HospitalInspections.org

Based on observation and interview, the hospital failed to conspicuously post a sign (in a form specified by the Secretary) specifying the rights of individuals regarding Emergency Medical Treatment and Labor Act (EMTALA) statute in places likely to be noticed by all individuals seeking treatment in the Emergency Department (ED).

The finding includes:

On June 19, 2017, at approximately 9:12 AM, during a tour of the ED, the hospital's ambulance entrance was observed not to have any sign posted providing EMTALA notification for patients arriving by ambulance.

This finding was confirmed by the ED Director on June 19, 2017 at approximately 9:12 AM. She stated "this entrance is sometimes used by walk in patients ... It makes sense to have an EMTALA sign in the ambulance entrance."

Based on document review and interviews, the hospital failed to provide an appropriate medical screening examination to a patient who arrived at the hospital seeking emergency treatment for 1 of 21 individuals reviewed (Patient #1).

The finding includes:

On June 12, 2017 at 2:45 p.m., the Division of Licensing and Certification received the following report from a hospital representative: On June 8, 2017 at 8:30 PM, an ambulance arrived at the hospital transporting a pediatric trauma case (Patient #1). The ambulance arrived in the hospital's ambulance bay and an Emergency Department (ED) Technician told the ambulance crew they needed to go to another hospital (Hospital B). The patient was not assessed before the ambulance left the hospital grounds.

On June 19, 2017 at 9:38 AM, a telephone interview was conducted with the ED Technician who was on duty in the evening of June 8, 2017. The Technician reported the following events occurred: She was sitting in the nursing station when the hospital received a radio call from the ambulance; she answered the radio and was informed, by the ambulance attendant, that they were enroute with a six (6) year old trauma patient; two (2) Physicians were nearby and overheard the ambulance report; "I was asked by [the ED contract Physician] to defer the ambulance to [trauma center in same city]"; she went to the ambulance bay to inform the ambulance crew of the diversion decision; she stated "I was alone; the only St. Joe's staff member out there"; the patient was not removed from the ambulance and the ambulance was in the bay less than one (1) minute. She also she reported she had not received any EMTALA training prior to this event.

On June 19, 2017 at approximately 11:45 AM, an interview was conducted with the ED Physician. The ED Physician reported the following: He verified he was on duty on June 8, 2017 and overheard the ambulance radio report; he discussed the case with the contract Physician working in the ED with him; this discussion included if this was an appropriate case for this hospital, which is not a trauma center; "I told the RN [Registered Nurse] to advise to divert over radio."; the Physicians were notified that the ambulance was already in the ambulance bay; the contract Physician reportedly grabbed his stethoscope and went out to the ambulance bay to assess the patient and the ambulance was already gone; "I knew it was a problem once [contract physician] came back in and said the ambulance was gone ...Giant red flag ... If they are on our property, they are our patient; and I followed up with my supervisor [ED Medical Director] regarding this at 8:43 PM on June 6, 2017, via email".

On June 19, 2017 at approximately 12:20 PM, a telephone interview was conducted with the contracted ED Physician. The contracted ED Physician verified he was on duty on June 8, 2017 and overheard the ambulance radio report. "It was about 8:30 on June 8, 2017 ... I went out to the ambulance bay to see the kid ... the ambulance was gone ... it was my understanding that if a patient is on the premise, we treat them. Nobody said to not send the child; we only asked why they were bringing a kid here when there is a trauma center a mile down the road. When I heard about this, it was my understanding that that the ambulance was here".

On June 19, 2017 at approximately 12:38 PM, an interview was conducted with the ED Charge Nurse. The ED Charge Nurse reported the following: On June 8, 2017 at approximately 8:30 PM, she was busy treating four (4) patients and was informed that an ambulance called and was coming in with a pediatric trauma patient; when she went out, the ambulance had come and gone; and it happened fast - all just a few minutes time. She reported that the ED Technician may take the ambulance call and then reports the information to the Charge Nurse. In this case, the hospital does not have inpatient pediatric department or pediatric trauma capabilities. "We were going to have to transfer this ped patient out if it were a true trauma". "We can ask an ambulance to divert if we don't have the capabilities to care for them, the physician makes that decision".

The ambulance run sheet was reviewed. The report indicated the following: the patient's mother requested transport to this hospital; they gave report, via radio, approximately five (5) minutes before arriving at the hospital; the ambulance arrived at the hospital on June 8, 2017 at approximately 8:38 PM; "Before unloading the patient from the ambulance, a St. Joseph's nurse came out and strongly suggested [ambulance] to consider diverting the patient to [nearby trauma center]. They thought it would be most appropriate for the young patient to receive proper pediatric and trauma care ... EMS [ambulance] cleared St. Joseph's at 2039 [8:39 PM] ..."

Based on the interviews conducted on June 19, 2017, the patient arrived on hospital grounds, via ambulance, for emergency care and the hospital failed to provide this patient with a medical screening examination before the ambulance was instructed to go to another hospital.