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Based on interview, and record review, it was determined the facility is not in compliance with the medical screening examination requirement to determine if an emergent medical condition exist, the facility failed to provide the necessary stabilizing treatment and failed to ensure an appropriate transfer for 1 out of 22 Sampled Patients (SP), (SP# 1).

The facility failed to be in compliance with the Emergency Medical Treatment and Labor Act requirements at 489.24.

Based on record review, observation and interview the facility failed to ensure that an appropriate medical screening examination (MSE) is provided within the capability of the hospital's emergency department on 1 of 22 Sampled Patients (SP#1).

Findings include:

Review of the facility ' s Medical Screening Examination shows that an individual requesting medical examination or treatment through the Emergency Department of this hospital has a right to:
1). A medical screening examination, within the capabilities of the Emergency Department and the ancillary services commonly available to the Emergency Department, to determine if an emergency medical condition exist.
2). Medical treatment as necessary to stabilize an emergency medical condition.


The Central Log revealed that sampled patient #1 came to the emergency room at hospital #1 on 04/29/2014 at 23:37 pm (first visit). The patient presented with Altered Mental Status and had ingested 24 beers. The patient was seen by the physician and labs were drawn and the serum alcohol level was 293 mg/dl. The patient was ordered sodium chloride and thiamine 100 mg of which he refused. According to the notes the patient was discharged home unaccompanied and walking.

Review of the reference provided by the facility, Serum ethanol level of greater than > 300 mg/dl can be potentially fatal.

Record Review of sampled patient #1 second visit to hospital #1 reveal that the emergency department (ED#1) Central Log noted that SP#1 arrived at the facility on 04/30/14 at 22:19 pm. The ED#1 log disposition showed that on 04/30/14 at 22:20 pm, SP#1 LPMSE (left prior to Medical Screening Examination).

Sample Patient #1 Note showed that he was brought in by two Police officers on 04/30/2014 around 22:19 pm, and a Rapid Initial Assessment/Triage was conducted by the Charge Nurse around 22:20 pm, and it was noted that the patient was brought in by the police for ingestion of ETOH (Ethyl Alcohol) and was on legal hold. Further record review showed a late entry by the Charge Nurse on 05/01/14 at 06:14 am for an incident that occurred at 22:20 pm the night before 04/30/2014 stating, apparently this patient was charged with trespassing the night before per Nursing Supervisor, and confirmed with security and ARNP (Advanced Registered Nurse Practitioner). Police took patient away.

Further review of SP#1 ' s reveal the information was entered in the ED Central Log, and an Initial Rapid Assessment was done. There was no evidence that a Medical Screening Examination was provided to SP#1. The ED#1 Nursing Director also stated that all of the ED#1's Staff knew that our policy is not to refuse services to anyone who comes, or brought to the emergency room requesting to be seen regardless of their status or ability to pay.


Record review of SP#1's visit at Hospital #2 showed on the Baker Act form " Report of Law Enforcement Officer Initiating Involuntary Examination " dated 04/30/2014 at 10:00 PM showed that " SP#1 called the police because he needed to see a Doctor. Upon making contact with SP#1, he (SP#1) advised he was hearing voices to kill black people and then kill himself. SP#1 then said, If I don't see a Doctor I have to do it. SP#1 was subsequently transported to hospital # 2 and Baker Acted. According to SP #1 admission information, he arrived at hospital #2 at 10: 21 pm. The emergency department psychiatric evaluation states that he is depressed, with suicidal/homicidal ideation. The serum (toxicology) toxi -screen ethanol level was 238.0 mg/DL. He was admitted to the psychiatric unit, treated, and discharged on 05/07/2014.



Interview with the Emergency Department (ED #1's) Nursing Director on June 30,2014 around 11 AM confirmed that SP#1 was brought by two Police#2 to the facility ' s ED on 04/30/2014 around 22:19 pm via the ambulance entrance. The ED#1 Nursing Director stated that there was a lot of confusion that evening. The ED#1 Charge Nurse at that time didn't know SP#1, and didn't know what happened the night before. The ED#1 Charge Nurse received the patient, entered patient information in the ED#1 Central Log, and did a Rapid Initial Assessment while the Nursing Supervisor and the Security Officer who happened to be in the ED were communicating with the police #2. The Nursing Supervisor and the Security Officer apparently recognized SP#1 as the same person who was seen in the ED#1 the night before (04/29/2014) for alcohol intoxication, and was seen, examined, stabilized, and then discharged by the ED#1 physician. Thereafter, Police #1 placed SP#1under police custody for disorderly conduct, and trespassing for refusing to leave the hospital property. The Nursing Supervisor and the security officer were trying to explain the situation with Police#2 who had no idea what happened the previous night since Police#1 was involved. The ED#1 Director stated that the incident happened so fast that by the time the ED#1 Charge Nurse knew it, SP#1 was taken away by the Police#2 and brought to ED#2 at Hospital #2. The police made a quick decision to take the patient to another facility and was not aware of the consequences to our facility.


Interview with the ACNO and the Director of ED on 07/01/2014 around 2PM revealed that corrective measures as presented on the Plan of Correction are in place and ongoing.

The following corrective measures began and are ongoing:
Face to face training on EMTALA/Emergency Access regulations for all active ED
Staff took place on June 2-5, 2014. Staff who were on vacation or were on leave will be re-educated upon return.

Continue with daily huddles as a constant reinforcement

Improve communication with nearby Police Departments, and Fire Rescue Squad regarding taking patients away when patients are already in the facility ' s ED or property.

Educate security officers on May 9, 2014, and nursing supervisors on EMTALA/Emergency Access regulations, and to refer to the ED Nurse the responsibility to initiate ED services
to patients who come or brought to the ED requesting to be seen.

Clarify Trespassing policy and educate appropriate staff.
Disciplinary measures on involved staff

Quality Assurance monitoring program is ongoing.


The facility self-reported a possible violation of the EMTALA (Emergency Medical Treatment & Labor Act) law on May 05, 2014.

Based on interview, review of policy and procedure, and medical record review, the facility failed to provide the necessary stabilizing treatment that was within the capability and capacity of the hospitals Dedicated Emergency Department (DED) for 1 out of 22 Sample Patients (SP) (SP#1) See tag 2406 for additional information on SP #1.

Findings include:

Review of the facility ' s Medical Screening Examination shows that an individual requesting medical examination or treatment through the Emergency Department of this hospital has a right to:
1). A medical screening examination, within the capabilities of the Emergency Department and the ancillary services commonly available to the Emergency Department, to determine if an emergency medical condition exist.
2). Medical treatment as necessary to stabilize an emergency medical condition.


The Central Log of the first visit revealed that sampled patient #1 came to the emergency room at hospital #1 on 04/29/2014 at 23:37 pm . The patient presented with Altered Mental Status and had ingested 24 beers. The patient was seen by the physician and labs were drawn and the serum alcohol level was 293 mg/dl. The patient was ordered sodium chloride and thiamine 100 mg of which he refused. According to the notes the patient was discharged home unaccompanied and walking.

Review of the reference provided by the facility, Serum ethanol level of greater than > 300 mg/dl can be potentially fatal.

Record Review of sampled patient #1 second visit to hospital #1 reveal that the emergency department (ED#1) Central Log noted that SP#1 arrived at the facility on 04/30/14 at 22:19 pm. The ED#1 log disposition showed that on 04/30/14 at 22:20 pm, SP#1 LPMSE (left prior to Medical Screening Examination).

Sample Patient #1 ED Notes showed that he was brought in by two Police officers on 04/30/2014 around 22:19 pm, and a Rapid Initial Assessment/Triage was conducted by the Charge Nurse around 22:20 pm, and it was noted that the patient was brought in by the police for ingestion of ETOH (Ethyl Alcohol) and was on legal hold. Further record review showed a late entry by the Charge Nurse on 05/01/14 at 06:14 am for an incident that occurred at 22:20 pm the night before 04/30/2014 stating, apparently this patient was charged with trespassing the night before per Nursing Supervisor, and confirmed with security and ARNP (Advanced Registered Nurse Practitioner). Police took patient away.

Further review of SP#1 ' s reveal the information was entered in the ED Central Log, and an Initial Rapid Assessment was done. There was no evidence that a Medical Screening Examination was provided to SP#1 nor was the emergent medical condition stablized.

Record review of SP#1's visit at Hospital #2 showed on the Baker Act form " Report of Law Enforcement Officer Initiating Involuntary Examination " dated 04/30/2014 at 10:00 PM showed that " SP#1 called the police because he needed to see a Doctor. Upon making contact with SP#1, he (SP#1) advised he was hearing voices to kill black people and then kill himself. SP#1 then said, if I don't see a Doctor I have to do it. SP#1 was subsequently transported to hospital # 2 and Baker Acted. According to SP #1 admission information, he arrived at hospital #2 at 10: 21 pm. The emergency department psychiatric evaluation states that he is depressed, with suicidal/homicidal ideation. The serum (toxicology) toxi -screen ethanol level was 238.0 mg/DL. He was admitted to the psychiatric unit, treated, and discharged on 05/07/2014.



The ED#1 Nursing Director also stated that all of the ED#1's Staff knew that our policy is not to refuse services to anyone who comes, or brought to the emergency room requesting to be seen regardless of their status or ability to pay.