HospitalInspections.org

Based on a review of facility documents, other documentation (OTH) and staff interviews (EMP), it was determined that the facility failed to document on the central log each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for one of one patient presenting to the emergency department (ED).

Findings include:

Review of Emergency Department Policy 001 effective June 3, 2014, revealed, "Emergency Department Register 1. A register shall be maintained for all patients presenting to the Emergency Department for treatment. 2. It is the responsibility of the nurse/nurses on duty to assure accurate completion of all patient information on the registry... 6. For Behavioral Health patients, Emergency Department staff will enter the date, triage time, patient name, medical record number, age, gender, mode of arrival, ER physician, class and emergent/non-emergent status ..."

1. A review of documentation from Millcreek Community Hospital, including surveillance video from the Emergency Department (ED), revealed PT1 had presented to the facility ED with police on May 27, 2015, at 4:42 PM. The review further revealed PT1 left the facility ED with police at 5:11 PM.

2. Review of the Millcreek Community Hospital Emergency Room Log revealed no documentation that PT1 had presented to the ED on May 27, 2015.

On June 4, 2015, EMP7 confirmed that PT1 was not entered into the ED Log stating, "We never had a name to log [him/her] in. ... [He/She] came in at 4:42 (PM) and the police took [him/her] at 5:10 (PM)."

3. Review of the ED Log further revealed another nameless patient (MR1) identified as "John Doe" who presented (with police) in October 2013.

On June 4, 2015, EMP7 confirmed MR1 was entered into the log. EMP7, referring to the triage and treatment of the patient further stated, "So they (ED staff) know what to do."

4. On June 5, 2015, when asked if there was any record of PT1 presenting to the ED, EMP16 stated, "No. [He/She] wouldn't triage."

5. Review of documentation from OTH1 [Acute Care Hospital] revealed PT1 presented to their Emergency Department on May 27, 2015, at 5:41 PM. Review of the documentation further revealed, "Patient presents with [police] ... has been nonverbal, has been cooperative but noncommunicative. The [police] took pt to Millcreek Community Hospital and was not seen because [he/she] didn't speak English."

Based on a review of facility documentation and interviews with staff (EMP), and other sources (OTH), it was determined that the facility failed to provide an appropriate medical screening examination to determine whether or not an emergency medical condition existed for one of one individuals (PT1) brought the the Emergency Department.

Findings include:

Review of the Millcreek Community Hospital Medical Staff Rules and Regulations, adopted December 2, 2014, revealed, "... XII EMTALA COMPLIANCE A. It is the intention of Millcreek community hospital to comply with CMS regulations 489.20 and 489.24 entitled the Emergency Medical Treatment and Labor Act (EMTALA) as outlined below and in the hospital's general EMTALA policy number 48. B. PATIENTS PRESENTING TO THE EMERGENCY DEPARTMENT 1. The emergency department physician on duty shall be responsible for the general care of all patients presenting themselves to the emergency department. ... 2. All patients will be triaged on arrival utilizing standard protocols approved by the Department of Emergency Medicine. 3. All patients presenting to the emergency department shall receive a medical screening examination in accordance with the Emergency Medical Treatment and Labor Act Policy of Millcreek Community Hospital (The "EMTALA Policy"). The provisions of the EMTALA Policy shall govern all patients who are found to have an "emergency medical condition", as that term is defined in the EMTALA policy."

Review of Millcreek Community Hospital Erie, Pennsylvania Hospital Policy No. 048 "EMTALA Compliance" effective April 3, 2007, revealed, "Required Emergency Services: The Emergency Department at Millcreek Community Hospital shall provide a medical screening examination by a licensed physician to any person who present to the Emergency Department and requests treatment for an emergency medical condition. A patient 'presents' when he/she is on the Millcreek Community Hospital campus and request emergency medical treatment. ..."

Review of "Millcreek Community Hospital Emergency Department Policies and Procedures" Addendum October 1984, revealed, "2.3 Insure that each patient who present himself at the Emergency Department shall be seen by the Emergency Department Physician on duty regardless of sex, age, creed, national origin or ability to pay... 4.10 The Emergency Department physician shall personally evaluate every patient coming to the Emergency Department and treat or advise regardless of sex, age, creed, national origin, or ability to pay... 4.12 Every patient who presents himself to the Emergency Department shall be seen by the Emergency Department physician within a reasonable time unless there is a life-threatening emergency elsewhere in the hospital."

Review of Millcreek Community Hospital Job Description Job Title: ER Tech, no date provided, revealed, "Primary responsibility will be to triage patients as they present to the ER and report of such patients to RN and/or ER physician... Duties and Responsibilities: 1. Responsible for triage of patients as they present to the ER. 2. Checks the patient ' s vital signs and elicits chief complaint and pertinent information. ..."

1. A review of documentation from Millcreek Community Hospital, including surveillance video from the Emergency Department (ED), revealed PT1 had presented to the facility ED with police on May 27, 2015, at 4:42 PM. The review further revealed PT1 left the facility ED with police at 5:11 PM.

2. On June 4, 2015, an interview was conducted with EMP3. When asked about PT1, EMP3 stated, "The police brought [him/her] in. They found [him/her] wandering in [local township]. They were not quite sure what to do with [him/her]. The patient did not speak, nor write." EMP3 added, "They [police] got a call. They said they were taking [him/her] to [OTH1- Acute Care Hospital] and would call Crisis and do a 302 (involuntary mental health commitment). [EMP9] said [PT1] did not meet 302 criteria." When asked if EMP9 would normally make that determination independently, EMP3 stated, "No. Normally there is an assessment and they (BH Tech) contact the physician. Without triage, I have no authority to register the patient. PT1 did not present for a Behavioral Health evaluation. Most of the others get an assessment."

3. On June 4, 2015, an interview was conducted with EMP2. EMP2 stated "It was the end of the shift. About 4:45 (PM). The police were talking about 302. Everybody was by the triage desk. ... The troopers were asking how to move forward. [With a 302?] I guess that was their interest. [EMP9] said they can bring the patient back but told them that it would be hard to assess someone who was not speaking. ... They (police) wanted to move forward with getting PT1 302d."

4. On June 8, 2015, an interview was conducted with OTH5 (police). OTH5 stated, "They (Millcreek ED) pretty much told them (police) they couldn't evaluate [PT1] because of that (inability to communicate). Crisis had been called. I don't remember who I spoke with. What we discussed was [PT1] was to go to Millcreek for an evaluation. They (Crisis) were to call them (Millcreek). [PT1] couldn't communicate and we didn't know why. I had to get a little forceful with Crisis because initially they didn't want to do anything. ... I can't remember who it was but they initially told us there was nothing they (Crisis) could do. ... I said this is a mental health situation. Identifying [PT1] was a police matter. Having [PT1] evaluated for [his/her] safety and wellbeing was out of our hands."

5. Review of documentation from OTH1 [Acute Care Hospital] revealed PT1 presented to the Emergency Department on May 27, 2015, at 5:41 PM. Review of the documentation further revealed, "Patient presents with [police] after they found [him/her] standing in a driveway ... has been nonverbal, has been cooperative but noncommunicative. The [police] took pt to Millcreek Community Hospital and was not seen because [he/she] didn't speak English."