HospitalInspections.org

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Based on interview, record review, and review of hospital policies and procedures, the hospital failed to provide a medical screening examination for a patient presenting to the emergency department for care, in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to comply with EMTALA regulations risks poor patient outcomes, injury and death.

Findings included:

The hospital failed to provide a medical screening examination for a patient who presented to the hospital requesting emergency medical care.

Cross-reference A2406
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Based on interview, document review, and review of hospital policies and procedures, the hospital failed to provide an appropriate medical screening exam (MSE) for 1 of 25 patients (Patient #1) seeking treatment in the emergency department (ED).

Failure to provide appropriate medical screening examinations by qualified medical professionals with stabilizing medical treatment prior to ED discharge or transfer risks poor health outcomes, injury, and death.

Findings included:

1. Review of the hospital's policy titled "Emergency Medical Treatment and Labor Act (EMTALA) Compliance," policy number 10953975, revised 12/2020, showed that a medical screening examination (MSE) will be conducted and documented by qualified medical personnel for any individual presenting to the hospital's emergency department (ED) seeking examination or treatment of a medical condition.

2. On 12/07/22, the investigator requested and received the Incident Activity Report from Thurston 9-1-1 Communications regarding the index patient's (Patient #1) emergency call and transport to Capital Medical Center (CMC). The report showed that Patient #1 was brought to MultiCare Capital Medical Center (CMC) on 11/04/22 at approximately 3:42 PM by American Medical Response (AMR) basic life support (BLS) ambulance 14. The report also showed that AMR 14 was rerouted to Providence St Peter Hospital (PSPH) at 3:50 PM.

3. On 12/13/22, the investigator reviewed the medical record of Patient #1. Patient #1's medical record showed no evidence of a medical screening examination or stabilizing treatment received on 11/04/22.

4. On 12/13/22, the investigator reviewed CMC's ED Ambulance Log. The log showed that emergency medical technician (EMT) #1 called CMC's ED on 11/04/22 at 3:41 PM to give report regarding Patient #1. The log indicated that the patient was redirected to PSPH.

5. On 12/07/22 At 9:30 AM, the investigator interviewed the EMT (EMT #1) assigned to Patient #1 on 11/04/22. EMT #1 stated that on 11/04/22 he responded to a call from a property near CMC's campus. Patient #1's family reported that the patient had fallen and experienced a seizure earlier in the day. Patient #1's primary provider requested that her family bring her in to the closest emergency department (ED) to evaluate for injuries related to her fall. EMT #1 stated that he was in the back of the ambulance taking care of the patient when they arrived at CMC's ambulance bay. EMT #1 then called the ED's recorded line to give report to the staff while readying the patient for transfer into the ED's care. The recorded line was answered by a female registered nurse (RN) (RN #14). EMT #1 stated that RN #14 told him to take the patient to Providence St Peter Hospital (PSPH) because they didn't have the resources to care for the patient. EMT #1 stated that he told RN #14 that he was directed to go to the nearest hospital and that he was already in the ambulance bay. EMT #1 stated that RN #14 reiterated that PSPH needed to take the patient. EMT #1 stated that he left CMC and took the patient to PSPH.

6. On 12/13/22 at 8:53 AM, the investigator listened to the audio on CMC's ED recorded report line with the ED Manager (RN #4). The audio recording from 11/04/22, beginning at 3:41 PM, showed that RN #14 answered the phone and that EMT #1 gave report. RN #14 told EMT #1 to go to Providence St Peter Hospital. EMT #1 told RN #14 that he was in the ambulance bay with Patient #1. RN #14 reiterated that they didn't have the resources to care for the patient and they needed to go elsewhere.

7. On 12/13/22 at 9:00 AM, the investigator interviewed RN #4. RN #4 confirmed that Patient #1 presented to MultiCare Capital Medical Center via ambulance for emergency care on 11/04/22. RN #4 also confirmed that RN #14 redirected the patient to Providence St Peter Hospital without a medical screening examination (MSE), stabilizing treatment, or hospital transfer.
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