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Tag No.: C2400
The CAH's "Emergency Treatment and Active Labor Act (EMTALA,) Medical Screening Examination" policy, dated 9/01/99, stated all patients who presented to the ED were to receive an appropriate MSE by a physician, RN, or mid-level provider. This policy was not followed as evidenced by the CAH's failure to provide an appropriate MSE to 1 of 22 patients reviewed (Patient #22), who came to the ED seeking emergency medical services.
Refer to A2406 as it relates to the failure of the CAH to ensure a MSE was completed for all patients presenting to the ED seeking emergency medical services.
Tag No.: C2406
Based on review of medical records and CAH policies, and CAH staff and EMS personnel interviews, it was determined the CAH failed to provide an appropriate medical screening examination to 1 of 22 patients reviewed (Patient #22) who came to the ED seeking emergency medical care. This resulted in the inability of the CAH to rule out emergency medical conditions before a patient was taken to a secondary hospital. Findings include:
1. An Ambulance Run Sheet, dated 3/24/10 at 9:36 PM, was reviewed. The Run Sheet included the following information:
Patient #22 complained of hip pain and needed the services of the EMS. The ambulance arrived at Patient #22's residence at 9:46 PM. Patient #22 was assisted out of his bed and was able to walk a short distance to the front door of his residence. At that point, he stated he could not proceed any further. Patient #22 was then placed on a back board and transferred to the CAH via ambulance. At 10:05 PM, the EMS personnel called the CAH and gave a report of Patient #22's condition and weight. At 10:07 PM, the ED LPN called back to the ambulance personnel advised them they could not care for Patient #22. The reason given was that the CAH did not have the equipment capable to take the needed X-rays of his hip. The CAH wanted the ambulance to divert to another hospital at this point. However, by the time the call came in, the ambulance had arrived at the CAH's ED. The EMS personnel then called their supervisor and advised him of the situation. Patient #22 remained in the ambulance. The EMS personnel went into the ED and talked to the physician and the ED LPN. The Ambulance Run Sheet stated the EMS personnel left the ED and took Patient #22 to another hospital. No one from the CAH's ED staff saw Patient #22 and at 10:50 PM, they arrived at the secondary hospital.
On 3/30/10 at 3:05 PM, the EMT involved in the above transport was interviewed. She confirmed the above events to be true and factual.
2. CAH personnel interviews were conducted. On 3/30/10 starting at 1:30 PM, the ED physician who was on duty when Patient #22 presented to the ED, was interviewed. She stated she was told by the LPN working in the ED that an ambulance was en route to the hospital with a patient who was complaining of lower back and hip pain. She stated she was further told by the LPN that Patient #22's vital signs were reported as normal. However, she said she was told by the LPN that the patient weighed approximately 500 lbs. She stated she was concerned because the CAH did not have the capability to perform radiologic diagnostic tests on Patient #22 due to his size. She stated she had the LPN call the Radiology Technician to see if the CAH could perform radiologic diagnostic tests on a patient that large. The ED physician stated the LPN called the Radiology Technician who confirmed the CAH was unable to perform radiologic diagnostic tests on Patient #22 due to his weight.
The ED physician further stated she directed the LPN to call the ambulance to divert the patient to another hospital but was told the ambulance had already arrived at the ED. The ED physician stated the LPN, with her permission, told ambulance personnel to take Patient #22 to a different hospital that was capable of performing radiologic diagnostic tests. She stated she did not see Patient #22 and said she did not perform an MSE. The above statement was confirmed in a written statement by the ED Physician that was not dated or timed.
The LPN who worked in the ED the evening of 3/24/10, confirmed the ED physician's statements in a written document, dated 3/24/10, which was not timed. He also confirmed the ED physician's statements during an interview on 3/31/10 at 9:10 AM. The LPN stated the ED physician did not conduct an MSE.
During an interview with the CNO on 3/30/10 at 1:30 PM, she stated a medical record had not been established for Patient #22. She stated he had come to the hospital but he had remained in the ambulance at the entrance to the ED before being transported to another hospital.
Patient #22 did not receive a medical screening examination.