HospitalInspections.org

The Hospital dedicated emergency department did not comply with the requirements for the Emergency Medical Treatment and Labor Act (EMTALA, §489.24).

Findings included:

1.) The Hospital failed to ensure signage specifying the individual's right to have an examination and treatment for an emergency medical condition and information related to the Hospital's participation in the Medicaid Program (EMTALA signage) was not conspicuously posted in the Emergency Department waiting room or anywhere in the Hospital.

Refer to TAG: A-2402.

2.) The Hospital failed to maintain a central log on each individual who came to the Emergency Department seeking treatment whether he or she refused treatment, was refused treatment, was transferred, or was discharged.

Refer to TAG: A-2405.

3.) The Hospital failed to ensure that one patient (Patient #1), in a total sample of 20 patients, was provided with an appropriate Medical Screening Examination.

Refer to TAG: A-2406.

4.) The Hospital failed for one patient (Patient #1) of 20 sampled patients to arrange an appropriate transfer.

Refer to TAG: A-2409.

Based on observations made during a Hospital tour conducted on 6/5/19, it was determined that signage specifying the individual's right to have an examination and treatment for an emergency medical condition and information related to the Hospital's participation in the Medicaid Program (EMTALA signage) was not conspicuously posted in the Emergency Department (ED) waiting room or anywhere in the Hospital.

Findings include:

A tour of the ED was conducted at 9:00 A.M. on 6/5/19. The Surveyor observed there was no EMTALA signage anywhere in the waiting room. The Surveyors interviewed the Chief Nursing Officer during the tour. The Chief Nursing Officer said he was unaware that the EMTALA signage was not posted.

Based on record reviews and interviews, the Hospital failed to maintain a central log on each individual who comes to the Emergency Department (ED) seeking treatment whether he or she refused treatment, was refused treatment, was transferred, or was discharged.

Findings included:

Patient #1 was brought to the Satellite Emergency Department of the Hospital by Emergency Medical Services (EMS) on 5/29/10 around 11:45 P.M. with complaints of right arm numbness and dizziness.

Review of the Emergency Room Log from 12/1/19 - 6/5/19 indicated that Patient #1 was not on the Log as a registered patient.

The Surveyors interviewed the Registration Clerk on 6/7/19 at 11:18 A.M. The Registration Clerk said that Patient #1 entered the Emergency Department, his/her name and date of birth were given, Patient #1 stayed for under 5 minutes and then left abruptly to go to another hospital. The Registration Clerk said that, although Patient #1 came to the Emergency Department, she was not entered into the database as a patient.

Based on record review and staff interviews, the Hospital failed to ensure that one patient (Patient #1), in a total sample of 20 patients, was provided with an appropriate Medical Screening Examination.

Findings included:

The Hospital failed to provide Patient #1 with an appropriate Medical Screening Examination. Patient #1 presented on Hospital property at their satellite Emergency Care Center for examination and treatment to determine if an emergency medical condition existed obligating the Hospital to provide an appropriate medical screening examination and subject to Emergency Medical Treatment and Labor act (EMTALA) requirements.

There was no documentation in the electronic medical record or in the paper medical records that Patient #1 had been present or treated by the covering physician or nursing staff when Patient #1 arrived to the satellite Emergency Care Center on 5/29/19.

The Surveyor interviewed the Vice President of Nursing and Ancillary Services on 6/5/19 at 1:23 P.M. The Vice President of Nursing and Ancillary Services said that, on 5/29/19, the Satellite Emergency Center of the Hospital's CT scan images were not loading into the Picture Archiving and Communication System (PACS) so the Hospital contacted Central Medical Emergency Dispatch (CMED) and informed them that the CT Scan and PACS system was not working. They alerted CMED to divert stroke patients to other area Emergency Departments in another hospital.

The Surveyor interviewed Registered Nurse (RN) #1 on 6/6/19 at 7:45 A.M. RN #1 said that, on 5/29/19, during the evening shift, she received a CMED call. The CMED caller informed RN #1 that a patient was being transported to the satellite emergency department of the Hospital. RN #1 said that she told the CMED operator that they were on stroke diversion and Patient #1 should not be brought to their Hospital. The Emergency Medical Services (EMS) personnel did bring the patient to the Satellite Emergency Center at the Hospital. RN #1 said Patient #1 was brought to the nursing station. Patient #1 was not registered or treated for stroke symptoms while in the hospital. When told about the stroke diversion, Patient #1 was taken by EMS to another area hospital without a medical screening evaluation being performed.

The Surveyor interviewed Physician #1 on 6/6/19 at 11:00 A.M. Physician #1 said that, although Patient #1 did arrive at the Hospital and was in the Emergency Room, she did not document a Medical Screening Examination. Physician #1 said that she was in the Emergency Room when the CMED call came through. Physician #1 understood that the caller informed RN #1 that the patient suffered from acute onset right arm numbness and dizziness. RN #1 informed Physician #1 that the Emergency Department was on stroke diversion. Physician #1 said that when Patient #1 arrived, the EMS personnel reiterated that the Patient #1 had right arm numbness, but scored a "0" on the stroke scale. Physician #1 told EMS that the Patient still needs to be evaluated. Physician #1 then went to the doctor's area to research transfer protocol and when Physician #1 returned to the Emergency Room, EMS had Patient #1 on the way out the door to go to another area hospital. Physician #1 said that she never spoke to the patient directly and the patient left before she was able to perform the medical screening exam.

Based on records reviewed and interview, the Hospital failed for one (Patient #1) of 20 sampled patients to arrange an appropriate transfer.

Findings included:

The Surveyor interviewed Physician #1 on 6/6/19 at 11:00 A.M. Physician #1 said Patient #1 presented to the Emergency Department with complaints of right arm numbness and dizziness (possible signs of a stroke). Physician #1 said she did not document a Medical Screening Examination. Physician #1 said she did not speak to Patient #1 and Patient #1 left (transported by Emergency Medical Service to another hospital) before Physician #1 was able to perform the Medical Screening Exam.

The Hospital provided no documentation to indicate:

The Hospital provided medical treatment within its capacity to minimize the risks to the Patient #1's health,

Physician #1 determined Patient #1 to have an emergency medical condition or to not have an emergency medical condition,

Physician #1 determined Patient #1's condition was stable or not stable for transfer,

Physician #1 informed Patient #1 regarding risks and benefits of transfer,

Physician #1 determined qualified medical personal and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer,

Other (Receiving) Hospital agreed to accept the transfer of Patient #1 to provide medical treatment regarding Patient #1's complaints of right arm numbness and dizziness.