HospitalInspections.org

Based on interviews, the facility failed to comply with the Condition of Care for EMTALA.
The facility failed to medically screen Patient #21 when presented at the Emergency Department Bay by EMS transport (refer to 2406); failed to stabilized Patient #21 when presented at the Emergency Department Bay by EMS transport (refer to 2407); failed to ensure an appropriate transfer with hospital to hospital communication (refer to 2409) and failed to maintain a medical record for Patient #21 (refer to 2403).

Based on interview, the facility failed to maintain a record of a patient who presented at the Emergency Department for 1 (Patient #21) of 21 sampled patients reviewed.

The findings include:

Record review revealed Patient #21 was listed on the ED log as " Jane Doe " on 7/10/11; however, there was no medical record available as this patient was never examined in the hospital ED.

Based on interviews, the facility failed to ensure that an individual patient presenting at the Emergency Department was medically screened before transfer for 1 (Patient #21) of 21 patients reviewed.

The findings include:

1. During an interview with the Risk Manager (RM), on 8/19/11 at 3:35 p.m., she revealed she was informed the charge nurse was speaking to Emergency Medical Services (EMS) personnel on the phone and she told them if the patient was stable, they should take the patient to another hospital with obstetric capabilities because they did not have obstetrical (OB) services. The medic was not sure whether the patient was stable and they would call back. They did not get a call back and 10 minutes later showed up in the hospital Bay. The physician went out to the ambulance bay and spoke to the medic before the patient was unloaded and the medic stated the BP was stable. The physician stated twice he would take the patient but would then have to transfer the patient to the other hospital for fetal monitoring. The medic then took the patient to the other hospital.

2. Interview with Registered Nurse (RN), on 8/19/11 at 3:51 p.m., who received the call revealed she received a phone call from Rescue 12, or 15, and they called to say that they were coming in with a 6 month pregnant female who had fallen on her belly. She asked if the patient was stable and they said she was and she explained to them they did not have a fetal monitor at the hospital and it would probably be in the patient's best interest to go to another hospital with OB capabilities. But, they would take the patient if they felt they needed to come to Doctor's Hospital. At no time did she refuse to take the pt. The guy that called was not the paramedic and he relayed the info to the paramedic who said they would call back. They never called back and just showed up at the hospital EMS bay. The physician was told about the call and they had not called back and she assumed they were going to the other hospital. They showed up at the back door and she informed the physician and he stated he wanted to talk to them. They went outside and the patient had not been unloaded and when they opened the door to the rig the physician stated she needed to go to the other hospital where she needed to be monitored; but, he also said if she's unstable we'll take her but she probably needs to go to the other hospital and said to the medic "it's your call." They took her to memorial. The RN stated they all took the EMTALA education and it's all important to them now. This re-education is very valuable. Took it within the past month. They have a crystal clear understanding of EMTALA.

3. Interview with the physician involved on 8/19/11 at 4:02 p.m., revealed he was told by the ER nurse that she received a call from EMS that a mother who was 6 months pregnant had fallen on her stomach and they were possible en route to Doctor's Hospital. She told the physician that they were going to be calling them back because she informed who she spoke to that they do not have the capability of fetal monitoring and it would probably be in the best interest of the patient to be taken straight to the other hospital. They had not heard anything back and then he was called out to the ambulance entrance where it was learned the mother was in the truck. He stated he told the medics he would treat the patient but he did not have the ability to do fetal monitoring; the best he could do would be an ultrasound and then would probably have to send her to the other hospital. He stated at no time did he refuse to take the patient; he felt it was in the best interest of the patient to be taken to the other hospital but never refused to take her. He walked back into the ER and the medics took her to the other hospital. He stated he has been addressed by the ED Medical Director, for this bad decision and has just recently taken another extensive course in EMTALA for which he has learned a valuable lesson.

Based on interviews, the facility failed to ensure that any patient presenting at the Emergency Department was medically stabilized before transfer for 1 (Patient #21) of 1 patients reviewed for transfer.


The findings include:

1. During an interview with the Risk Manager (RM), on 8/19/11 at 3:35 p.m., she revealed she was informed the charge nurse was speaking to EMS on the phone and she told them if the patient was stable, they should take the patient to another hospital with obstetric capabilities because they did not have OB. The medic was not sure whether the patient was stable and they would call back. They did not get a call back and 10 minutes later showed up in the Bay. The physician went out to the ambulance bay and spoke to the medic before the patient was unloaded and the medic stated the BP was stable. The physician stated twice he would take the patient but would then have to transfer the patient to the other hospital for fetal monitoring. The medic then took the patient to the other hospital.

2. Interview with Registered Nurse (RN), on 8/19/11 at 3:51 p.m., who received the call revealed she received a phone call from Rescue 12, or 15, and they called to say that they were coming in with a 6 month pregnant female who had fallen on her belly. She asked if the patient was stable and they said she was and she explained to them they did not have a fetal monitor at the hospital and it would probably be in the patient's best interest to go to another hospital with OB capabilities. But, they would take the patient if they felt they needed to come to Doctor's Hospital. At no time did she refuse to take the pt. The guy that called was not the paramedic and he relayed the info to the paramedic who said they would call back. They never called back and just showed up at the hospital EMS bay. The physician was told about the call and they had not called back and she assumed they were going to the other hospital. They showed up at the back door and she informed the physician and he stated he wanted to talk to them. They went outside and the patient had not been unloaded and when they opened the door to the rig the physician stated she needed to go to the other hospital where she needed to be monitored; but, he also said if she's unstable we'll take her but she probably needs to go to the other hospital and said to the medic "it's your call." They took her to memorial. The RN stated they all took the EMTALA education and it's all important to them now. This re-education is very valuable. Took it within the past month. They have a crystal clear understanding of EMTALA.

3. Interview with the physician involved on 8/19/11 at 4:02 p.m., revealed he was told by the ER nurse that she received a call from EMS that a mother who was 6 months pregnant had fallen on her stomach and they were possible en route to Doctor's Hospital. She told the physician that they were going to be calling them back because she informed who she spoke to that they do not have the capability of fetal monitoring and it would probably be in the best interest of the patient to be taken straight to the other hospital. They had not heard anything back and then he was called out to the ambulance entrance where it was learned the mother was in the truck. He stated he told the medics he would treat the patient but he did not have the ability to do fetal monitoring; the best he could do would be an ultrasound and then would probably have to send her to the other hospital. He stated at no time did he refuse to take the patient; he felt it was in the best interest of the patient to be taken to the other hospital but never refused to take her. He walked back into the ER and the medics took her to the other hospital. He stated he has been addressed by the ED Medical Director, for this bad decision and has just recently taken another extensive course in EMTALA for which he has learned a valuable lesson.

Based on interviews, the facility failed to ensure that any patient presenting at the Emergency Department was appropriately transferred for 1 (Patient #21) of 1 patients reviewed for transfer.


The findings include:

1. During an interview with the Risk Manager (RM), on 8/19/11 at 3:35 p.m., she revealed she was informed the charge nurse was speaking to EMS on the phone and she told them if the patient was stable, they should take the patient to another hospital with obstetric capabilities because they did not have OB. The medic was not sure whether the patient was stable and they would call back. They did not get a call back and 10 minutes later showed up in the Bay. The physician went out to the ambulance bay and spoke to the medic before the patient was unloaded and the medic stated the BP was stable. The physician stated twice he would take the patient but would then have to transfer the patient to the other hospital for fetal monitoring. The medic then took the patient to the other hospital.

2. Interview with Registered Nurse (RN), on 8/19/11 at 3:51 p.m., who received the call revealed she received a phone call from Rescue 12, or 15, and they called to say that they were coming in with a 6 month pregnant female who had fallen on her belly. She asked if the patient was stable and they said she was and she explained to them they did not have a fetal monitor at the hospital and it would probably be in the patient's best interest to go to another hospital with OB capabilities. But, they would take the patient if they felt they needed to come to Doctor's Hospital. At no time did she refuse to take the pt. The guy that called was not the paramedic and he relayed the info to the paramedic who said they would call back. They never called back and just showed up at the hospital EMS bay. The physician was told about the call and they had not called back and she assumed they were going to the other hospital. They showed up at the back door and she informed the physician and he stated he wanted to talk to them. They went outside and the patient had not been unloaded and when they opened the door to the rig the physician stated she needed to go to the other hospital where she needed to be monitored; but, he also said if she's unstable we'll take her but she probably needs to go to the other hospital and said to the medic "it's your call." They took her to memorial. The RN stated they all took the EMTALA education and it's all important to them now. This re-education is very valuable. Took it within the past month. They have a crystal clear understanding of EMTALA.

3. Interview with the physician involved on 8/19/11 at 4:02 p.m., revealed he was told by the ER nurse that she received a call from EMS that a mother who was 6 months pregnant had fallen on her stomach and they were possible en route to Doctor's Hospital. She told the physician that they were going to be calling them back because she informed who she spoke to that they do not have the capability of fetal monitoring and it would probably be in the best interest of the patient to be taken straight to the other hospital. They had not heard anything back and then he was called out to the ambulance entrance where it was learned the mother was in the truck. He stated he told the medics he would treat the patient but he did not have the ability to do fetal monitoring; the best he could do would be an ultrasound and then would probably have to send her to the other hospital. He stated at no time did he refuse to take the patient; he felt it was in the best interest of the patient to be taken to the other hospital but never refused to take her. He walked back into the ER and the medics took her to the other hospital. He stated he has been addressed by the ED Medical Director, for this bad decision and has just recently taken another extensive course in EMTALA for which he has learned a valuable lesson.