HospitalInspections.org

Based on observations and interviews the facility failed to post any signage related to patient rights regarding examination and treatment for emergency medical conditions, examination and treatment for women in labor and/or whether the hospital participated in the Medicaid program.

The findings included:

An observation conducted in the facility's main lobby on October 31, 2012 at 11:01 a.m. did not reveal signage related to patient rights regarding examination and treatment for emergency medical conditions, examination and treatment for women in labor and whether the hospital participated in the Medicaid program.

An interview conducted in the main lobby on October 31, 2012 at 11:05 a.m. with Staff #2 and Staff #3 revealed patients could utilize the main lobby to gain access to the facility's emergency department. Staff #2 reported the facility's protocol if a patient approached the information desk and requested emergency services.

An observation conducted in the ambulatory emergency department lobby was conducted on October 31, 2012 at 11:26 a.m. with Staff #1 and Staff #6. Staff #1 and Staff #6 were not able to locate the required signage related to examination, treatment and Medicaid participation. Staff #1 reported facility staff probably failed to re-post the signs after completion of lobby construction work. Staff #1 and Staff #6 acknowledged the ambulatory entrance and waiting area for the emergency department did not have the required signage posted.

An observation by the second surveyor of the ambulance entrance to the emergency on October 31, 2012 at approximately 11:21 a.m., Staff #8 did not have the required signage regarding examination, treatment and Medicaid participation.

Observations and interviews were conducted during the tour of the facility's emergency department on October 31, 2012 from 11:30 a.m. to 12:28 p.m., with Staff #1, Staff # 4, Staff #5, Staff #6, Staff #8 and two surveyors. Observations of patient holding areas, treatment bays (emergent and non-emergent) and nurse's station did not have the required signage related to examination and treatment for emergency medical conditions, examination and treatment for women in labor and the hospital participated in the Medicaid program posted. Staff #1 verbally acknowledged "The signs regarding EMTALA [Emergency Medical Treatment and Active Labor Act] are not posted." Staff #1 and Staff #6 verified the facility did not have any signage regarding patient rights, EMTALA or Medicaid participation posted as required.

Based on record review and interview the facility failed to document the medical risks associated with transfer had been explained to the patient (or the individual legally responsible for the patient) for three of ten transferred patients (Patients #3, #6, #15, #18, #20, #21, #36, #39, #41, and #44) included in the total sample of fifty patients (Patients #1-#50). [Patients #15, #18 and #44]

The findings included:

Review of the forms utilized by the facility's emergency department for transferring patients to another facility revealed a form titled "Patient Transfer Certification For: Physician Assessment and Certification". The form revealed a section for the documentation of medical risks associated with transfer. The section "Risks" read: "Based on reasonable risks and benefits to the patient and/or the unborn child(ren), and based upon the information available at the time of the patient's examination, I certify the medical benefits expected from transfer exceed the expected risk of continued treatment at this facility Medical risk that could occur en route include:." Two or three lines for the provider to list the medical risk followed this statement.

1. Patient #44 was evaluated in the facility's emergency department on June 9, 2012 related to alcohol and flank pain. Medical screening tests and evaluation performed by the facility's physician revealed Patient #44 was experiencing acute sepsis and pneumonia. The physician deemed Patient #44 status as critical and post stabilization for transport the patient was transferred to another facility. Patient #44's "Patient Transfer Certification For: Physician Assessment and Certification" revealed the section for documenting the "Medical risks that could occur en route include:" was blank.


2. Patient #18 was evaluated in the facility's emergency department on April 25, 2012 and April 26, 2012 for suicidal ideation. Patient #18 was evaluated by the emergency room physician and contracted psychological services on April 25, 2012 and was cleared to be discharged home with family for follow-up outpatient treatment. Patient #18's medical record revealed approximately three hours after discharge, police returned Patient #18 to the facility's emergency department. Patient #18's medical record documented the patient had "...superficial scratches" on the back of his/her right "hand from a beer bottle ..." Patient #18's medical record documented the police picked up the patient while he/she was "... on the bridge attempting to jump ..." Patient #18 was stabilized for transfer and transported to another facility. Patient #18's "Patient Transfer Certification For: Physician Assessment and Certification" revealed the section for documenting the "Medical risks that could occur en route include:" was blank.


3. Patient #15 was evaluated in the facility's emergency department on April 7, 2012 related to suicidal ideation. Review of Patient #15's "Patient Transfer Certification For: Physician Assessment and Certification" revealed the section for documenting the "Medical risks that could occur en route include:" was blank.

Interviews were conducted on November 02, 2012 from 2:52 p.m. to 4:28 p.m. with Staff # 1, Staff #6, Staff #7 and Staff #8. The facility staff reviewed the above records and verified the cited patient's "Patient Transfer Certification For: Physician Assessment and Certification" revealed the section for documenting the "Medical risks that could occur en route include:" were blank.