HospitalInspections.org

Based on facility policy review, review of Medical Staff Rules and Regulations, review of Emergency Medical Services (EMS) records, review of the Sheriff's Department incident reports, review of the facility's Emergency Department (ED) Central Log, review of the hospital's daily census, review of Tennessee Highway Patrol (THP) reports, and interviews, facility failed to provide a medical screening exam examination (MSE) for 1 patient (patient #31) of 31 ED patients' medical records reviewed.

The findings include:

Please refer to A-2406 for failure to provide a medical screening examination.

Based on review of facility policy, review of Emergency Medical Services (EMS) records, review of the Sheriff's Department incident reports, review of the facility's Emergency Department (ED) Central Log, and interviews, the facility failed to ensure 1 patient with an altered mental status (Patient #31) was listed on the ED Central Log of 31 ED patients reviewed.

The findings included:

Review of facility's policy titled "LL.026 EMTALA [Emergency Medical Treatment and Labor Act] - Medical Screening and Treatment of Emergency Medical Conditions" dated 11/10/2003 revealed "...Central Log is a log that a Hospital is required to maintain on each individual who comes to its emergency department or any location on the Hospital Property or Premises seeking assistance...Each such presenting individual must be listed in the Central Log..."

Review of EMS records dated 4/17/2020 revealed "...Arrived on Scene [accident scene] 1821 [6:21 PM]...EMS requested...for pt [patient] for AMS [altered mental status]...Pt did seem a little off [confused]. Pt stated to be looking for a 'Greek God' at the church. EMS stated to the pt that he may need to be checked out at a local ER [emergency room]. Pt stated that he was not going with EMS...He states he is fine. EMS tried once again to get pt to be transported. Pt still refused. EMS talked to [Sheriff's Deputies] that maybe we could get one of them [a Deputy] to ride with us with pt. At this time the pt became agitated...[a Deputy] placed cuffs on pt...[Deputies] they state they will take him [Patient #31] to ER..."

Review of a Sheriff's Department Incident Report written by Deputy #1 and dated 4/17/2020 revealed the Deputy responded to a motor vehicle accident involving Patient #31. Further review revealed "...someone has ran a truck off into their yard...walking barefoot caring [carrying] his shoes...looked a little confused when I approached him...It was clear [Patient #31] was having some kind of altered mental issues going on...EMS talked to him, they came to same conclusion that he is altered in some way...[Patient #31] refused to go [to the hospital] by ambulance...We were all trying to explain to [Patient #31] that he needed to be checked out and that we could not leave him in this state of mind...he had a choice to go with us or be taken to a Doctor to be checked out...He agreed to go to [Hospital B]..."

Review of a Sheriff's Department Incident Report Supplemental Report written by Deputy #2 and dated 4/17/2020 revealed "...[Deputy #1] approached me and stated he needed [Deputy #2 and Deputy #3] to transport [Patient #31] to [Hospital B] for an evaluation...Upon arriving at [Hospital B] we were met by two Police Officers...they advised that [Patient #31] was banned from the property and that the hospital would not see [Patient #31] because he had refused medical attention from [EMS]...a nurse [Registered Nurse (RN) #1] approached us and was very rude and angry and advised that we needed to take [Patient #31] and leave the property...[RN #1] began to walk to the patrol car...she spoke with [Patient #31] for approximately one minute...[RN #1] stated to me [Deputy #2] that [Patient #31] was not a threat to himself or anyone else and we left the hospital at that time...we took [Patient #31] to [a local hotel]..."

Review of a Sheriff's Department Incident Report Supplemental Report written by Deputy #3 and dated 4/17/2020 revealed "...upon arrival [to Hospital B] we were met by [local] Police Department who advised [Patient #31] was trespassed [banned] from the whole property [the University Campus where Hospital B is located] earlier in the day after running through a barricade. They [police officers] also stated the hospital would not examine [Patient #31] due to him refusing treatment from [EMS]...[RN #1] said we could take [Patient #31] and leave and [Patient #31] was not going to be seen there...she made her way to the patrol vehicle to make contact with [Patient #31]. [RN #1] deemed [Patient #31] was not a threat to himself or others. [Patient #31] was transported to [a local motel]..."

Review of the ED Central Log dated 4/17/2020 revealed Patient #31 was not listed.

During an interview on 4/27/2020 at 9:30 AM the Quality Director stated the facility was aware of the 4/17/2020 incident involving Patient #31's visit to the ED at Hospital B. Continued interview revealed the hospital was notified of the incident on 4/18/2020 and begun an investigation immediately. Continued interview confirmed Patient #31 was not listed on the ED Central Log dated 4/17/2020.

During a telephone interview on 4/28/2020 at 10:10 AM RN #1 stated she remembered Patient #31 being brought by Sheriff's Officers to the ED at Hospital #B on 4/17/2020. RN #1 stated she received a phone call from EMS prior to the patient's arrival and was told by EMS that the patient had been in a car accident and had no injuries. RN #1 stated EMS reported the patient had refused treatment at the scene of the accident and had refused transportation by them to the ED. RN #1 stated EMS reported the patient did not want to be seen at the ED, but the Sheriff's Officers were transporting the patient there anyway. RN #1 stated she had called the local police department and notified them Patient #31 was being transported by the Sheriff's Department to the ED. RN #1 stated she went outside the ED when the patient arrived and there were 4 Sheriff's Officers outside with the patient. RN #1 stated the Sheriff's Officer told her they planned to leave the patient at the ED for an evaluation. RN #1 stated the Patient was sitting in an Officer's car in the ED parking lot just outside the ED. RN #1 stated she spoke with Patient #31 and he told her he did not want to be seen or treated in the ED and that the police had forced him to come to the ED. RN #1 stated the patient was alert and oriented to time, place, and person. RN #1 stated the patient denied being suicidal or homicidal and did not appear to be at risk of harm to himself or others. RN #1 stated the patient appeared "...to be a little bit crazy..." RN #1 stated after the Sheriff's Officers spoke with their supervisor they left with the patient. RN #1 confirmed Patient #31 was not listed on the ED log.

During a telephone interview on 4/29/2020 at 9:15 AM Captain #1 with the Sheriff's Department stated he was the Officer in Charge on 4/17/2020 when Patient #31 was transported to Hospital B. Captain #1 stated the Deputies notified him by telephone that Patient #31 had obvious altered mental status of unknown cause and the patient was being transported to Hospital B by Deputy #2 and Deputy #3. Captain #1 stated Deputy #1 told him the patient had agreed to see a doctor at Hospital B before they had transported him. Captain #1 stated he was telephoned by RN #1 and she told him that the Deputies and Patient #31 had arrived at Hospital B and were outside of the ED. Captain #1 stated RN #1 told him Patient #31 would not be seen there and that the patient and Deputies would have to leave. Captain #1 stated he explained to RN #1 that he and the Deputies believed the patient was mentally impaired and had altered mental status from unknown cause and felt the patient needed to be evaluated. Captain #1 stated RN #1 told him she had spoken to Patient #31 and he was refusing treatment and in her opinion he was able to make that decision. Captain #1 stated RN #1 told him they were not allowed in the building and they were not going to care for the patient. Captain #1 stated he told his deputies to take the patient to a local hotel since he would not be seen or treated at Hospital B.

During a telephone interview on 4/29/2020 at 10:45 AM Deputy #1 stated he remembered the 4/17/2020 incident involving Patient #31. Deputy #1 stated he responded to a report of a vehicle running off of the road and into a yard. Deputy #1 stated he found Patient #31 walking around in a nearby church yard carrying his shoes. Deputy #1 stated the patient was alert and responsive, but was obviously confused about location, time, or specifics of the accident. Deputy #1 stated he called EMS to evaluate Patient #31 due to the patient having an altered mental status of unknown cause. Deputy #1 stated the patient refused to allow EMS to evaluate him or transport him to the local hospital. Deputy #1 stated EMS and the other two Deputies present believed Patient #31 was confused and mentally impaired for some unknown reason. Deputy #1 stated he remained at the scene of the accident and Deputy #2 and Deputy #3 transported Patient #31 to Hospital B to be evaluated for his altered mental status.

During a telephone interview on 4/29/2020 at 4:05 PM Deputy #2 stated he remembered transporting Patient #31 to Hospital B for a medical evaluation on 4/17/2020. Deputy #2 stated "...he seemed to be suffering from PTSD [post-traumatic stress disorder] or something like it...he was real edgy...told us that 'God told him to come to Tennessee'..." Deputy #2 stated he and Deputy #3 transported Patient #31 in their patrol car to Hospital B for an evaluation of the patient's altered mental status. Deputy #2 stated they arrived on Hospital B property and parked in the parking lot just outside the ED. Deputy #2 stated before they could get Patient #31 out of the patrol car they were met by two local police officers. Deputy #2 stated they were told by the police officers that the patient could not go into the hospital. Deputy #2 stated RN #1 came out of the ED and told them Patient #31 would not be treated at the ED and refused to allow the patient into the ED. Deputy #2 stated he explained to RN #1 they had transported the patient there for a medical evaluation of his altered mental status. Deputy #2 stated Patient #31 was not allowed out of the patrol car and was never examined by a Physician or other health professional. Deputy #2 stated "...[RN #2] talked to him [Patient #31] in the car for about 45 seconds and told me he [Patient #31] was not a threat to himself or anyone and he had refused treatment..." Deputy #2 stated they left Hospital B with Patient #31 and transported him to a local hotel.

During a telephone interview on 4/29/2020 at 4:50 PM Deputy #3 stated he remembered transporting Patient #31 to Hospital B on 4/17/2020 for a medical evaluation of his altered mental status. Deputy #3 stated when they arrived on Hospital B's property, in the parking lot just outside the ED entrance, two police officers told them they could not take the patient into the ED. Deputy #3 stated the police officers told him the patient was banned from the Sewanee University Campus property, on which Hospital B is located, and Patient #31 could not go into the hospital. Deputy #3 stated RN #1 came out of the ED and told him and Deputy #2 to "take your happy asses out of here" and told them to take the patient and leave the hospital. Deputy #3 stated RN #1 told them the patient was not going to be seen there because he had refused treatment by EMS at the accident scene. Deputy #3 stated they explained to RN #1 that Patient #31 was having symptoms of mental illness and they had brought him to Hospital B for a medical evaluation. Deputy #3 stated Patient #31 was never allowed out of the patrol car and was not examined by any health professional while on the hospital property. Deputy #3 stated RN #1 went to the patrol car and talked to the patient briefly. Deputy #3 stated RN #1, after speaking with the patient, told him [Deputy #3] the patient was not a threat to anyone. Deputy #3 stated RN #1 told him the patient had refused treatment and they could not leave him there at the hospital. Deputy #3 stated they transported the patient from Hospital B to a local hotel.

During a telephone interview on 4/30/2020 at 10:00 AM the Quality Director stated the facility received the Sheriff's Department reports on 4/28/2020 and decided the facility needed to initiate an action plan to address possible EMTALA violations.

Based on review of facility policy, review of Medical Staff Rules and Regulations, review of Emergency Medical Service (EMS) records, review of the Sheriff's Department incident reports, review of the hospital's daily census, review of Tennessee Highway Patrol (THP) reports, medical record review, and interviews, the facility failed to provide a Medical Screening Examination (MSE) for 1 Emergency Department (ED) patient (Patient #31) with an altered mental status of 31 ED patients reviewed.

The findings included:

Review of the facility's policy titled "LL.026 EMTALA [Emergency Medical Treatment and Labor Act] - Medical Screening and Treatment of Emergency Medical Conditions" dated 11/10/2003 revealed "PURPOSE...to ensure that individuals coming to an affiliated Hospitals Dedicated Emergency Department seeking assessment or treatment of a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination...Any individual who comes to the Hospital Property or Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exists..."

Review of the facility's Medical Staff Rules and Regulations dated June 29, 2000 revealed "...Any individual, who presents to the hospital property or premises, with a request for care, will be provided a medical screening examination to determine if an emergency medical condition exists. The exam may be performed by the Emergency Department physician in the Emergency Department or in the case of an obstetrical patient, by a Qualified Medical Person (designated Obstetrical Registered Nurse) in the Childbirth Center..."

Review of EMS records dated 4/17/2020 revealed "...Arrived on Scene [accident scene] 1821 [6:21 PM]...EMS requested...for pt [patient] for AMS [altered mental status]...Pt did seem a little off [confused]. Pt stated to be looking for a 'Greek God' at the church...stated to the pt that he may need to be checked out at a local ER [emergency room]. Pt stated that he was not going with EMS...He states he is fine. EMS tried once again to get pt to be transported. Pt still refused. EMS talked to [Sheriff's Deputies] that maybe we could get one of them [a Deputy] to ride with us with pt. At this time the pt became agitated...[a Deputy] placed cuffs on pt...[Deputies] state they will take him [Patient #31] to the ER..."

Review of a Sheriff's Department Incident Report written by Deputy #1 and dated 4/17/2020 revealed the Deputy responded to a motor vehicle accident where an individual (Patient #31) had run their truck off the road and into a yard. Deputy #1 discovered Patient #31 near the scene of the accident walking barefoot and carrying his shoes. Continued review revealed Patient #31 "...looked a little confused when I approached him...It was clear [Patient #31] was having some kind of altered mental issues going on. I called for EMS to come on scene and evaluate...EMS talked to him, they came to same conclusion that he is altered in some way...[Patient #31] refused to go by ambulance...We were all trying to explain to [Patient #31] that he needed to be checked out and that we could not leave him in this state of mind...He agreed to go to [Hospital B]..."

Review of a Sheriff's Department Incident Report Supplemental Report written by Deputy #2 and dated 4/17/2020 revealed Deputy #2 and Deputy #3 transported Patient #31 to Hospital B for an evaluation. Further review revealed when the Deputies arrived at the ED at Hospital B with Patient #31, two Police Officers advised the Deputies that Patient #31 was banned from the hospital property and the hospital would not see the patient because he had refused medical attention from EMS. Continued review revealed "...a nurse identified as [Registered Nurse (RN) #1] approached us and was very rude and angry and advised that we needed to take [Patient #31] and leave the property...[RN #1] spoke with [Patient #31] for approximately one minute...[RN #1] stated to me [Deputy #2] that [Patient #31] was not a threat to himself or anyone else and we left the hospital at that time...we took [Patient #31] to [a local hotel]..."

Review of a Sheriff's Department Incident Report Supplemental Report written by Deputy #3 and dated 4/17/2020 revealed "...upon arrival [to Hospital B], we were met by [local] Police Department who advised [Patient #31] was trespassed [banned] from the whole property [the University Campus where Hospital B is located] earlier in the day after running through a barricade. They [police officers] also stated the hospital would not examine [Patient #31] due to him refusing treatment from [EMS]...[RN #1] exited the hospital and became verbally aggressive with [Deputy #2] and myself. She said we could take [Patient #31] and leave...[Patient #31] was not going to seen there, she also stated we were notorious for dropping people off and leaving them..." Further review revealed RN #1 spoke with Patient #31 and then told the Deputies the patient was not a threat to himself or others. Patient #31 was then transported to a motel by the Deputies.

Review of Hospital B's census dated 4/17/2020 revealed Patient #31 was not listed. Further review revealed there was no medical record or a medical screening examination for Patient #31 and no documentation Patient #31 refused treatment.

Review of a THP Electronic Crime Report dated 4/18/2020 revealed "...On 4/18/2020 I [THP Trooper] was dispatched to Interstate...for a subject lying in the roadway...Identified as [Patient #31]...Initial assessment [Patient #31] showed some clues or signs of possible intoxication by drugs...he made a gesture like he was going towards the lane of travel [interstate lane]...[Patient #31] physically began to resisting and trying to pull myself out into the roadway with him...[Patient #31] was transported to [Hospital C]..."

During an interview on 4/27/2020 at 9:30 AM the Quality Director stated the facility was aware of the 4/17/2020 incident involving Patient #31's visit to the ED at Hospital B. Continued interview confirmed the facility had no medical record for Patient #31 and no documentation the patient refused treatment.

During a telephone interview on 4/28/2020 at 10:10 AM Registered Nurse (RN) #1 stated she remembered Patient #31 being brought by Sheriff's Officers to the ED at Hospital B on 4/17/2020. RN #1 stated she had received a phone call from EMS prior to the patient's arrival and was told by EMS that the patient had been in a car accident and had no injuries. RN #1 stated EMS reported the patient had refused treatment at the scene of the accident and had refused transportation by them to the ED. RN #1 stated EMS reported the patient did not want to be seen at the ED, but the Sheriff's Officers were transporting the patient there anyway. RN #1 stated she called the local police department and notified them a patient was being transported by Sheriff's Officers to the ED. RN #1 stated she went outside the ED when the patient arrived and there were 4 Sheriff's Officers outside with the patient. RN #1 stated the Sheriff's Officers told her they planned to leave the patient at the ED for an evaluation. RN #1 stated she told the Officers the patient was refusing treatment and they could not force the patient to be seen by a doctor if the patient did not want to be seen. RN #1 stated the Patient was sitting in the Officer's car in the ED parking lot just outside the ED. RN #1 stated she spoke with the patient and he told her he did not want to be seen or treated in the ED and that the police had forced him to come to the ED. RN #1 stated the patient was alert and oriented to time, place, and person. RN #1 stated the patient denied being suicidal or homicidal and did not appear to be at risk for harm to himself or others. RN #1 stated the patient appeared "...to be a little bit crazy..." RN #1 confirmed a medical record was not completed for Patient #31 and a MSE was not done.

During a telephone interview on 4/29/2020 at 9:15 AM, Captain #1 with the Sheriff's Department stated he was the Officer in Charge on 4/17/2020 when Patient #31 was transported to Hospital B. Captain #1 stated RN #1 called him on the telephone and said the Deputies had arrived at the ED with Patient #31. Captain #1 stated RN #1 said the patient would not be seen there and that the patient and Deputies would have to leave. Captain #1 stated he told RN #1 that Patient #31 appeared to have an altered mental status and needed to be evaluated. Captain #1 stated RN #1 told him Patient #31 had refused treatment and the Sheriff's Officers were not allowed in the building and the hospital was not going to provide care Patient #31. Captain #1 stated he believed RN #1 had spoken to the patient before talking to him, but later learned RN #1 had not seen or spoken with Patient #31 when she made the decision the patient was refusing treatment and was well enough to not need a medical evaluation. Captain #1 stated RN #1 refused to allow the patient inside the hospital.

During a telephone interview on 4/29/2020 at 10:45 AM Deputy #1 stated he remembered the 4/17/2020 incident involving Patient #31. Deputy #1 stated he responded to a report of a vehicle running off of the road. Deputy #1 stated he found Patient #31 walking around in a nearby church yard carrying his shoes. Deputy #1 stated the patient was alert and responsive, but was obviously confused about location, time, or specifics of the accident. Deputy #1 stated Deputy #2 and Deputy #3 transported Patient #31 to Hospital B to be evaluated for his altered mental status.

During a telephone interview on 4/29/2020 at 4:05 PM Deputy #2 stated he remembered transporting Patient #31 to Hospital B for a medical evaluation on 4/17/2020. Deputy #2 stated "...he seemed to be suffering from PTSD [post-traumatic stress disorder] or something like it...he was real edgy...told us that 'God told him to come to Tennessee'..." Deputy #2 stated he and Deputy #3 transported Patient #31 in their patrol car to Hospital B for an evaluation of the patient's altered mental status. Deputy #2 stated they arrived on Hospital B property and parked in the parking lot just outside the ED. Deputy #2 stated before they could get Patient #31 out of the patrol car they were met by two local police officers. Deputy #2 stated they were told by the police officers that the patient could not go into the hospital. Deputy #2 stated RN #1 came out of the ED and told them Patient #31 would not be treated at the ED and refused to allow the patient into the ED. Deputy #2 stated he explained to RN #1 they had transported the patient there for a medical evaluation of his altered mental status. Deputy #2 stated Patient #31 was never examined by a Physician.

During a telephone interview on 4/29/2020 at 4:50 PM Deputy #3 stated he remembered transporting Patient #31 to Hospital B on 4/17/2020 for a medical evaluation of his altered mental status. Deputy #3 stated when they arrived on Hospital B's property, in the parking lot just outside the ED entrance; two police officers told them they could not take the patient into the ED. Deputy #3 stated the police officers told him the patient was banned from the Sewanee University Campus property, on which Hospital B is located, and Patient #31 could not go into the hospital. Deputy #3 stated RN #1 came out of the ED and told him and Deputy #2 to "...'take your happy asses out of here'..." Deputy #3 stated RN #1 told them to take the patient and leave the hospital because the patient was not going to be seen there because he had refused treatment by EMS. Deputy #3 stated they explained to RN #1 that Patient #31 was having symptoms of mental illness and needed a medical evaluation. Deputy #3 stated Patient #31 was not examined by a Physician.

During a telephone interview on 5/6/2020 at 9:00 AM Physician #1 stated he was the ED Physician on duty at Hospital B on 4/17/2020 when Patient #31 arrived at the ED with the Sheriff's Deputies. Physician #1 stated he had no knowledge of Patient #31 arriving at the hospital with Sheriff's Deputies. Physician #1 stated he was the only qualified medical professional on duty in the ED on 4/17/2020 and he did not perform a MSE on Patient #31.

During a telephone interview on 5/6/2020 at 8:25 AM the Quality Director stated RN #1 was not a Qualified Medical Provider (QMP) and therefore was not able to perform a MSE on patients presenting to the facility with a medical condition.