HospitalInspections.org

Based on interview and document review, the hospital failed to implement their policies and procedures for evaluation and treatment of a patient that presented for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health outcomes, injury and death.

Findings included:

1. The hospital failed to ensure that a patient received a medical screening exam before they left the emergency department (ED).

Cross-reference: Tag A-2406

Based on interview and document review the hospital failed to implement its policies and procedures to provide a medical screening exam for a patient that came to the emergency department (ED) seeking emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) for 1 of 25 patient records reviewed (Patient #1).

Failure to provide a medical screening exam for patients before they leave the ED puts patients at risk for harm from a medical or psychological emergency that is not screened and treated.

Findings included:

1. Document review of the hospital's policy titled, "EMTALA: General Guidelines to Examination, Treatment and Transfer of Patient," last reviewed 02/19 showed that patients that presented to the ED were to receive a medical screening exam (MSE) to rule out an emergency medical condition.

2. On 01/28/20 at 8:02 AM, the investigator interviewed Patient #1. Patient #1 stated that he had been sent over from his physician's office for concerns about a possible stroke. The patient's physician had wanted the patient to get a CT (computerized tomography) scan of his brain. The patient stated that he became upset while being asked questions by patient registration and was asked to leave by registration and security personnel. The patient stated that registration staff and security personnel did not go get a nurse or physician to speak with him before he left the ED.

3. Review of Patient #1's medical record showed that:

a) The patient was sent over from their physician's office on 11/16/19 for a possible stroke. The physicians office called the ED about the patient's arrival. The patient had declined ambulance transport from the physicians's office.

b) On 11/16/19 at 4:44 PM, the patient presented to the ED for care. A nurse took the patient's vital signs and then the patient was placed in an exam room. The ED physician documented they planned to do a medical work-up of the patient that was to include a CT scan of the patient's brain. When the ED physician went to the patient's room the patient was no longer in the exam room. It was documented by the physician that the patient had eloped.

4. Review of security documents for 11/16/19 showed that:

a) The admitting/registration representative told security that the patient was refusing to register. The patient told security that they did not like the intrusive questions from the admitting representative. The patient voiced concerns about security's attitude towards the patient. The patient then became upset and decided to leave the hospital.

5. On 01/28/20 at 10:00 AM, the investigator interviewed the ED manager (Staff #5). Staff #5 stated that all patients that presented to the ED were to receive a MSE unless they refused an exam. Security and registration staff were expected to alert the nurse for any patients that were upset and wanting to leave before a MSE could be performed. The nurse would then talk to the patient about the importance of the MSE and alert the physician about the patient wanting to leave.

6. On 01/28/20 at 10:45 AM, the investigator interviewed the Director of Security (Staff #8). Staff #8 stated that security staff were expected to alert the nurse to come talk to any patients wanting to leave before a medical screening exam had been performed.

7. On 01/28/20 at 1:00 PM, the investigator interviewed the supervisor of Admitting/Registration (Staff #12). Staff #12 stated that admitting/registration staff were to alert the nurse anytime a patient wanted to leave before a MSE had been performed so the nurse could talk to the patient.

8. On 01/28/20 at 1:30 PM, the investigator interviewed the Patient Safety/Risk Management manager (Staff #13). Staff #13 verified the above information.