HospitalInspections.org

Based on review of medical records, hospital policies, procedures, and protocols, interviews with key hospital staff and local law enforcement agencies, on March 23-24, 2010, review of law enforcement documentation of transport, and review of accepted Emergency Medicine Standards, it was determined that the governing body failed to assure that the emerency services requirements were met.

Findings include:

1. The hospital ' s policy entitled ' Emergency Screening, Stabilization and Management of Patient Transfer to another Facility ' was last reviewed by the hospital in October 2009. The ' Policy Summary ' stated " The Federal Emergency Medical Treatment and Active Labor Act (EMTALA) requires hospitals with emergency departments to provide specified emergency services to any individual who comes to the hospital and requests examination or treatment for a condition that may be an emergency, including pregnant women in labor. It is the purpose of this policy to ensure that (1) all patients who come to the hospital requesting emergency services receive an appropriate medical screening examination to determine of an emergency medical condition exists; (2) patients with an emergency medical condition (as defined below) are stabilized; (3) patients requiring or requesting transfer are transferred in accordance with EMTALA requirements regardless of their diagnosis, ability to pay, race, color or national origin. "

2. This policy also stated, " An Emergency Medical Condition (EMC) is defined as a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in (a) placing the health of the individual (or with respect to pregnant women, the health of the woman or her unborn child) in serious jeopardy; or (b) serious impairment to bodily functions, or (c) serious dysfunction of any bodily organ or part. " This section continues, " A psychiatric patient is considered to have an EMC if either (a) acute psychiatric or acute substance abuse symptoms are manifested; or (b) the individual is expressing suicidal or homicidal thoughts or gestures and is determined to be a danger to self or others. "

3. A review of law enforcement documentation dated March 17, 2010, revealed Patient A was transported to Maine Medical Center (MMC) at 1630 in protective custody of the law enforcement agency.

4. A review of the REMIS [Regional Emergency Medical Information System]
documentation indicated that a page was sent on March 17, 2010 at 1658 to " Triage 5A ED [emergency department] NSG [nursing] CC [chief complaint]: Suicidal ideations, ETOH [ethyl alcohol] not cooperative via South Portland Police " . It was confirmed with the Director of Accreditation during an interview on March 24, 2010 at 1448 that this page related to Patient A.

5. The Clinical Nurse III, indicated in a written " Timeline of events March 17, 2010 between 5p-6p " that he/she had been " ...asked by [evening security supervisor] to come outside via ambulance bay. 3 police officers were standing outside of a cruiser...a police officer ...informed me that in the back of the cruiser was a [patient] who was an emergency room employee. [Patient] was combative and refusing to come to Maine medical center because [patient] was an employee here in this emergency department. I asked why [patient] was here, was told [patient] was intoxicated...I opened the door [to the cruiser] the individual kicked out at me and yelled [obscenities]...I asked [patient] what was going on and [patient] stated I told them not to bring me here. I turned to the police and asked if this was true, and they [police] said yes [patient] told us [patient] was an employee at MMC and did not want to come to this hospital. [Patient] asked to go to [receiving hospital]. I asked why [patient] was not taken there and was told by the police because [patient] was combative. The officer then asked the individual if now [patient] would go cooperatively to [receiving hospital] vs having to be taken out of the cruiser forcefully. [Patient] stated...would go cooperatively to [receiving hospital] as [patient] had first requested. The police stated they would rather have [patient] be cooperative and would take [patient] to [receiving hospital] and asked if I would call to let them [Receiving hospital] know they [police with patient] were coming. I agreed... "

6. During an interview on March 23, 2010 at 1535, the Clinical Nurse III, who was the triage nurse on March 17, 2010, stated, that she went outside and saw there were three police officers behind a police car. Additionally, she saw that the patient was an ED employee who was intoxicated and combative. The nurse opened the door to the police car, addressed the patient by name and the patient proceeded to kick out at the nurse and yell obscenities. The Clinical Nurse III continued, " I then asked the police why they brought [the patient] here. The police indicated that he/she had become combative during the transport to [receiving hospital] and decided to stop here for assistance. The police came to an agreement with the patient to go to [receiving hospital] if he/she would cooperate. The police then asked me to call [receiving hospital] as a courtesy. "

7. During an interview with the Security Supervisor - Second Shift on March 23, 2010 at 1510, he stated, " ...I received a call via radio that the patient was coming in. The PD called for our assistance for a combative patient. I got the triage nurse -Triage 5. The nurse went outside and the patient became quite aggressive, not saying nice things, combative. The nurse spoke to me and asked what I thought. I told the nurse to transfer to [receiving hospital], however, it wasn ' t my call...The nurse asked the police if they minded transferring to [receiving hospital]. They said they did not mind. The nurse then went in and called [receiving hospital]. "

8. A review of Patient A ' s medical record at the receiving facility indicated that the patient had arrived to the ED at 1736 on March 17, 2010. The triage assessment documentation, revealed, " pt handcuffed, to ER via SPPD [South Portland Police Department] with 3 officers...from patient ' s home and then MMC ER driveway...actively suicidal... " The " Emergency Physician Record " , dated March 17, 2010, indicated, " Brought in by police [after] expressing wish to kill self...Intoxicated. Refuses to speak but says, ' I ' m going to do it! ' - won ' t give details. "

9. During an interview on March 23, 2010 at 0940, MMC's Patient Safety Officer and Associate VP of Medical Affairs stated, " We didn ' t treat the patient...We facilitated the individual ' s request to go to [receiving hospital]....[He/she] refused treatment and didn ' t come here of [his/her] own volition."

10. A review of the ED log on March 23, 2010, revealed no information related to Patient A on March 17, 2010. During an interview on March 23, 2010 at 0930, the Director of Accreditation stated that the hospital did not have a medical record on Patient A for March 17, 2010, because Patient A had never left the custody of the South Portland Police Department.