HospitalInspections.org

Based on document review and staff interview, it was determined the Critical Access Hospital (CAH) failed to provide a Medical Screening Exam and Appropriate Transfer to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24. This has the potential to affect all patients receiving care in an Emergency Department that treats approximately 30 patients per day.

Findings include:

1. The CAH failed to ensure a Medical Screening Exam was performed. See deficiency cited at C2406.

2. The CAH failed to ensure an appropriate Transfer was completed. See deficiency cited at C2409.

Based on document review and staff interview, it was determined for 1 of 20 (Pt #1) patients seeking care for an emergency medical condition, the CAH failed to provide a medical screening exam (MSE). This failure has the potential to affect all patients seeking care at the emergency department (ED) that treats approximately 30 patients per day.

Findings include:

1. The medical record of Pt #1 was reviewed on 5/11/17 at 11:00 AM. On 4/30/17 at 2100, Pt #1 presented to the ED with chief complaint of "stroke like symptoms". Pt #1's private vehicle, driven by daughter, was in the ambulance bay. The ED Security Officer (E#5) approached the vehicle in the ambulance bay to assess and assist Pt #1. Documentation indicated E#5 informed Pt#1's daughter the Computerized Tomography (CT) was not working. Pt #1's daughter wanted to transfer Pt #1 to nearest stroke center for care (approximately 20 minutes). E#5 spoke with the ED physician (E#4). E#4 agreed to call 911 and have Pt #1 transported for further assessment and treatment. Pt #1 was transferred at 2120. Pt #1 did not come inside the ED or receive a medical screening exam.

2. On 5/11/17 at 1:00 PM, an interview was conducted with the ED physician (E#4). E#4 recalled Pt #1 and that the CT scan was not working. E#4 was asked, who would provide a MSE? E#4 replied, "the ED physician". E#4 was asked if Pt #1 was seen and provided a MSE." E#4 stated, "No, I never saw this patient and did not complete a MSE."

Based on document review and staff interview, it was determined for 1 of 20 (Pt #1) patients seeking care for an emergency medical condition, the CAH failed to ensure an appropriate transfer was completed. This has the potential to affect all patients seeking care in the Emergency Department (ED) that treats approximately 30 patients per day.

Findings include:

1. The medical record of Pt #1 was reviewed on 5/11/17 at 11:15 AM. On 4/30/17 at 2100, Pt #1 presented to the ED with chief complaint of "stroke like symptoms" . Pt #1's private vehicle, driven by daughter, was in the ambulance bay. The ED Security Officer (E#5) approached the vehicle in the ambulance bay to assess and assist Pt #1. Documentation indicated E#5 informed Pt#1's daughter that the Computerized Tomography (CT) was not working. Therefore, the daughter wanted Pt #1 to go to nearest stroke center. E#5 spoke with the ED physician (E#4). E#4 agreed to call 911 and have Pt #1 transferred for further assessment and treatment. Documentation indicated Pt #1's daughter was verbally agreeable to the transfer. Pt #1 did not come inside the ED or receive a medical screening exam. Pt #1 was transferred by Emergency Medical Services (EMS) at 2120.

2. On 5/11/17 at 11:30 AM, the "Authorization for Transfer Form" was reviewed. On page 1, under "8. Patient Consent to Transfer" nothing was marked. It was dated 4/30/17 at 2115. Under "9. Documents sent with patient or faxed." It was marked "this form, Lab tests/results, EMS run report and consult notes" were sent. However, Pt#1 was never seen by the ED physician. Therefore, Pt #1 did not receive any testing or consultation.

3 On 5/11/17 at 11:00 AM, an interview was conducted with the ED Nurse Manager (E#3). E#3 recalled Pt #1 and the CT not working. E#3 verbalized the CT went down on 4/28/17 sometime around 4:00 PM. At that time, they notified the EMS (4 total), that normally come to their hospital, to let them know our CT was down. E#3 stated, "I told them we were on diversion for anyone needing time sensitive CT scans and they would need to go to another hospital." E#3 was asked about completion of transfer forms. E#3 stated, "The transfer forms were completed and sent after patient left."

4. On 5/11/17 at 1:00 PM, an interview was conducted with the ED physician (E#4). E#4 was asked about the transfer of Pt #1. E#4 stated, "I called the ED physician at the other hospital and told him about patient. I told him she was 100 years old and had stroke like symptoms and our CT was down. I told him I was going to see patient, but she was already in the rig." E#4 stated, "The physician said go ahead and send her it's ok."