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Based on record review and interview, the facility failed to ensure the Governing Body Bylaws were in compliance with the EMTALA (Emergency Medical Treatment and Labor Acts) requirements.

This failed practice has the likelihood for governing body members and staff, including medical staff, to be uninformed of their responsibilities under EMTALA requirements.


Findings:

On 11/19/19 at 1:10 pm, a request was made for Governing Body Bylaws.

On 11/19/19 at 1:10 pm, Staff F stated the previous managing group had taken the Governing Body Bylaws with them and there was no meeting minutes, or bylaws.

Based on record review and interview, the hospital failed to ensure:

1. Appropriate medical screening examinations were conducted in six (Patient #1, 2, 11, 12, 13, 19) of 20 patients.

2. Appropriate medical screening examinations were conducted by a qualified member of the medical staff for 20 (Patient # 1 to 20) of 20 patients.

3. Documentation of Emergency Triage Levels for patient care priorization for emergency department (ED) patients for four (Patient #11, 12, 15, 16 ) of 20 patients.


This failed practice has the likelihood for an emergency medical condition to go unidentified and untreated thereby, increasing the risk of undesirable health outcomes and no identification of patients requiring immediate care.


Findings:

1. A policy titled "Scope of Service" read in part, "All patients that present seeking emergency care shall receive a medical screening exam by an emergency department physician that includes providing all necessary testing and on-call services within the capability to reach a diagnosis. Support services including but not limited to clinical laboratory services and x-rays will be provided to the patient in a timely manner."


A review of patient records showed no medical screening examinations were provided for six (Patient #1, 2, 11, 12, 13, 19) of 20 patients.

Patient #1 was triaged on 09/11/19 at 10:48 pm and patient records showed no documentation of a medical screening examination.

Patient #2 was triaged on 10/01/19 at 5:05 pm and patient records showed no documentation of a medical screening examination.

Patient #11 was triaged on 11:20 pm and patient records showed no documentation of a medical screening examination.

Patient #12 was treated on 11/17/19 at 3:25 pm and patient records showed no documentation of a medical screening examination.

Patient #13 was traiged on 10/23/19 at 10:30 pm and patient records showed no documentation of a medical screening examination.

Patient #19 was triaged on 09/28/19 at 12:43 am and patient records showed no documentation of a medical screening examination.


On 11/19/19 at 1:35 pm Staff D stated, the managing company implemented an Emergent/Non-Emergent Form to be used for screening patients that came for treatment in the emergency room. Staff D reviewed the record for patient #13 and stated, patient #13 was not examined in the emergency room and was told to come back in the morning for treatment at Staff U's clinic.


2. A document titled "Physician PRN Employment Agreement" between previous managment company and:
1. Staff U was signed on 04/14/2014.
2. Staff V was not signed and dated.


A review of patient records showed no documentation of appropriate medical screening examinations by a qualified member of the medical staff were provided for 14 (Patient #3, 4, 5, 6, 7, 8, 9, 10, 14, 15, 16, 17, 19, 20) of 20 patients.

Patient #3 was triaged on 10/01/19 at 9:00 pm and patient records showed no documentation of a medical screening examination by a qualified member of the medical staff.

Patient #4 was treated on 10/18/19 at 11:50 pm and patient records showed no documentation of a medical screening examination by a qualified member of the medical staff.

Patient #5 was treated on 10/21/19 at 6:15 pm and patient records showed no documentation of a medical screening examination by a qualified member of the medical staff.

Patient #6 was treated on 10/22/19 at 9:00 pm and patient records showed no documentation of a medical screening examination by a qualified member of the medical staff.

Patient #7 was treated on 11/05/19 at 10:40 am and patient records showed no documentation of a medical examination by a qualified member of the medical staff.

Patient #8 was treated on 11/09/19 at 9:55 am and patient records showed no documentation of a medical screening examination by a qualified member of the medical staff.

Patient #9 was treated on 11/11/19 at 11:40 am and patient records showed no documentation of a medical screening examination by a qualified member of the medical staff.

Patient #10 was treated on 11/07/19 at 11:00 am and patient records showed no documentation of a medical screening examination by a qualified member of the staff.

Patient #14 was treated on 10/25/19 at 4:20 pm and patient records showed no documentation of a medical screening examination by a qualified member of the staff.

Patient #15 arrived at 6:30 pm on 10/11/19 and patient records showed no documentation of a medical screening examination by a qualified member of the staff.

Patient #16 was treated on 10/31/19 at 6:00 pm and patient records showed no documentation of a medical screening examination by a qualified member of the staff.

Patient #17 was triaged on 09/27/19 at 8:21 am and patient records showed no documentation of a medical screening examination by a qualified member of the staff.

Patient #18 was triaged on 09/28/19 at 10:49 am and patient records showed no documentation of a medical screening examination by a qualified member of the staff.

Patient #20 was triaged on 10/21/19 at 11:40 pm and patient records showed no documentation of a medical screening examination by a qualified member of the medical staff.


On 11/15/19 at 2:20 pm, Staff A stated Staff U was working as a volunteer and not a paid employee.

On 11/19/19 at 12:50 pm, Staff A stated Staff V is the covering physician when Staff U is out of town.


3. A policy titled "Emergency Triage Policy and Procedure" read in part, "The charge nurse in the emergency department is responsible for the triage of all patients that present to the emergency department for evaluation and/or treatment.... Triage Level 5 - stable with minor problems and will not utilize any resources.... Level 4 - stable with minor or chronic problems and require one resource during.... Level 3 - stable, present with normal vital signs and require at least 2 or more resources.... Level 2 - high risk, confused, lethargic, or disoriented, or in severe pain or distress (physical or psychological) or present with unstable vital signs, including psychiatric complaints that require 1:1 observation. These patient are placed directly into an emergency department bed.... Level 1 - patients who are intubated, apneic, pulseless or unresponsive. These patients are placed directly into an emergency department bed."


A review of patient records showed no:

a. Documentation of and Emergency Triage Level for Patient #11 who was triaged on 10/28/19 at 11:20 pm.

b. Documentation of and Emergency Triage Level for Patient #12 who was triaged on 11/17/19 at 11:20 pm.

c. Documentation of and Emergency Triage Level for Patient #15 who was triaged on 10/25/19 at 3:50 pm.

d. Documentation of and Emergency Triage Level for Patient #16 who was triaged on 10/31/19 at 6:00 pm.


On 11/19/19 at 11:50 am, Staff C stated patients may be taken back, immediately, to an exam room if needed. The patient would be triaged and have vital signs taken while in the exam room.