HospitalInspections.org

Based on a tour of the ED and staff interview conducted on February 25, 2014 at approximately 10:30 AM, it was determined that the facility failed to conspicuously post signage specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment of emergency medical conditions and women in labor or information indicating whether or not the hospital participates in the Medicaid program.

Findings include:

1. Observation of the ambulance entrance to the ED revealed no signs posted pertaining to EMTALA law and information indicating whether or not the hospital participates in the Medicaid program.

2. Observation of the main entrance of the hospital revealed no signs posted pertaining to EMTALA law or information indicating whether or not the hospital participates in the Medicaid program posted under the television.

3. Observation of the hallway from the main lobby leading into the ED waiting area revealed no signs posted pertaining to EMTALA law or information indicating whether or not the hospital participates in the Medicaid program posted.

4. All of the above findings were confirmed by Staff #3.

Based on a review of the ED on call lists, it was determined that the facility failed to ensure that a physician on call list that identifies the name of an individual physician on call for all specialties was maintained.

Findings include:

1. Review of the on call list for an Orthopedic specialist revealed that a physician group was listed as on call for January 2013 through December 2013.

2. The above findings were confirmed by Staff #3.

Based on a review of medical records and Staff interview it was determined that the facility failed to ensure that all patients were properly informed when refusing to consent for treatment.

Findings include:

1. Review of Medical Record #5 revealed the following:

a. Patient #5 presented to the Emergency Department (ED) at 19:43 on 6/5/13 complaining of (C/O) "bodyaches x 1 week, states worse today." Pt C/O a pain level 8 of 10.

b. Patient #5 was triaged at 19:51 and assigned a Triage Level of 4- Semi-urgent.

c. The Physician's Assistant examined the Pt at 20:03.

i. A nurse's note at 20:20 states, "pt [patient] left after exam by PA [physician's assistant], upset we don't do anything for her because she has no insurance."

ii. The PA's note, dated 6/5/13 at 20:03 stated, "... I told the patient that she would need further evaluation and treatment with a primary care, patient became angry and states that I did nothing for her. ..." There was no evidence that any effort was made to address the patient's medical condition, pain, until after this interaction. The PA later states he/she offered pain management but the patient refused.

iii. The medical record failed to include any evidence that the risks and benefits of staying for treatment, and/or what treatment would be offered should he/she decide to stay, was explained to the patient.

iv. The PA documented at 20:03 that the patient's condition upon discharge was stable.

v. The final disposition of the patient is listed as Eloped at 20:18.

d. The above findings were confirmed by Staff #

2. Review of Medical Record #13 (same patient as medical record #5, 2nd visit) revealed the following:

a. Patient #13 returned to the ED at 21:21 on 6/5/13 C/O "generalized bodyaches, ... pain is constant..." Pt C/O a pain level 10 of 10.

b. Patient #13 was triaged at 21:33 and assigned a Triage Level of 4- Semi-urgent.

i. A Triage note states, "pt [patient] states she returned to get enough information to sue the hospital.

c. The Physician's Assistant examined the Pt at 20:03.

i. A nurse's note at 21:47 states, "pt [patient]verbally abusive with registration, nurses, and ED techs. pt told nursing supervisor that she taped the conversations between her and the PA when she was here earlier without the consent of the PA and wants to sue the hospital, security made aware."

ii. A nurse's note at 21:57 states, "pt refused consent to hospital and medical treatment. expressed to the pt the MD can not see her if she does not consent to treatment. pt states, 'fu** you.' security made aware, nursing supervisor made aware."

iii. A nurse's note at 21:59 states, "pt removed from facility by security."

d. There was no evidence that the facility ensured that the risks and benefits of staying for treatment, and/or what testing and/or treatment would be offered should the patient decide to consent for treatment was explained to the patient.