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Based on review of policy and procedures and interview with staff (EMP), it was determined that Carlisle Regional Medical Center failed to ensure that Emergency Department (ED) services were provided to meet the emergency needs of patients in accordance with acceptable standards of practice for one (MR1) of ten ED medical records reviewed (MR1).

Findings include:

A review conducted on December 6, 2010, of Carlisle Regional Medical Center "Emergency Medical Treatment and Active labor Act (EMTALA) Policy effective date 09/15/08" revealed, "...Any individual who comes to the hospital's Dedicated Emergency Department ...and on whose behalf a request is made for examination or treatment for a medical condition will be provided with: a) an appropriate medical screening examination within the Emergency Department's capabilities, including ancillary services routinely available to the Emergency Department, to determine whether or not an emergency medical condition exists. ..."

1) A review on November 22, 2010, of MR1 revealed that the patient presented via ambulance to the ED on August 18, 2010, for an allergic reaction to a medication. MR1 revealed the following medical history: seizure disorder, aortic coarctation, atrial fibrillation, endocarditis, asthma, GI bleed, hypertension, pacemaker, gastroesophageal reflux, Kartagener syndrome and sick sinus syndrome. MR1 was seen by the ED physician and discharged and refused to leave the Deprtment, requesting additional treatment. A nursing addendum at 05:02 PM revealed "MR1 was discharged from the Emergency Department (ED) and refused to leave. EMP1 was called. MR1 continued to refuse to leave the ED. EMP1 place [sic] hand on MR1 elbow to assist leaving department. At that time MR1 sat down on floor and started to kick EMP1. MR1 was forcibly removed from the department to the waiting area."


2) An interview conducted on November 22, 2010, at 1:45 PM with EMP1 revealed that "the ER secretary called me to escort MR1 out. I arrived on the scene and the patient was dressed with their shoes on, sitting on the litter. I asked the patient to leave and the patient said they wanted to see the doctor again. The doctor said the patient was taking up a bed. I asked the patient to leave and they refused. I picked up their belongings and took them to the ER registration. I thought MR1 would follow their belongings and the registration could keep an eye on the belongings. I told the patient that I called the state police and they had no regard for this. I tried to get the patient off the bed by grabbing their whole left arm. The patient flopped down on the floor. I tried to lift the patient up from the floor by their left arm. The patient was hollering and screaming that they wanted to be seen. The doctor was across the room standing at the desk. Everyone in the emergency room was shaking their heads. The patient started to fight and kick. I grabbed their ankles and dragged the patient out to registration. The patient went to registration and asked to be seen again. I explained to the ER registration what happened. The patient then sat there in registration until the police got there and refused to co-operate with the police. The police had to lift the chair up to get the patient to get up off the chair. They escorted the patient and their belongings out of the hospital."

EMP1 confirmed that the discharged patient (MR1) was not seen by the physician after they were dragged out of the emergency room.

Based on review of facility policy, medical record (MR) and interview of staff (EMP), it was determined that Carlisle Regional Medical Center failed to follow their adopted complaint policy by not ensuring that patient complaints were addressed and investigated for one of ten medical records reviewed (MR1).

Findings include:

A review on November 22, 2010, of the Carlisle Regional Medical Center Administrative Policies and Procedures "Subject: Grievance/Complaint Policy reviewed 9/10" revealed, "Purpose: To provide a process that substantively addresses grievances and complaints from patients or patient representatives as a method of improving patient care and services delivered through problem resolution; ... A "complaint" is an expression of displeasure or discontent about a situation (housekeeping, food dissatisfaction, etc.) requiring a response taken to address the concern at issue. ..."

1) A review on November 22, 2010, of MR1 revealed that the patient voiced a complaint that they wanted to see the physician again and refused to leave. Security was called and dragged the patient out of the emergency room by their ankles. The police were called and forcibly removed the patient from the waiting area.

2) An interview was conducted on November 22, 2010, at 3:00 PM with EMP2. EMP2 stated there was "no internal investigation performed on this incident.We did not identify this as a complaint. There is no incident report. When the police were called the patient lost their right to file a complaint."

Based on a review of facility policy, facility documentation, medical records (MR) and interview with staff (EMP), it was determined that Carlisle Regional Medical Center failed to ensure the patient's right to be free of abuse was enforced; they failed to provide staff education regarding non-violent crisis intervention; they failed to allow a patient to be registered and examined; and they failed to investigate and report an episode of patient abuse for one of ten medical records reviewed (MR1).

Findings include:

A review on November 22, 2010, of the Administrative Policies and Procedures, Subject: Patient Bill of Rights and Responsibilities revised February 2007 revealed, "Patients at Carlisle Regional Medical Center have the right: ... to respectful care given by competent personnel with reflects consideration of personal values and belief systems and which optimizes patient comfort and dignity. ..."

A review conducted on December 6, 2010, of Carlisle Regional Medical Center "Emergency Medical Treatment and Active labor Act (EMTALA) Policy," effective date 09/15/08, revealed, "...Any individual who comes to the hospital's Dedicated Emergency Department ...and on whose behalf a request is made for examination or treatment for a medical condition will be provided with: a) an appropriate medical screening examination within the Emergency Department's capabilities, including ancillary services routinely available to the Emergency Department, to determine whether or not an emergency medical condition exists. ..."

1) A review on November 22, 2010, of MR1 revealed that the patient presented via ambulance to the ED on August 18, 2010, for an allergic reaction to a medication. MR1 revealed the following medical history: seizure disorder, aortic coarctation, atrial fibrillation, endocarditis, asthma, GI bleed, hypertension, pacemaker, gastroesophageal reflux, Kartagener syndrome and sick sinus syndrome. MR1 was seen by the ED physician and discharged and refused to leave the Deprtment, requesting additional treatment. A nursing addendum at 05:02 PM revealed "MR1 was discharged from the Emergency Department (ED) and refused to leave. EMP1 was called. MR1 continued to refuse to leave the ED. EMP1 place [sic] hand on MR1 elbow to assist leaving department. At that time MR1 sat down on floor and started to kick EMP1. MR1 was forcibly removed from the department to the waiting area."

2) An interview conducted on November 22, 2010, at 1:45 PM with EMP1 revealed that "the ER secretary called me to escort MR1 out. I arrived on the scene and the patient was dressed with their shoes on, sitting on the litter. I asked the patient to leave and the patient said they wanted to see the doctor again. The doctor said the patient was taking up a bed. I asked the patient to leave and they refused. I picked up their belongings and took them to the ER registration. I thought MR1 would follow their belongings and the registration could keep an eye on the belongings. I told the patient that I called the state police and they had no regard for this. I tried to get the patient off the bed by grabbing their whole left arm. The patient flopped down on the floor. I tried to lift the patient up from the floor by their left arm. The patient was hollering and screaming that they wanted to be seen. The doctor was across the room standing at the desk. Everyone in the emergency room was shaking their heads. The patient started to fight and kick. I grabbed their ankles and dragged the patient out to registration. The patient went to registration and asked to be seen again. I explained to the ER registration what happened. The patient then sat there in registration until the police got there and refused to co-operate with the police. The police had to lift the chair up to get the patient to get up off the chair. They escorted the patient and their belongings out of the hospital."

Further interview with EMP1 revealed, " I was trained how to hold people down and how to restrain them. I am the only security personnel that work on the night shift."

EMP1 confirmed that the patient presented at the registration desk to be seen again by the physician. EMP1 confirmed that the discharged patient was not seen by the physician after they were dragged out of the emergency room by their ankles.

3) A review of untitled, undated and unsigned facility document revealed EMP1 "grabbed hold of MR1's ankles to keep from being kicked and started dragging MR1 across the floor ... I just continued to drag MR1 out of the registration area and in the process MR1 had grabbed hold of a wheelchair by the registration window and EMP2, EMP3 and EMP4 helped to free MR1's hands from the wheelchair."

4) A review of "Carlisle Regional Medical Center Security Officer Qualifications" revealed, "1) Annual compliance and HIPPA Privacy and Security Training 2) Yearly Performance Evaluation 3) CPR Training/First Aid Training 4) Health.edu for required year 5) Security Competency Assessment as a part of new hire and annual performance evaluation."

5) A review on December 10, 2010, of EMP1 personnel file PF revealed that EMP1's most recent performance evaluation was conducted on March 14, 2008, and that the most recent "Security Competency" course was March 09, 2008.

6) An interview on December 10, 2010, at 10:40 AM with EMP8 confirmed that last performance evaluation for EMP1 was March 14, 2008, and their last training was March 09, 2008.

7) An interview was conducted on November 22, 2010, at 3:00 PM with EMP2. EMP2 stated there was "no internal investigation performed on this incident."