HospitalInspections.org

Based on record review and interview, the facility failed to ensure a patient presenting to the emergency department for treatment was identified on the central log and failed to provide a medical screening exam to a patient who presented to the emergency department.

See A2405 and A2406

Based on record review and interview, the facility failed to ensure every patient who presented to the Emergency Department (ED) for treatment was listed on the central log. The affected one (Patient #1) of 20 patients reviewed.
The facility logged an average of 904 individuals on the ED log in the preceding 11 months.

Finding include:

Review of the facility's complaint and grievance log revealed the facility had received a complaint via the facility's internet home page "Care Experience" link that documented [Patient #1] was transported via Emergency Medical Services (EMS) to the Orrville ED on the morning of 08/29/22 due to being assaulted by the Wayne County Sheriff. Patient #1 documented "I was dazed and confused due to having my head slammed into a concrete bridge. Your staff refused to treat me because I could not recall my last name. The EMS workers failed to give report and I was asked to leave your ED. Is this how all head injury patients are treated? I know there is really no treatment for concussions, but it is recommended that the patient not be left alone. I am currently homeless. I was released from a hospital I was not familiar with. I was vomiting and very disoriented and I had no idea how to even find my way out of the ED parking lot. Your staff laughed and thought it was funny. I pray no one else is treated in this manner in the future. I certainly expect that this will be thoroughly investigated, and employees will be retrained and reprimanded."

Review of the police report, dated 08/29/22, revealed Patient #1 was not cooperative with the deputies. Patient #1 was tazed, then complained of arm pain and chest pain. The deputies called a squad for transport.

Review of the ambulance run report, dated 08/29/22 at 4:33 AM, documented the local fire department EMS received a call for emergency transport. The reported documented the EMS squad arrived at the scene at 4:45 AM. Patient #1 vital signs recorded by the EMS documented Patient #1 with a heart rate of 116 beats per minute (normal is 60-100), blood pressure 150/100 mmHg (normal systolic less than 120 and normal diastolic less than 90 mmHg); the heart rhythm was documented as tachycardic (fast heart rate). The report documented "upon EMS arrival 44-year-old found lying prone [face down] position with arm pain. Initial impression: behavioral/psychiatric disorder. Called for [Patient #1] who was tazed by police and complaining of chest pain and arm pain found lying face down on pavement in handcuffs. Report called to AOH [Aultman Orville Hospital]. Patient [#1] was transported, treated, transferred care to the RN."

Review of the emergency department (ED) log, dated 08/29/22 revealed Patient #1 was not on the ED log. There was no medical record for Patient #1 related to the ED visit on 08/29/22.

During interview on 12/12/22 at 3:00 PM, Facility Staff A stated all people who come to the facility's emergency department were to be placed on the ED log. Staff A confirmed Patient #1 was not on the ED log. Staff A stated unidentified patients can be issued a temporary identifier as to not delay treatment.

During interview on 12/20/22 at 10:41 AM, Registration Clerk Staff G revealed she was on duty the night shift of 08/29/22 along with Registration Staff I when Patient#1 was brought in by the EMS squad. Staff G stated the process was the EMS squad called in and gave a short description of the patients they were transporting to the facility's ED. Registration staff than went to the ambulance bay arrival doors and awaited the ambulance and received initial information and the central emergency log for that patient was initiated. Staff G verbalized that Registration Clerk Staff I was the person who met the ambulance on the morning of 08/29/22 but she was currently unavailable to interview. Staff G could not explain why there was no central log entry for Patient #1.

Review of the facility's policy titled "EMTALA", revised 05/10/22, directed the following: The hospital will maintain a central log to include information on each individual who comes to the hospital seeking treatment for an emergency medical condition. The Central Log includes patients from other areas of the hospital that may be considered as dedicated emergency departments such as Labor and Delivery.

Purpose: To establish guidelines for tracking the care and disposition of each individual who seeks care for an emergency medical condition.

Based on record review and interview, the facility failed to provide a medical screening exam to all patients who presented to the emergency department (ED) for treatment. The affected one (Patient #1) of 20 patients reviewed. The facility registered an average of 904 patients per month in the preceding 11 months of 2022.

Findings include:

Review of the facility's complaint and grievance log revealed the facility had received a complaint via the facility's internet home page "Care Experience" link that documented Patient#1 was transported via EMS to the Orrville ED on the morning of 08/29/22 due to being assaulted by the Wayne County Sheriff. "I was dazed and confused due to having my head slammed into a concrete bridge. Your staff refused to treat me because I could not recall my last name. The EMS workers failed to give report and I was asked to leave your ED. Is this how all head injury patients are treated? I know there is really no treatment for concussions, but it is recommended that the patient not be left alone. I am currently homeless. I was released from a hospital I was not familiar with. I was vomiting and very disoriented and I had no idea how to even find my way out of the ED parking lot. Your staff laughed and thought it was funny. I pray no one else is treated in this manner in the future. I certainly expect that this will be thoroughly investigated, and employees will be retrained and reprimanded."

Review of the police report, dated 08/29/22, revealed Patient #1 was not cooperative with the deputies. Patient #1 was tazed, then complained of arm pain and chest pain. The deputies called a squad for transport.

Review of the ambulance run report, dated 08/29/22 at 4:33 AM, documented the local fire department EMS received a call for emergency transport. The reported documented the EMS squad arrived at the scene at 4:45 AM. Patient #1 vital signs recorded by the EMS documented Patient #1 with a heart rate of 116 beats per minute (normal is 60-100), blood pressure 150/100 mmHg (normal systolic less than 120 and normal diastolic less than 90 mmHg); the heart rhythm was documented as tachycardic (fast heart rate). The report documented "upon EMS arrival 44-year-old found lying prone [face down] position with arm pain. Initial impression: behavioral/psychiatric disorder. Called for [Patient #1] who was tazed by police and complaining of chest pain and arm pain found lying face down on pavement in handcuffs. Report called to AOH [Aultman Orville Hospital]. Patient [#1] was transported, treated, transferred care to the RN."

There was no medical record for Patient #1 related to the ED visit on 08/29/22. There was no evidence a medical screening exam was performed on arrival to the ED.

During interview on 12/12/22 at 1:42 PM, ED Staff Nurse F stated she was on duty on 08/29/22 when Patient #1 was brought in by EMS with complaints of chest pain after being tazed by police. Patient #1 was brought into the ED and placed in the room on the cot. Staff F had face to face contact with the patient and attempted communication with the patient. Staff F stated Patient #1 refused to give her name or any information. Patient #1 was instructed she could leave.

During interview on 12/20/22 at 11:16 AM, ED Physician Staff H staff H verbalized the ED was not busy the night of 08/29/22 and he was in the physician's room. By the time he arrived in the ED, Patient #1 had already left. Nursing staff informed him of the incident. He did not perform a medical screening exam on Patient #1. Physician Staff H stated the expectation was that all patients who come to the ED and desired to be seen, all received a medical screening exam to determine if a medical emergency condition existed and received stabilizing treatment if indicated.

During interview on on 12/21/22 at 11:15 AM, Nursing Staff D stated Patient #1 arrived via ambulance on 08/29/22 at approximately 5:06 AM to the facility's ED per the ambulance run report with complaints of chest pain and history of being tazed by police. Staff D stated the facility could provide no documentation Patient #1 was provided a medical screening exam for determination of an emergency medical condition.

Review of the facility's policy titled "EMTALA", revised 05/10/22, directed the following:

A Medical Screening Examination is required to determine whether individual is experiencing an emergency medical condition when an individual:

a. Presents to the Emergency Department seeking care; or
b. Is pregnant and is in true labor; or
c. Arrives anywhere on the hospital's premises and requests emergency care; or
d. Presents for pharmaceutical services.

The following individuals may request an emergency medical screening examination:

a. An adult may request an evaluation and treatment.
b. A person (representative) acting on behalf of the individual who comes to the Emergency Department may request an evaluation and treatment.
c. A minor may request an examination and treatment, even without parental consent, which may be performed without delay.

The medical screening is generally performed by the QMP in the in the Emergency Department who is responsible for the general care of patients. A pregnant woman may be moved to the hospital's labor and delivery area, so long as the emergency medical screening examination is performed timely, without delay. The physician on duty, or the QMP when permitted, retains responsibility for the patient until the patient's provider or an on-call specialist assumes care for the patient, the patient is discharged, or the patient is transferred to another facility.

In providing a medical screening examination, the QMP shall not discriminate against any individual because of diagnosis, financial status, race, color, national origin, or handicap.