HospitalInspections.org

Based on observation, interview, and document review, it was determined that Medical Screening examination was not conducted on patients to determine whether or not an emergency medical condition existed. It was determined that the facility:

Findings:

a. On July 22, 2021, during very busy hours in the emergency department and a back up in the waiting room, four patients left the emergency department to seek care at a different emergency location without having a medical screen examination to determine whether or not an emergency medical conditions existed.


b. Interviewed emergency physician (Staff #2) who was on the day shift 6:00 am to 6:00 pm on July 22, 2021. The physician was interviewed by phone at 2:45pm while surveyor was at the facility on August 11, 2021. Staff #2, MD, said the Emergency department received a huge influx of patient during various times during his shift on July 22, 2021, causing a back up in seeing patients. All beds were filled on the units. There were patients waiting to be admitted that were in beds in the emergency department. There were angry patients in the outer waiting room who were tired of waiting to be seen.

Staff #2 said, he went in the waiting room to check on the patients and his staff in the front area who were getting harassed by angry people waiting for care. He said, he wanted to explain to the patients waiting and inform them of why the wait was taking a longer time than usual in hopes of informing people in room so they will be more understanding.

He said, after he inform the crowd in the waiting room and was heading back into the ED treatment area four of the patient approached him with a few other questions. He spoke to them individually in a room. He said, all 4 explained that they had been waiting for awhile and before this, came from another emergency department at a different locations where they also had to wait and grew tired of waiting and came to this emergency department hoping to be seen quicker than the last place. They also said they were about to leave this site and asked if there was another ED that they could go to where they would be seen quicker.

Staff #2 explained that he did not want to lose these patients and did not want them to leave the Christus Santa Rosa system. In order to answer their question knowing that the Christus Santa Rosa Stand alone Emergency center known as the Alons Emergency center did not have as many patients as Christus Santa Rosa Medical Center emergency department, he told the 4 people about Alons emergency center. He said, he also explained to the individuals that he preferred they stay at Medical Center and receive an appropriate medical screening examination to determine if an emergency medical condition existed. He told them if they decide not to wait for a medical screening examination and decided to leave the medical center ED site they would have to sign a waiver from medical screening exam forms. All four patients signed the waiver on July 22, 2021, during the day shift.


c. Interviewed staff #1, chief nursing officer (CNO), at 11:45 am on August 11, 2021, in a boardroom at Christus Santa Rosa Medical Center. Staff confirmed that staff #1, MD, called her on July 23, 2021, with concerns about having the 4 patients sign the medical waiver on July 22, 2021, and wondering if he was within regulatory requirements or not in having the patients signed those medical screening waivers and informing them about Alons Emergency center which is also a Christus Santa Rosa emergency department. It was never the physicians intention of turning a patient away from care at the medical center ED site. Staff #1(CNO) told the physician not to refer patients to another emergency center and make sure all patient who come to the medical center site receive a medical screening examination to determine whether or not an emergency medical condition existed.


d. In a follow-up review of the 4 patient who signed the medical screening examination waivers on July 22, 2021, it was found that two of the patients actually were seen at Christus Santa Rosa Alons Emergency center. One of those two patients that were seen at Alons had an ESI 2 category and was admitted to Christus Santa Rosa Medical Center. The other was discharged to home. A 3rd person who signed the waiver came back to the emergency department at Christus Santa Rosa Medical Center the next day July 23, 2021, and received a medical screening exam with appropriate treatment and was discharged to home. The fourth person who signed the waiver was never seen again.