HospitalInspections.org

Based on observation, interview and policy review, the facility failed to clearly post signs for all individuals using the ED's reception/waiting area when seeking medical attention with respect to examination and treatment of emergency medical conditions (EMC) and for women in labor, and indicating whether the hospital is part of the Medicaid (MediCal) Program.

Findings:

During the initial observation of the Emergency Department (ED) on 5/8/17 at 10:20 a.m., the entrance from the outside had two sets of sliding automatic doors for foot traffic exiting and entering. Upon entering the ED between the two sliding automatic doors was a wall to the left with prominent signage for Section 1867 of the Act indicating the rights of individuals seeking medical treatment. After entering the second set of sliders was the registrar's desk at the far end of the room. To the left, were triage and storage rooms and to the right of the registrar's desk was a solid wall with the hospital's core values signage of Dignity, Excellence, Service and Justice in four large frames approximately 18 inches by 24 inches each. In the center of the waiting room were chairs back to back and along the outside wall for individuals waiting to be seen for their medical conditions. There was no EMTALA signage in the waiting/registrar room. The only availability for individuals coming into the ED to be made aware of their EMTALA rights was when they would walk into the waiting/registrar room or when they are exiting the ED through the two sets of sliding automatic doors.

During an observation with concurrent interview on 5/12/17 at 11:15 a.m., in the ED waiting/registrar room Individual 1 when queried stated he had not noticed the signs between the two sets of glass doors at the entrance/exit of the ED. He stated the signs "should be more visible" so he would be aware of his rights. He also stated he had time to read them while waiting to be seen by the ED staff. Individual 2 was sitting in the waiting area when approached. After introductions, individual 2 was queried to see if she was aware or had noticed the signs between the two sets of glass doors at the entrance/exit of the ED. She stated no, but it would be nice to know her rights. Staff Nurse L in discussing the location of the signage corroborated that a reasonable person entering the ED has a purpose/need in mind and would walk through both doors and go to triage or the registrar's desk 25 to 30 feet to the opposite side of the room and never notice the EMTALA signage.

During a review of the hospital's "EMTALA: Screening, Stabilization and Transfer of Individuals with Emergency Medical Conditions" with last review/revision date of 10/15 indicated the following: "The Hospital shall post conspicuous signs that specify the rights of individuals under the law with respect to the examination and treatment for EMCs and of women who are pregnant and are having contractions. These signs shall be posted in the DEDs and main entry points to the Hospital, including all areas where patients wait prior to examination and treatment..."