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Based on review of policy and procedures, staff interview, and hospital documentation review during an EMTALA investigation, the facility failed to ensure that it delivered an appropriate medical screening exam and stabilizing treatment according to the EMTALA requirements for 1 (Patient 21) out of 21 patients that were reviewed. Patient 21 did not have a medical record for the visit in question.

Findings include:

Please see narrative under A2406 regarding medical screening exam.

This substantiates the allegations in complaint number OH00063885.

Based on review of facility's documentation regarding the incident and review of hospital policies in regard to EMTALA, the facility failed to ensure that each patient presenting to the "emergency department" is provided an appropriate medical screening examination. This affected 1 (Patient 21) out of 21 patients reviewed. Patient 21 did not have a medical record for this visit.

Findings include:

According to hospital documentation the Patient 21 was brought to the emergency department (ED) main entrance in a car by 3 "family" members in the early morning on 01/01/12. The driver of the car, Patient 21's sister, went into the ED and stated to the security person stationed there that her brother needed treatment as he was intoxicated, bi-polar, off of his medications and violent. The security guard and the triage nurse went outside with the sister to help assist Patient 21 into the ED. The patient was noted to be restrained by 2 other persons in the back seat of the car and was fighting and thrashing to get loose from them. When told that the staff could not pull Patient 21 out of the car to take into the ED, the 2 family members released their hold on Patient 21 who then exited the car. At that point Patient 21 hit one of the security guards, attempted to strike a second security guard and then was noted to hit the vehicle he was brought in.

The security guards restrained Patient 21 with handcuffs, but the patient was still fighting them, kicking and trying to get loose. A call for assistance was sent out to the local Police Department. The response to the "911 officer needs assistance" call resulted in additional police and an ambulance being dispatched to the scene. While the officers held Patient 21 on the ground, who was still kicking and thrashing, a discussion about Patient 21's disposition ensued.

At no time did the ED staff whom witnessed Patient 21's medical emergency attempt to involve the physician, paramedic or physician assistant to determine what could be done for Patient 21 regarding his behavior.

According to the hospital's policy titled "EMTALA Program Manual", May 2010, which includes all EMTALA policies, states "When an individual arrives at the ED, and a request is made on the individual's behalf for a medical examination or treatment, the Hospital must provide for an appropriate Medical Screening Examination..." and "Hospital personnel may be required to leave the ED to examine and/or treat an individual in need of emergency services..." The incident was documented and agreed upon by all as having taken place on hospital grounds, yet no medical screening exam was done or stabilizing treatment offered.

There was no documentation that the ED staff (RN), who witnessed Patient 21's medical emergency attempted to involve a physician, paramedic or physician assistant who could intervene to to provide a medical screening exam and stablizing treatment for Patient 21 regarding his medical/psychiatric emergency.

This citations substantiates the allegations in complaint OH00063885.