HospitalInspections.org

Based on review of facility documents and staff interviews (EMP), it was determined that the facility failed to maintain a central log on each individual who comes to the emergency department, as defined in ?489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for one of one patients (PT1).

Findings include:

Review of "Compliance - Emergency Medical Treatment and Active Labor Act (EMTALA) ... Date of Last Revision: 06/15/2009" revealed "I. Policy Statement Any individual who comes to the Hospital Property or Premises requesting examination or treatment and appears to be suffering from an Emergency Medical Condition or expresses a complaint which could reasonably be construed as an Emergency Medical Condition, or who comes to the Dedicated Emergency Department requesting examination or treatment of a medical condition is entitled to and shall be provided an appropriate Medical Screening Examination to determine whether or not an Emergency Medical Condition exists, stabilization to the extent the facility is able to do so, and an Appropriate Transfer if necessary ... III. Policy Definitions ... Central Log is a log that a Hospital is required to maintain on each individual who comes to its emergency room or any location on the Hospital Property or Premises seeking emergency assistance and the disposition of each individual, whether he or she refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged. The purpose of the central log is to track the care provided to each individual who comes to the Hospital Property or Premises seeking care for and Emergency Medical Condition."

1) An interview was conducted with EMP3 on February 11, 2010, at approximately 10:20 AM. EMP3 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP3 stated "There were a set of parents that came in with a child and wanted to have [PT1] committed ... They came up to the window ... I called [the Behavioral Health Unit] ... I was told that we did not take children and that the process is very long to find a bed ... The parents said they were going to [another hospital]."

During further interview with EMP3, EMP3 was asked if they ascertained the name of the patient or if the patient was logged into the Emergency Department Log and EMP3 stated "No, I don't think they said it to me ... Looking back I regret not registering the patient. I should have just registered [them]."

2) An interview was conducted with EMP4 on February 11, 2010, at approximately 10:55 AM. EMP4 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP4 stated "I am [aware] ... I took a phone call from the ED ... I was assuming [they] were asking for beds and I said that there would have to be a bed search ... I never said we could not see the patient."

3) An interview was conducted with EMP8 on February 12, 2010, at approximately 10:00 AM. EMP8 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP8 stated "I came in from the back and a [person] came and said 'I need to 302 my [child].' I said to [EMP3] 'You need to call upstairs because we don't have a [Behavioral Health] nurse down here right now' ... [EMP3] got off the phone and said 'We don't have beds' ... The parent said that [they] would go to [another hospital]."

4) An interview was conducted with EMP9 on February 12, 2010, at approximately 11:05 AM. EMP9 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP9 stated "I was with a patient in triage. I went to walk to the back and heard a [parent] say '... I want to 302 [the child] ... I came back and they were gone ... They [ED staff] called upstairs and said we don't have pediatric psych ... I called the charge nurse because I knew they should have had a screening."

Based on review of facility documents and interview with staff (EMP), it was determined that the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists for one of one patients (PT1).

Findings include:

Review of "Compliance - Emergency Medical Treatment and Active Labor Act (EMTALA) ... Date of Last Revision: 06/15/2009" revealed "I. Policy Statement Any individual who comes to the Hospital Property or Premises requesting examination or treatment and appears to be suffering from an Emergency Medical Condition or expresses a complaint which could reasonably be construed as an Emergency Medical Condition, or who comes to the Dedicated Emergency Department requesting examination or treatment of a medical condition is entitled to and shall be provided an appropriate Medical Screening Examination to determine whether or not an Emergency Medical Condition exists, stabilization to the extent the facility is able to do so, and an Appropriate Transfer if necessary ... IV. Policy Guidelines I. Medical Screening Examination ... D. How to Provide the Medical Screening Examination. 1. Hospitals are obligated to perform the Medical Screening Examination to determine if an Emergency Medical Condition exists."

1) An interview was conducted with EMP3 on February 11, 2010, at approximately 10:20 AM. EMP3 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP3 stated "There were a set of parents that came in with a child .... They came up to the window ... They were leaning into the window stating that their [child] threatened their lives ... [PT1] was standing right behind them ... I called [the Behavioral Health Unit] ... I was told that we did not take children and that the process is very long to find a bed ... The parents said they were going to [another hospital]."

During further interview with EMP3, EMP3 was asked if they ascertained the name of the patient or if the patient was logged into the Emergency Department Log and EMP3 stated "No, I don't think they said it to me ... Looking back I regret not registering the patient. I should have just registered [them]."

2) An interview was conducted with EMP4 on February 11, 2010, at approximately 10:55 AM. EMP4 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP4 stated "I am [aware] ... I took a phone call from the ED ... I was assuming [they] were asking for beds and I said that there would have to be a bed search ... I never said we could not see the patient."

3) An interview was conducted with EMP8 on February 12, 2010, at approximately 10:00 AM. EMP8 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP8 stated "I came in from the back and a [person] came and said 'I need to 302 my [child].' I said to [EMP3] 'You need to call upstairs because we don't have a [Behavioral Health] nurse down here right now' ... [EMP3] got off the phone and said 'We don't have beds' ... The parent said that [they] would go to [another hospital]."

4) An interview was conducted with EMP9 on February 12, 2010, at approximately 11:05 AM. EMP9 was asked about her knowledge of PT1 coming to the Emergency Department on February 3, 2010. EMP9 stated "I was with a patient in triage. I went to walk to the back and heard a [parent] say '[The child] is threatening us and I want to 302 [the child] ... I came back and they were gone ... They [ED staff] called upstairs and said we don't have pediatric psych ... I called the charge nurse because I knew they should have had a screening."