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Based on record review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the reporting obligation. See A2406 and A2407.

Based on a focused record review and interview, it was determined that the facility failed to perform and record a medical screening examination of an unstable patient (#26) experiencing an emergency medical condition. The findings include:

Patient #26 was struck by a motor vehicle, suffered acute injuries and was transported by ambulance services to the ED on April 9, 2011 with intent to further transfer by airlifted to a Lansing hospital. The ambulance brought the patient into the ED for care while waiting for air transport. No medical screening exam was provided, no physician care was provided and no medical record was generated. The patient was ultimately taken out of the ED when the air transport arrived, at which time Patient #26 was further assessed by air transport personnel and determined that intubation was indicated. The patient was then intubated by personnel from the air transport team, loaded into the helicopter and departed for Lansing.

During a phone interview on 6-22-11 at approximately 1530 with RN #2 in regards to the treatment for patient #26, she was asked about the policy of logging patients into the emergency room log and she said, " It is policy to log all patients ". When asked why this patient had not been put into the log, she stated, " I don't know ". When asked to look at the patient #26 medical record nursing notes to verify it was her writing and signature, she stated, "Yes" . When asked when the documentation was completed in the medical record, she stated, "The next day when the Director of Nursing came in and told me to complete the papers " . Then when asked how did she know the blood pressure, pulse, respirations, pain and oxygen saturation, she stated, " I took them from the EMS run sheet ".

Her documentation at 2225 states, " Patient remains on EMS cot rapid assessment completed, Dr aware of patient". When asked how the doctor was made aware, she stated, "He was standing right there, he heard the complete report, he was standing right there when the call came in (nurses station) ".

Her documentation at 2226 states, "No mediastinal shift, symmetrical chest movement resp 30 and labored. Reported hyperresonant lung sounds in abdomen. Patient is alert. No obvious bleeding, large abrasion to left flank area. Awaiting Dr in room ". When asked where the doctor was during this time, she stated, "He was behind the nurses' desk". When asked how she knew this, she stated, "Because you could visualize him ".

Her documentation at 2228 states, "Patient remains on MMR cot, no changes in LOC, awaiting Dr. (#1)" . When asked if she knew where he was, she stated," I don't recall ".

Her documentation at 2229 states, " Patient remains on MMR cot, Life net landing MMR rolls patient out to rig. Loaded and reported they would meet Life net at helipad. Dr. (#1) aware " . When asked how Dr. #1 was made aware, she stated, " He was standing behind the unit secretary, someone told him I guess " . When questioned if it's expected for the doctor to examine any patient that enters the emergency department, she stated, " Absolutely" .

The phone interview was conducted via speaker phone with Manager of Risk and Infection Prevention present in the room with RN #2.

Based on a focused record review and interview, it was determined that the facility failed to provide stabilizing treatment to an unstable patient (#26) experiencing an emergency medical condition. The findings include:

Patient #26 was struck by a motor vehicle, suffered acute injuries and was transported by ambulance services to the ED on April 9, 2011 with intent to further transfer by airlifted to a Lansing hospital. The ambulance brought the patient into the ED for care while waiting for air transport. No physician assessment or care was provided and no medical record was generated.

During a phone interview on 6-22-11 at approximately 1030 with the physician on duty (Physician #1) when Patient #26 was brought into the ED, the Physician #1 was asked if he was aware of the trauma patient being in route, he stated, "I heard it over the radio". When asked if he knew the patient was coming in, he stated, "Yes" .

When asked what had happened at 2225, he stated, "I saw them, EMS coming in, going to the trauma room " . When asked where he was at that moment, he stated, "I was in the work area, because the nurse completes her assessment."

When asked where he was at 2226, he stated, "I was still working at the work station. I heard the helicopter was coming (landing). I remember the nurse was in triage with EMS still doing the assessment " .

When asked where he was at 2228, he stated, "I was working on orders in the doctor work area, I heard the nurse and paramedics talking, so when I got up they were leaving. There was no chart or vital signs.".

When asked where he was at 2229, he stated, "They were going out the door " .