HospitalInspections.org

Based on document review, and interview, it was determined that the Hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24, as evidenced by:

Findings include:

1. The Hospital failed to ensure that all patients who presented to the Hospital for Emergency services received a medical screening examination, to determine if an emergency medical condition existed. See deficiency at A 2406.

The immediate jeopardy began on 9/21/2019, due to the Hospital's failure to provide medical screening examinations. The IJ was identified on and announced on 9/24/2019 at 3:00 PM, during a meeting with the Chief Executive Officer, the Chief Operating Officer, the Assistant Chief Executive Officer, the Interim Chief Nursing Officer, and the Performance Improvement Coordinator. The Hospital failed to implement any corrective measures. The IJ was not removed by the survey exit date of 9/26/2019.

Based on document review and interview, it was determined that for 8 of 8 (unknown) patients, who presented to the Hospital seeking emergency services, the Hospital failed to ensure they were entered onto the Emergency Department's Central Log.

Findings include:

1. The Hospital's policy entitled, "EMTALA Central Log Policy," (Last Reviewed: 8/2016 by Hospital) was reviewed on 9/25/19 at approximately 10:00 AM and included, "Procedure...1. Each Hospital must maintain a Central Log to track the care provided to each individual who comes...2. The Central Log must include patients presenting to the Dedicated Emergency Room regardless of whether they receive treatment..."

2. On 9/25/19 at approximately 10:45 AM, the Emergency Room Log dated 2/1/2019 through 9/20/2019 was reviewed. The log indicated that as of 9/20/19 at 11:59 PM, there were no patients listed that presented to the Emergency Department seeking emergency medical assistance. The Hospital did not maintain an Emergency Room Log after 9/20/2019.

3. The Hospital provided an email from the Hospital to the City of Blue Island dated 9/20/19 at 7:09 PM, and included, "Blue Island, Illinois Sept. 20, 2019 - MetroSouth Medical Center will immediately stop accepting new patients..."

4. On 9/24/19 at approximately 9:48 AM, an interview was conducted with a Public Safety Officer (PSO - E #3). E #3 stated that, during huddle (end of shift report from previous shift PSO) on 9/21/19 he was informed that the Emergency Department (ED) was not accepting any patients and that PSOs would need to assist any person that required an ambulance by calling 911 (emergency telephone number in North America) for an ambulance to transport the patients to another Hospital. If a patient is in distress and needs help right away the PSO will call the Rapid Response Team (RRT-team of health care providers that responds to hospitalized patients with early signs of deterioration) over the intercom. E #3 stated that an RRT and 911 was called on 9/24/19 for a patient with chest pain and an OB (obstetrics) patient who was transferred to another Hospital by Blue Island EMS (Emergency Medical Services) over the weekend. E #3 stated that the PSO's were instructed not to keep a record of the people that come to the ED and we're not sure of the number of people that have presented. E #3 stated that, therefore we have no idea as to where the patient was transferred.

5. During a phone interview with a Public Safety Officer (E #7) on 9/24/19 at approximately 12:30 PM, who worked post 1 (ED - Emergency Department front desk) on Saturday (9/21/19), stated, "I recall one young lady coming to the ED in labor, Saturday (9/21/19) morning after 5:00 AM and I had to call a RRT (Rapid Response Team) and 911 for the lady. We were not instructed to keep a record or log of people that show up, just to tell them nearest hospital and assist with calling 911 for an ambulance." E #7 stated that she was instructed during her change of shift huddle (change of shift report), by her Manager (E #2)."

6. During an interview on 9/24/19 at approximately 10:00 AM, and at 11:35 AM, with the Chief Quality Officer (E #5) stated, "We do not have the two patients listed on the Hospital Emergency Department (ED) Log."

7. During an interview on 9/25/19 at approximately 9:05 AM, the Interim Chief Nursing Officer (E #1) stated, "We do not have documentation of the patients that have walked in for services. The Front Desk called 911 and the local paramedics responded. We do not know the patients' names or where they were transferred to. We were not privy to the patients' information because they were not our patients."

8. On 9/25/19 at approximately 11:00 AM, an interview was conducted with the Interim Chief Nursing Manager (E #1). E #1 stated that, as of 9/21/2019 at 12:00 AM, the ED services were suspended, and the Hospital has not kept a log of any individuals that presented to the ED.

9. During a phone interview on 9/26/19 at approximately 9:45 AM with the Lieutenant of Blue Island Fire Department - Emergency Medical Services (Z #1) stated, "We picked up the following patients from the Hospital: on 9/20/19 at 11:36 PM - Psych Evaluation sent to (Hospital #l); on 9/23/19 at 5:59 AM - Pregnancy sent to (Hospital #2); on 9//23/19 at 1:40 PM - breathing problems sent to (Hospital #2); on 9/23/29 at 2:52 PM - diabetic problems sent to (Hospital #2); on 9/24/19 at 5:49 AM - Over Dose was sent to (Hospital #3); on 9/24/19 at 2:02 PM - traumatic injury sent to (Hospital #2); on 9/25/19 at 8:33 AM - pregnancy sent to (Hospital #2); on 9/25/19 at 5:40 PM gun shot wound was sent to (Hospital #4).

Based on observation, document review, and interview, it was determined that for 8 of 8 patients (unknown) transferred to another Hospital following a 911 call, the Hospital failed to ensure that all patients who presented to the Hospital for Emergency services, received a medical screening examination, to determine if an emergency condition existed. This potentially affects all patients presenting to the Hospital for Emergency Care.

Findings include:

1. A walk-through of the Hospital was conducted on 9/24/19 between 9:35 AM and 10:00 AM. The main entrance of the Hospital was locked and there were signs posted on the door stating, "MetroSouth Medical Center Ceasing New Admissions, Temporarily Suspending Emergency Departments ...will immediately stop accepting new patients ...suspend the general department and the obstetrics emergency department ..." The Emergency Department (ED) was staffed with one Public Safety Officer (PSO) to ensure that no unauthorized persons enter the ED and if patients required transportion by ambulance, the PSO will call 911. The ED driveway was blocked by barricades and there was a Public Safety Officer posted 24 hours a day inside the ED lobby and at the entrance of the ED driveway since Saturday 9/21/19 at 1:00 AM. The ED signage has been covered with silver duct tape.

2. The Hospital's Rules and Regulations dated 6/19/2019, included, "...Article VI Emergency Medical Screening. Treatment, Transfer, & On - Call Roster Policy...6.1 Screening, Treatment, and Transfer: 6.1(a) Screening: (1) Any individual who presents to the Emergency Department of this Hospital for care shall be provided with a medical screening examination to determine whether that individual is experiencing an emergency medical condition."

3. The Hospital provided an email from the Hospital to the City of Blue Island dated 9/20/19 at 7:09 PM, and included, "Blue Island, Illinois Sept. 20, 2019 - MetroSouth Medical Center will immediately stop accepting new patients..."

4. A document titled, "MetroSouth Medical Center Ceasing New Admissions, Temporarily Suspending Emergency Departments" dated 9/20/19, included, "...Additionally, the physician groups providing...emergency services submitted notice they will cease all services for the hospital later this month..."

5. During an interview on 9/23/19 at approximately 3:15 PM, the Interim Chief Nursing Officer (E #1) stated, "When a patient comes in the Main Lobby, seeking medical attention, the Security at the front desk will inform patient that there is no one available to provide services and offers to call 911(emergency telephone number in North America) for the patient. If the patient agrees, security or registration will wait with the patient until EMS (Emergency Medical Services) arrives. If the patient appears to be in severe distress, the security officer or reception clerk will call the Rapid Response Team (RRT - high acuity response team of health care providers that responds to patients with early signs of deterioration) and 911. There is no MSE (Medical Screening Examination), triage, or stabilization because there is no ED (Emergency Department) physician or ED Nurse to provide care. The patient is assessed by EMS and transported. The Hospital does not keep documentation of the patients."

6. On 9/24/19 at approximately 9:48 AM, an interview was conducted with a Public Safety Officer (PSO - E #3). E #3 stated that, during huddle (end of shift report from previous shift PSO) on 9/21/19 he was informed that the Emergency Department (ED) was not accepting any patients and that PSOs would need to assist any person that required an ambulance by calling 911 (emergency telephone number in North America) for an ambulance to transport the patients to another Hospital. If a patient is in distress and needs help right away the PSO will call the Rapid Response Team (RRT-team of health care providers that responds to hospitalized patients with early signs of deterioration) over the intercom. E #3 stated that an RRT and 911 was called on 9/24/19 for a patient with chest pain and an OB (obstetrics) patient who was transferred to another Hospital by Blue Island EMS (Emergency Medical Services) over the weekend. E #3 stated that the PSO's were instructed not to keep a record of the people that come to the ED and we're not sure of the number of people that have presented. E #3 stated that, therefore we have no idea as to where the patient was transferred.

7. During an interview on 9/24/19 at approximately 12:18 PM, the Hospitalist (MD #1) stated, "Today is the first day I work since Saturday, this is uncharted territory. If a Rapid Response Team (RRT) is called in the Hospital, I do attend along with other staff on the RTT. Now that there are no Emergency Department (ED) physicians, and if there is a RRT called, my role is still to lead the code. However, now I have to do nothing, basically just look at patient and wait for the ambulance to pick up the patient and transport to an accepting Hospital. Since these individuals are not considered patients of the Hospital, and we have no ED, we have no choice but to call 911 and transfer them."

8. During an interview on 9/26/19 at approximately 1:20 PM, the Hospitalist (Hospitalist on duty - MD #2) stated, "If a patient presents to the Hospital for emergency services, the RRT is called and 911 for transport, I can not actually assess the patient such as vital signs or other diagnostics. I just stand by the patient until the ambulance arrives, I explain to the patient that I can not assess them. I do not think we even have a crash cart or critical equipment down in that area anymore. If a person requires assistance with breathing CPR (cardiopulmonary resuscitation-emergency procedure that combines chest compressions and artificial ventilation) may be initiated."

9. During a phone interview a Public Safety Officer (E #7) on 9/24/19 at approximately 12:30 PM, who worked post 1 (ED - Emergency Department front desk) on Saturday (9/21/19) stated, "I was instructed that if any person presents to the ED and needs medical services to let them know the ED services are suspended. We direct patients to the nearest Hospital. If they have an emergency we call a Rapid Response Team (RRT) and also call 911 and wait for the ambulance to pick up the person. I recall one young lady coming to the Hospital, in labor, Saturday (9/21/19) morning after 5:00 AM and I had to call a RRT (Rapid Response Team) and 911 for the lady. We had her in the main lobby, I told her we were not taking patients, I called rapid and 911 for ambulance. When we call a RRT all of security shows up and we just wait for ambulance to come."

10. On 9/25/19 at approximately 11:00 AM, an interview was conducted with the Interim Chief Nursing Officer (E #1). E #1 stated that, as of 9/21/2019 at 12:00 AM, the Public Safety Manager (E #2) was instructed to give instructions to all Public Safety Officers scheduled to work in the ED, to inform individuals coming for service, that the Hospital was no longer accepting new patients and to call 911 for the person seeking emergency services. The PSOs were also instructed to call the RRT (Rapid Response Team). E #1 stated that, the role of the RRT was to just go to the location where the person was and wait for the paramedics to pick up the person that presented to the Hospital. The RRT's do not take vital signs or perform any type of medical screenings examinations (MSE). E #1 stated that the Hospital no longer has ED Physicians as of 9/20/19, and they are the only ones qualified to do MSEs.

11. During a phone interview on 9/26/19 at approximately 9:45 AM with the Lieutenant of Blue Island Fire Department - Emergency Medical Services (Z #1) stated, "We picked up the following patients from the Hospital: on 9/20/19 at 11:36 PM - psychiatric evaluation sent to (Hospital #l); on 9/23/19 at 5:59 AM - pregnancy sent to (Hospital #2); on 9//23/19 at 1:40 PM - breathing problems sent to (Hospital #2); on 9/23/29 at 2:52 PM - diabetic problems sent to (Hospital #2); on 9/24/19 at 5:49 AM - overdose was sent to (Hospital #3); on 9/24/19 at 2:02 PM - traumatic injury sent to (Hospital #2); on 9/25/19 at 8:33 AM - pregnancy sent to (Hospital #2); on 9/25/19 at 5:40 PM gun shot wound was sent to (Hospital #4)."