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Based on interview, patient record review and a review of the Emergency Department Log, Florida EMTALA Medical Screening Examination and Stabilization" and "Triage Process hospital policies, and video, the hospital failed to triage on arrival and provide a medical screening exam for 1 of 20 sampled patients (Patient #3).

Findings:

Refer to A2406.

Based on patient and staff interviews, review of hospital video, patients' Emergency Department's medical records, Emergency Department (ED) log, and hospital policies on "Emergency Department Triage" and "Patient Flow", the hospital failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether an emergency medical condition existed for 1 of 20 sampled patients (Patient #3).

Findings:

1. EMERGENCY DEPARTMENT (ED) LOG

The emergency department (ED) Log revealed that patient #3 arrived at 11:57 PM on 5/07/2022. The "Disposition Category" was listed as "Refused Treatment". The Disposition Type was listed as "Left Prior to Triage".


2. INTERVIEWS

On 05/11/2022 at 8:52 AM, Patient #3 said he walked into the ED on 05/07/2022 at 11:57 PM with chief complaints of shortness of breath and a loss of consciousness after a bicycle accident near the hospital. The patient said he signed into the kiosk and waited to be triaged and get medically screened. Upon Nurse B's arrival to the desk, he went to the desk to let the staff know he had difficulty breathing. The patient said a verbal altercation occurred between Nurse B and the patient. Patient #3 said Nurse B asked security to "take me [Patient #3] out of the waiting room". Patient #3 said the Security Guard then removed him from the ED waiting area.

On 05/11/2022 at 2:05 PM, the Security Guard who escorted Patient #3 out of the ED stated, "The nurse [Nurse B] asked me to escort him [Patient #3's name] out because she didn't want to deal with him anymore. He [Patient #3] made some remark about her [Nurse B] and that was it."

On 5/11/2022 at approximately 3 PM, chart review and interviews with the Patient Safety Director and Nurse B confirmed patient #3 was removed from the ED by Security personnel and was not provided a medical screening examination within the capability of hospital's ED to determine whether an emergency medical condition existed.

On 05/12/2022 at 9:30 AM, Nurse B stated Patient #3 had approached her at the desk and kept saying he had a "triageable complaint". When she tried to explain the process of taking him out of the kiosk and putting him into the system so she could get him assessed, the patient began yelling at her. Nurse B said she didn't think he had a major concern because she continued to be "verbally assaulted" by the patient.


3. ED RECORDS

Patient #3's ED chart contained documentation from Nurse B about the event. It read, "Patient [Patient #3] signed into ER [ED]. As soon as I arrived to move patient information from Kiosk, patient began harassing me with his complaint of being in an accident. I replied, 'No problem, let me move you to triage and place you in a bed.' Patient sat down and then stood up again within seconds and started yelling that he had a 'triageable complaint'. I informed patient I was moving his information over, and it would take a second, but he refused and started yelling at me again stating that it is people like me that drive up the cost of medical care and he works at [named of hospital]. I called security and had the patient removed from lobby."

Patient #3's medical record was requested and received on 05/18/2022 from another hospital where Patient #3 stated he went after he was denied services and removed from the ED. Diagnoses from that hospital's evaluation and treatment on 5/8/2022 at 12:27 AM included "Mild left sided parietal scalp edema and Acute non-displaced fractures of the left lateral 7th and 8th ribs".

On 05/12/2022 at 2 PM, Patient #3's ED chart was reviewed with the Patient Safety Director and Nurse B. Both confirmed the patient was removed from the ED by Security and was not provided a medical screening examination within the capability of hospital's ED to determine whether an emergency medical condition existed.


4. VIDEO

The incident was also captured on hospital video and reviewed on 05/11/2022 at 1:24 PM and 05/13/2022 at 3:20 PM, confirming security escorted Patient #3 out of the ED with neither a medical screening examination nor provided treatment.


5. Hospital Policies

A review of hospital's policy & procedure "Emergency Department Triage and Patient Flow", last reviewed on 04/14/2021, read that the hospital is to "provide a standard screening process that will be applied uniformly to all individuals in similar medical circumstances" with "the objective of the triage system to promptly identify individuals requiring immediate definitive care using the 5 level Emergency Severity Index (ESI) a triage system." This requirement is also stated in two other hospital policies "Florida EMTALA Medical Screening Examination and Stabilization Policy", last approved on 04/01/2018, and "Assessment & Reassessment in the ED", last approved on 08/01/2021.