing treatment.

2. PI # 6 presented to the ED and was registered on 5/12/21 at 1:15 PM with a Chief Complaint of Suicidal Thoughts/Mental Health Issues.

Review of the facility Leaving Against Medical Advice Log provided by the facility revealed PI # 6 left prior to triage.

Review of the MR revealed PI # 6 signed the General Consent for Treatment and Tests at 1:16 PM. There was no documentation PI # 6 was triaged, including a Suicide Risk Assessment, or had a MSE to determine if PI # 6 had an EMC requiring stabilizing treatment.

There was no documentation the facility staff implemented steps to prevent PI # 6 from leaving the ED prior to receiving a MSE and stabilizing treatment.

In an interview conducted on 8/25/21 at 2:17 PM with EI # 2, the surveyor asked what time did PI # 6 leave the ED? EI # 2 stated 1:30 PM per patient access/ED registration, and there was no documentation anyone saw PI # 6 leaving. The surveyor then asked what was the protocol for patients presenting to the ED with suicidal thoughts? EI # 2 stated per policy 760.182 staff should be immediately notified when the patient presents. EI # 2 confirmed that PI # 6 was not seen in triage, did not receive MSE and stabilizing treatment, and that the registration clerk was the only patient encounter.

3. PI # 21 was observed by the surveyor at the facility ED ambulance bay inside the ambulance with EMS on 8/24/21 at 11:04 AM. EI # 9, RN, was present and obtaining VS, asking COVID screening questions, and beginning triage assessment. EI # 9 obtained a COVID swab sample at 11:08 AM and PI # 21 remained in the ambulance.

PI # 21 was observed being brought into the ED and placed in treatment room number 6 at 11:45 AM.

Review of the ED record revealed PI # 21 was registered at 11:09 AM, and had Triage assessment at 11:03 AM with an assigned acuity level of 3.

VS at 11:14 AM: BP 141/86, HR 90, RR 18, O2 saturation 96%, Temp 98.7, Pain level 7/10. PI # 21 had a history of Chronic Lower Extremity Pain, Hypertension, AFib (Atrial Fibrillation), Intervertebral Disc Disease, Coronary Artery Disease, Depression, Diabetes Mellitus, and Congestive Heart Failure.

PI # 21 waited inside the ambulance for 44 minutes for the COVID test results, which resulted at 11:51 AM, before receiving the MSE and stabilizing treatment.

PI # 21 received the MSE by the physician at 11:53 AM. Review of the MSE documentation revealed a chief complaint of dyspnea that had started that day and was gone at time of the MSE. PI # 21 received several labs, urinalysis, rapid COVID and Flu test, and chest x-ray. IV (intravenous) access was obtained with a 20 gauge to the left wrist. Review of the documented lab results revealed PI # 21 had a low white blood count, hemoglobin, platelets, and slightly low potassium. PI # 21 was discharged home with the diagnoses Pancytopenia and Kidney Stone.

An interview was conducted on 8/25/21 at 2:37 PM with EI # 2, who was asked if a room was available for PI # 21 at the time of arrival by EMS? EI # 2 stated, "yes." The surveyor then asked why was PI # 21 not placed in a room upon arrival? EI # 2 stated "it was pending the COVID test."

4. PI # 23 was transported via ambulance from the scene of a motor vehicle accident (MVA) to JHMH on 7/16/21. Per review of the EMS PCR number 64334 narrative, PI # 23 was ambulatory on scene and stated he/she had been running over 70 miles per hour (MPH) at the time of the accident, and requested EMS transport him/her to JHMH. Further review of the PCR narrative revealed when EMS called report to JHMH, EI # 6, ED Medical Director, refused to accept the patient and stated EMS needed to divert to another facility. After being informed by EMS of JHMH refusal, PI # 23 refused to go to any other hospital. EMS called back to JHMH, again spoke with EI # 6, gave EI # 6 full report and that PI # 23 refused to go elsewhere. Per the PCR narrative, EI # 6 still refused to accept the patient, but stated if PI # 23 walked into the ED, he/she would have to take her, but EMS could not bring him/her in.

Documentation/log of communications between EMS and ED staff during transport were requested. EI # 2, ED Director, stated the staff document the communication in the electronic medical record but they failed to document the EMS communication. Documentation was not provided.

Review of video surveillance and still shots provided by the facility, with content confirmed by EI # 1, Vice President (VP) of Operations, of the hospital's main parking lot and entrance on 7/16/21 revealed PI # 23 arrived to the front (main) entrance of the hospital via ambulance at 8:48 AM, and then PI # 23 walked around to the ED walk in entrance at 8:51 AM. Further review of video surveillance and still shots revealed PI # 23 walking away from the ED walk in entrance at 9:10 AM. The video surveillance and still shots did not reveal PI # 23 ever entered the facility.

The facility failed to accept a this patient arriving via ambulance and provide a MSE and stabilizing treatment.

In an interview conducted on 8/24/21 at 10:40 AM, EI # 3, Chief Nursing Officer, confirmed there was no MR for PI # 23, and PI # 23 was not on the ED central log.




36271

5. Review of the EMS PCR # 68397 dated 7/28/21 for PI # 14 revealed:

Chief complaint of Malaise/General Weakness with a history of Hypertension, Schizophrenia and Seizure Disorder. EMS arrived on scene at 12:52 PM CT (Central Time) and PI # 14 was sitting on the porch, reported he/she ran out of seizure med's and had been vomiting for 3 days.

VS at 1:14 PM CT: BP 182/115, Pulse 89 and regular, Respirations 18 and Oxygen (O2)saturation 99% on room air.

VS at 1:23 PM CT: BP 169/107, Pulse 91, Respirations 18 and O2 99% on room air.

IV access obtained with 18 gauge in right AC (antecubital). Temp 97.7 (forehead). Alert/oriented. Transported non emergency to JHMH. Report called with 5 minute ETA. Mask placed on patient and started to get patient out of ambulance but staff met crew at door and advised to keep patient in ambulance for now...patient was registered....COVID tested at back door of ambulance...staff stated did not have a room...after approximately 40 minutes of not being allowed inside the ER, patient wanted to go somewhere else...transported to Hospital B.

Review of the ED records revealed PI # 14 was registered on 7/28/21 at 2:44 PM ET (Eastern Time). A COVID 19 swab was obtained at 2:44 PM while the patient was in the ambulance. PI # 14 left the Emergency Department at 3:11 PM (ET) before triage, "the patient appears to be alert, oriented x 4, coherent and in no acute distress. He/she stated leaving with EMS going to another facility. Notified the ED physician of patient departure. Patient left without signing form prior to leaving...the COVID 19 test was resulted negative at 3:27 PM.

There was no documentation the hospital staff provided stabilizing treatment for PI # 14 who presented via ambulance and had elevated BP. There was no documentation the hospital staff explained to PI # 14 the risks and benefits of refusal of the MSE and further treatment and no documentation of efforts to obtain a written refusal prior to leaving the ED, as directed per facility policy.

Review of the hospital video surveillance dated 7/28/21 revealed the ambulance arrived in the ED bay at 2:36 PM, EMS personnel approached the ED door at 2:38 PM, a hospital employee came out to obtain a COVID swab at 2:49 PM, and the ambulance left the bay at 3:12 PM transporting PI # 14 away from JHMH. Still photos were provided and verified as PI # 14 by EI # 1, VP of Operations on 8/26/21 at 2:00 PM.

PI # 14 waited in the ambulance on hospital property from 2:36 PM to 3:11 PM, a total of 35 minutes prior to being transported to another facility for treatment.

The surveyor requested documentation of the communication report by EMS prior to PI # 14 arriving at the ED. EI # 2, ED Director, stated the staff document the communication in the electronic medical record but they failed to document the EMS communication. No documentation was provided.

The facility failed to provide a MSE and stabilizing treatment for a patient with elevated BP who arrived by ambulance.

An interview conducted 8/24/21 at 1:55 PM with EI # 2, ED Director, confirmed PI # 14 was held in the ambulance pending results of a COVID 19 test, no triage assessment was performed, no MSE was performed and no treatment was provided. PI # 14 was transported to another facility prior to signing forms.

6. Review of the EMS PCR # dated 8/17/21 for PI # 20 revealed:

Responded to scene with patient sitting in driver's seat of vehicle on roadside. Patient stated began having severe migraine, was driving to the hospital, began vomiting, pulled to roadside and called EMS, pain 10/10, pain increases with bright light. Patient requested transport to JHMH.

From scene to JHMH without incident, at destination staff would not let EMS unload patient until they could get nasal swab for COVID 19 and get results back.

Arrived at JHMH at 11:40 PM CT.

Review of the ED records revealed a rapid COVID 19 swab was obtained at 12:55 AM ET (8/18/21) and resulted as negative at 1:28 AM ET.

Further review of the PCR revealed IV (intravenous) access was obtained at 12:05 AM (1:05 ET) and Ondansetron 4 milligrams IV was administered to PI # 20 by EMS (EI # 10) while the patient was waiting in the ambulance. PI # 20 was transported into the ED at 12:39 AM (1:39 ET).

Review of the facility video surveillance and still shots provided confirmed PI # 20 arrived by ambulance at 12:45 AM on 8/18/21 and was taken from the ambulance into the ED at 1:36 AM. Still photos were provided and verified as PI # 20 by EI # 1, on 8/26/21 at 2:00 PM.

PI # 20 waited in the ambulance 59 minutes prior to being brought into the ED for a MSE and stabilizing treatment.

An interview conducted 8/26/21 at 12:25 PM with EI # 10, Paramedic, confirmed PI # 20 was not allowed to enter the facility ED until after a COVID 19 test was obtained and resulted. EI # 10 further confirmed PI # 20 required IV medication administration while waiting in the ambulance on hospital property, and stated "they were not treating (him/her) so I did."


7. Review of the ambulance run report # 74053 dated 8/13/21 for PI # 25 revealed:

Chief complaint Psychotic/psychosis

Dispatched emergency to parking lot of Jack Hughston Memorial Hospital in reference to an AMS (Altered Mental Status) patient. On arrival..PD (Police Department) advised they picked pt up elsewhere and brought to Jack Hughston because the pt told them "people were out to kill him and people are following him."..." just wants to be taken back to the hospital so (he/she) can be safe."

VS at 10:16 PM CT: BP 131/89, Pulse 125 strong, O2 96% on room air, refused temp.

Pt walked without assistance to ambulance...tx (transported) to Midtown (Hospital B)...care turned over to nurse at 10:54.

Review of the facility video surveillance and still shots provided confirmed PI # 25 was brought in to the ED entrance accompanied by 2 police officers at 10:48 PM on 8/13/21 and was escorted out of the ED with the police officers at 10:51 PM. The ambulance arrived at 11:04 PM and departed at 11:12 PM. Still photos were provided and verified as PI # 25 by EI # 1 on 8/26/21 at 2:00 PM.

The facility failed to provide a MSE and stabilizing treatment for a patient brought to the ED by the police, who stated people were trying to kill him/her and he/she wanted to be safe.

An interview was conducted on 8/25/21 at 3:26 PM ET with EI # 8, Registered Nurse ED, who works evening shift. EI # 8 confirmed he/she remembered a time when a patient was brought in to the ED with police, "2 police cars came up - when they called me I was just asked where they could seek psych services. We don't have psych here."