HospitalInspections.org

Based on interview and document review, the hospital failed to ensure compliance with the requirements of 42 CFR 489.24 as evidenced by the deficient practice cited at 42 CFR 489.24 (d) (1-3).

Based on document review and interview, the hospital failed to inform a patient of the risks and benefits of the medical screening examination (MSE) and stabilizing treatment for 1 of 22 (#1) patient records reviewed. Patient #1 presented to the emergency department (ED) with a known medical emergency condition and left the ED without receiving an appropriate medical screening examination and stabilizing treatment. No attempt was made by the ED staff to inform the patient of the risks and benefits of the MSE and stabilizing treatment. Findings include:

Patient #1's ED record was reviewed and revealed the only portion completed was the triage section of the record. Patient #1 presented with her spouse to the ED and was immediately triaged at 10:30 p.m. on 5/26/2012. Patient #1 presented with a known ectopic pregnancy and had been administered methotrexate on 5/17/2012, by the patient's primary physician. Patient #1 was complaining of more severe pain rating the pain at 5 on a 1 to 10 scale with 10 being the worst pain. In addition, Patient #1's symptoms included nausea with menstrual bleeding. The vital signs taken during the triage revealed a blood pressure of 104/63, pulse of 91, temperature of 97.6 degrees Fahrenheit, respirations of 18 and an oxygen saturation of 100% on room air. Patient #1 was assigned a triage category of a 3 or urgent on a scale from 1 being emergent (critical) and 5 being non-urgent. After the triage, Patient #1 was asked to sit in the ED waiting room because the ED was full. The documentation indicated at 11:10 p.m. (forty minutes after triage) Patient #1 informed ED staff she wanted to leave the ED and go to another hospital ED approximately 25 miles away.

Interview with Patient #1 at 9:36 a.m. on 7/12/2012, established Patient #1 went to the ED due to increased menstrual pain on 5/26/2012. Patient #1 presented to the ED because the hospital was closer to her home. Patient #1 stated she was unable to stand upright due to the abdominal pain and while waiting in the waiting room the nasuea worsened. Patient #1 stated after approximately 40 minutes in the waiting room her spouse spoke with the ED staff and informed them that her nausea and pain were worse and requested if Patient #1 could be seen sooner. According to Patient #1 her spouse was informed the wait could be another two to three hours. At that time, Patient #1's spouse informed the ED staff he was driving Patient #1 to another hospital (25 miles further). Patient #1 stated the ED staff did not inform her or her spouse of the risks of leaving the ED without a medical screening examination or stabilizing treatment. Patient #1 was allowed to leave the ED without an assessment of her current condition.

Interview with employee (A)/registered nurse supervisor at 11:38 a.m. on 7/13/2012, confirmed she had been informed Patient #1 was leaving the ED but he did not inform or attempt to obtain a signed consent from the patient of education regarding the risks and benefits of leaving the ED without a medical screening examination and stabilizing treatment. Employee (A) said Patient #1 was allowed to leave the ED and he did not assess the patient's condition prior to the patient leaving the ED.

Interview with employee (B)/administrative nurse at 10:52 a.m. on 7/6/2012, revealed ED staff should re-assess patients in the waiting area every thirty minutes. Employee (B) stated when ED staff were aware that a patient was leaving the ED without having a medical screening examination, the staff were to make every attempt to educate the patient regarding the risks of leaving without an examination.

Interview with Employee (B) at 9:35 a.m. on 7/16/2012, revealed when Patient #1 indicated the nausea was worse, the ED staff should have obtained vital signs, assessed the patient and informed the supervisor or physician of the patients intent to leave the ED without an examination and treatment. According to employee (B), there was no policy that addressed educating patients of risks and benefits of leaving the ED without receiving the medical screening examination or obtaining an assessment of a patient in the waiting room that was exhibiting signs of deterioration of their medical status.