HospitalInspections.org

Based on findings documented in data tags 2402, 2405, and 2406, the hospital failed to comply with the requirements of 42 CFR 489.24.

Based on observation, the hospital failed to conspicuously post a sign specifying the rights of individuals under Section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor. Findings:

The hospital received patients requesting emergency care through the emergency room and labor and delivery department (for patients 16 weeks pregnant).

On 2/23/11, during a tour of the labor and delivery department, it was noted that a sign regarding patient rights for emergency care was posted in a corridor leading to the nurses station. Patients would not see this sign unless they stopped in the hall on their way to the nurses station to register. Patients arriving from the emergency room who were escorted in a wheelchair, unless instructed, would be wheeled past the sign by staff accompanying the patient.

In both instances, the sign was not posted in a place likely to be viewed by individuals seeking emergency care.

Based on documentation, the hospital failed to ensure the central log which tracked individuals who request emergency care, was maintained in a manner that included their disposition after being seen. Findings:

The hospital received patients requesting emergency care through the emergency room and through the labor and delivery department (for patients 16 weeks pregnant). Logs were kept in both departments to track these patients. Both logs, covering a six-month period of time, were reviewed.

On 2/23/11, the central log maintained in the labor and delivery department was reviewed. The log included among other things, the patients' names, arrival times, MDs, patient complaints, treatments and disposition.

During the review, it was noted that patient entries were not always complete. Entries such as the patient's disposition, treatment and complaint were missing. This inconsistency remained throughout the review.

Example:

From 1/9/11 from 3:30 p.m. to 7:50 p.m. a total of four patients were seen. There was no documentation regarding the patients' disposition after treatment. On 1/10/11 at 2:05 a.m. and 3:00 a.m. two patients were seen but there was no documentation regarding the patients' disposition and chief complaints. The same errors occurred on 1/13/11 (four patients) and 1/18/11 (seven patients).

Without an accurate log, the hospital could not track the care of patients that arrive at the hospital seeking emergency care.

Based on interview and record review, the hospital emergency department (ED) failed to provide an appropriate medical screening examination to determine whether an emergency medical condition existed for one of 36 sampled patients (36). Patient 36 was denied service when a police officer requested ED staff to help Patient 36 who was found lying on the ground outside the hospital's emergency department. Findings:

The record review on 2/4/11 and 2/23/11 indicated Patient 36 was agitated when he initially arrived by ambulance to the ED on 5/3/10 at 5:25 p.m. The physician assistant's (PA) report dated 5/3/10 documented the patient had a history of congestive heart failure and chronic hip pain but would not allow a physical exam and would not answer medical information questions.

The patient was permitted to leave the ED without completing a medical screening examination. The Admission Discharge Record (ED) indicated the admit diagnosis was pain. Patient 36 was discharged as an ED-Elopement at 6:23 p.m. on 5/3/10.

The ER nursing note indicated the police arrived on the scene by 5:45 p.m. The police officer (PO 1) took the patient into custody for allegations that he assaulted an employee.

The hospital's security report for 5/3/10 described the incident as follows: "nurse assist at ER (emergency room)- patient did not want to be treated, he only wanted to take a nap. When hospital staff tried to explain he got loud and angry- he is a disabled person that uses 2 arm walkers. Security and hospital staff escorted him out- he threw one of the arm walkers at security and staff- no injuries sustained- police spoke to the discharged patient outside- he was escorted off property."

PO 1 was interviewed on 2/14/11 and 2/23/11. According to PO 1, Patient 1 was found outside on the curb at the emergency department entrance at 5:39 p.m. The patient stated to the officer he wanted to be seen by a physician. PO 1 stated he went into the emergency department and asked a staff member wearing scrubs whether the patient could be examined. The officer stated he was told no. PO 1 stated he had no choice but to take the patient to another hospital. Patient 1 was seen in the another hospital ED and admitted to the hospital for treatment.

During a telephone interview on 2/4/11, Patient 36 stated he was dependent on forearm crutches (type of crutch where the arm is slipped through a cuff and the hand holds a handgrip) for mobility within short distances. He lost the grip of his crutch while ambulating to the ED exit when one crutch struck the lower leg of a hospital employee. He was upset and distressed that morning because of the dark color of his urine and because his electric wheelchair was not working. He also stated he thought he "would be safe in the hospital" and wanted to be seen by a doctor.