HospitalInspections.org

Based on medical record review, document review and staff interview, there was no evidence that patients received complete or adequate medical screening exams. This finding was evident in one (1) of 10 medical records reviewed.(Patient #1)


Findings include:

Review of the medical record for Patient #1 revealed: this 22 year old male with a history of Bio-Polar disorder has been on medication for more than 2 years. On 1/13/16, patient was assessed and brought to the facility by the mobile crisis unit; the report documented patient was "combative and agitated" and patient agreed to be transported to the facility.
Upon arrival at the hospital Emergency Department on 1/13/16 at 9:46 PM, the Mobile Life Support Services team was met by two Security Officers from the hospital. The patient was escorted into the Behavioral Health Unit. While in the Behavioral Unit the Mobile Life Support staff was told by a Registered Nurse (Staff #1) that "the patient was not allowed to be treated at the hospital, and that he had "threatened to harm multiple staff." Registered Nurse (Staff #2), refused to sign for Hospital acceptance of the patient.


The Mobile Life Support Services team documented: " Due to patient being restraint, and unable to sign and due to the hospital refusing to sign for patient, and facility acceptance, Mobile life unit crew signed. "The patient was transported to another Hospital for care."



At 10:15 PM, Staff #2 documented: "Patient was seen here the other day and a note was left for security and charge nurses that if patient arrives security needs to be notified. Patient had made multiple threats to various hospital personnel. Upon arrival patient is not cooperating and making threats to staff Per security officer. Patient is not allowed to be seen here, he must go to another facility. Nursing Supervisor made aware. Security informed Charge RN that he spoke with the Director of security, who spoke to (COO) Chief Operating Officer, patient is to be sent elsewhere."

There is no documentation in the medical record that the hospital triaged the patient.


At 11:31, PM Medical Director for the Emergency Department (Staff #3) documented that he examined the patient. "He is agitated but speaking in complete sentences. The patient's lungs was clear, his heart normal and his abdomen was non tender and soft, told by the Clinical Supervisor RN, that as per our COO and Chief of Security, we are not to care for the patient". The Medical Director documented that the patient needs to be cared for at another facility.

The physician wrote that on 1/13/16, he observed the patient and that his mood was "angry". Affect was labile, speech was pressured, coherent but illogical. He was delusional, making threats. His speech was gibberish. He was impulsive, unpredictable and his memory was fair. Insight and judgement was poor.
The PLAN: "The patient needs to be admitted in another psychiatric facility this time as the patient remained aggressive and dangerous to self and others."


At 11:47 PM, Staff #2 (RN) documented that the patient left the hospital with Town Police.


On 1/27/16, (Staff #4) a Psychiatrist in the emergency department documented a late entry for the event of 1/13/16. No time was entered for 1/13/16.
This psychiatrist documented that the patient came in handcuff and was "very agitated and was making threat to hurt people." He ordered Haldol and Ativan IM, but did not know that patient should not be treated at the hospital, as a result the patient was never administered the medication. The patient was transferred.

The facility initiated an assessment but there is no documentation of a complete or adequate medical screening examination.


During interview on 2/10/16 at 1:35 PM, the Chief Operating Officer and Director of Security were both present. The COO stated that on 1/13/16, he received a telephone call from the Emergency Department advising him that patient was present. He called the Director of Security and told him to instruct the Emergency Room staff not to treat the patient, and to send the patient to another hospital. His decision was based on a phone call from the patient to the hospital on 1/12/16, where he made verbal threats to members of the hospital board.

The Director of Hospital Security confirmed that he received a telephone call from the Chief Operating Officer on 1/13/16, instructing him not to have the emergency staff treat the patient and to send him to another hospital for treatment.
The Director of Hospital Security said he gave these instructions to the Security Officers assigned to the Emergency Room and the emergency room Nursing Supervisors.


During interview on 2/10/16 at 2:20 PM The Medical Director for Emergency Services (Staff #3) stated that on 1/13/16, he was advised by The Clinical Supervisor for Emergency Room that he is not to treat the patient. The patient is to be sent to another hospital for care. He said he took the patient's vital signs to ensure that the patient was "stable" for the transfer.


During interview on 2/10/16 3:30 PM, The Director of Accreditation and Regulatory Affairs (Staff #5) acknowledged that the patient was denied care by the Hospital. When asked whether or not this was due to a shortage of psychiatric beds she said no. The inpatient psychiatric unit has 30 beds and 3 in the emergency department. Both areas had available beds on 1/13/16.

20003

Based on medical record review and interview, the hospital failed to ensure that patients are appropriately transferred. This finding was evident in one (1) of 10 medical records reviewed(Patient #1).

Findings include:

Review of the medical record for Patient #1 identified: This 22 year old male with a psychiatric disorder, who was brought to the Hospitals' Emergency department on 1/13/16 at 9:47 PM, by Mobile Life Support Services (EMS).
The Hospital refused to accept the patient and advised the Mobile Life Support Team to take the patient to another hospital.

There is documentation in the medical record that the other hospital did not agree to the transfer. The facility sent the patient to the recipient hospital without an accepting provider at the recipient hospital.
In addition, there is no documented evidence that the facility provided the required documentation for the transfer to the recipient hospital.



As per documentation in the patient's medical record, on 1/27/16 at 10:14 PM, a Psychiatrist in the Emergency Department wrote a late entry for 1/13/16. He documented that the patient "will be transferred to another hospital by the police. It took a while to get the transfer because the {accepting} hospital put up with resistance and they talked back and forth between security and finally the police transferred the patient there."


During an interview on 2/10/16 at 2:20 PM, the Medical Director for Emergency Services (Staff #3), stated that on 1/13/16, he was advised by The Clinical Supervisor for Emergency Room that he is not to treat the patient. The patient is to be sent to another hospital for care. He said he took to patient's vital signs to ensure that the patient was "stable" for the transfer. He also stated that the patient was in handcuff and was "not threatening." He called the receiving Hospital and spoke with an Emergency Room Physician regarding the transfer. The Physician did not agree to the transfer. The patient was taken to that same hospital by the police and EMS; however, there was no written information or transfer package sent with the patient.