HospitalInspections.org

Based on document review and interview the hospital failed to ensure that its emergency department staff and physicians provided an appropriate medical screening examination to Patient #1 when he presented in the emergency department on 10/29/12 at 2:05 am with a complaint of methamphetamine abuse and psychotic behavior. This failure to provide a medical screening exam resulted in the patient leaving the hospital and traveling to hospital #2 for treatment. The failure to provide a medical screening exam and stabilization treatment creates the likelihood that other patients seeking emergency treatment might also be discouraged from seeking treatment for substance abuse and psychiatric problems. The findings are:

A. On 10/29/12 at 2:00 am Patient #1 presented in the Emergency Department (ED) of hospital #1 complaining of intense methamphetamine abuse during the previous four days. Patient #1 was experiencing both visual and auditory hallucinations during the triage process. ED physician #1 intervened in the triage process and advised Patient #1 and accompanying friend that hospital #1 did not have any inpatient psychiatric capability, could only do a metabolic workup and that any inpatient admission would have to be made at hospital #2. After the intervention by ED physician #1, Patient #1 and his friend got up, left hospital #1 and traveled to hospital #2 for treatment. No effort was made by any staff of hospital #1 Emergency Department to try to get Patient #1 to stay long enough for the Medical Screening Exam and stabilization treatment to be done.

B. On 11/14/12 at 3:05 pm ED Nurse #1 at hospital #1 was interviewed. He stated that Patient #1 was accompanied by a friend and that Patient #1 was significantly impaired by drug usage and was having trouble answering the questions in the medical history. ED Nurse #1 stated that while he was attempting to obtain the medical history, ED physician #1 overheard the conversation and intervened in the triage process. ED Nurse #1 confirmed that ED physician #1 told Patient #1 and friend that: (1) hospital #1 did not have any inpatient psychiatric capability, (2) he could only do a metabolic workup and (3) any inpatient admission would have to be made at hospital # 2.
ED Nurse #1 was asked if ED physician #1 had mentioned stabilization and transfer to Patient #1 & friend. ED Nurse #1 stated quite emphatically that no mention of transfer was ever made to Patient #1. ED Nurse #1 stated that after ED physician #1 indicated that Patient #1 would have to seek services at hospital #2, the friend stated, "Well, since we are going to have to go to the other hospital anyway, we might as well go now." Patient #1 & friend got up and left hospital #1. ED Nurse #1 was asked if any ED staff made any effort to persuade Patient #1 to remain in hospital #1's ED until the Medical Screening Exam and stabilizing treatment could be offered. He stated, "No." ED Nurse #1 also confirmed that no Medical Screening Exam was ever completed.

C. On 10/29/12 at 8:05 pm ED physician #1 was interviewed. He confirmed that he had intervened in the triage process and did tell Patient #1 & friend that : (1) hospital #1 did not have any inpatient psychiatric capability, (2) he could only do a metabolic workup and (3) any inpatient admission would have to be made at hospital #2. ED physician #1 also confirmed that no efforts were made to persuade Patient #1 to remain in hospital #1's ED until the Medical Screening exam and stabilizing treatment could be provided. He also confirmed that no Medical Screening Exam was ever done on Patient #1.