HospitalInspections.org

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Based on interviews and review of hospital policies and procedures, the hospital failed to develop and implement policies and procedures for evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death.

Findings included:

1. The hospital failed to provide medical screening examinations to patients that presented to the hospital for emergency treatment during lockdown procedures.
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Based on interview, record review and review of hospital policies and procedures and medical staff bylaws, the hospital failed to ensure that staff followed hospital policies and procedures related to EMTALA requirements for medical screening examinations (MSE) to be performed by a qualified health care provider.

Failure to ensure patients received a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health outcomes, injury, and death.

Findings included:

1. Review of the hospital's medical staff bylaws showed that in the Emergency Department, physicians are authorized to perform medical screening examinations.

2. Review of the hospital policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," no policy number, last reviewed 03/17/21, showed that: 1) a MSE would be performed by a qualified provider. The policy defined a qualified provider as a physician, physician assistant, nurse practitioner, and registered nurses with obstetric training and competency to perform medical screening examinations 2) the hospital provides a medical screening examination to determine whether an Emergency Medical Condition (EMC) exists to any patient who comes to the emergency department 3) Yearly policy review and EMTALA training via Healthstream and ED/OB annual training and posttest are required 4) An Emergency Medical Care Log is a record maintained of all individuals who come to a department seeking emergency care.

3. Review of the Emergency Medical Care Log for 08/10/22 showed that the complainant was not registered as coming to the hospital for emergency care.

4. Review of the hospital policy titled, "Lockdown Policy," no number, effective date 07/19/19, showed that in the event of a perceived or actual threat from outside the hospital towards a patient, visitor, and/or staff member, the hospital will have a procedure to control, manage, limit, and/or stop individuals from entering or exiting the hospital. All outside doors will be secured, locked if possible. The only point of entry in the facility should be the ED entrance. Security or a designee may be posted at both the front entrance and the ED entrance. Security will determine when it is safe for patients, visitors, and staff to move through the facility.

5. On 09/28/22 at 4:12 PM, during an interview with the investigator, the security site supervisor (Staff #11) stated that when a patient arrived at the hospital during a lockdown, they are greeted by the security officer in the vestibule of the Emergency Department between the two doors. The inner door to the hospital is locked, but the outer door would be unlocked by the guard. The guard would ask the patient why they were coming to the hospital and would tell the patient that the hospital was on lockdown, and it wasn't safe for them to be there. Then Staff #11 stated that if the patient wasn't an emergency like chest pain, they would tell them that their best bet would be to drive to one of the other hospitals in either Prosser or Toppenish. If he wasn't sure if the patient had an emergency, Staff #11 would call the hospital supervisor and tell them the reason the patient wanted to be seen in the emergency department and whether they should be allowed in or to be sent away. Staff #11 stated that they had been instructed to send people away by the hospital supervisor. Staff #11 stated that they had no training about EMTALA.

6. On 09/28/22 at 4:25 PM, during an interview with the investigator, the Systems Director of Quality (Staff #19) stated that the security guard had not followed hospital policies and procedures related to EMTALA. Patients presenting for emergency care during lockdown were to be allowed to enter the facility to be seen by the Emergency Departement provider for medical screening examination, stabilizing treatment and appropriate discharge, admission, or transfer.

7. On 09/29/22 at 7:30 AM, during an interview with the investigator, a security guard (Staff #12) stated that they called the hospital supervisor when a person came to the emergency department during a lockdown. Staff #12 stated that they had sent patients away during lockdowns. Staff #12 stated that they had not received any EMTALA training from the hospital or through the contracted security company.

8. On 09/29/22 at 8:05 AM, during an interview with the investigator, a hospital supervisor (Staff #14) stated that the hospital policy for lockdown was not clear regarding allowing patients into the emergency department. Staff #14 stated that in the past they had contacted the Administrator on Call regarding ambulances arriving during lockdown and were told that yes, the ambulances were allowed to bring patients to the emergency department during lockdown. There was no discussion regarding walk-in patients. Staff #14 stated that when they were trained, they were told that no one was allowed to enter the facility during a lockdown. They did not recall any specific conversations with security about refusing treatment to a patient on 08/10/22, the night the complainant stated they were turned away.

9. Review of the contract for Allied Universal Security signed 12/04/20, showed that there was no requirement for training about EMTALA.

10. On 09/28/22 at 2:02 PM, during an interview with the investigator, the Director of Human Resources (Staff #8) stated that the contracted security guards were not included in the hospital's online education training and tracking program called Healthstreams.
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