HospitalInspections.org

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Based on observation, interview, record review, and review of hospital policies and procedures and medical staff bylaws, the hospital failed to develop and implement policies and procedures for evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death.

Findings included:

1. The hospital failed to post signs notifying patients presenting to the emergency department whether or not they participated in the Medicaid program.

2. The hospital failed to ensure that the medical staff bylaws identified the qualifications for physicians, mid-level providers, and registered nurses who performed medical screening examinations.

Cross Reference: Tags C-2402, C-2406
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Based on observation, interview, and review of hospital policies and procedures, the hospital failed to post signs notifying patients presenting to the emergency department whether or not the hospital participated in the Washington State Medicaid program.

Failure to post this information risked violation of the patient's right to receive a medical screening examination, stabilizing treatment, and/or transfer regardless of ability to pay for services.

Findings were:

1. Review of the hospital's policy and procedure titled "Emergency Medical Treatment and Active Labor (EMTALA)", policy #4416807 revised 12/17, read: "The ED will display a sign with wording as required by EMTALA."

2. On 09/04/19 at 9:55 AM during a tour of the emergency department with the Director of Patient Care Services (Staff #1), the investigator observed there were no posted signs in the entrance and waiting areas of the emergency department notifying patients that the hospital participated in the Washington State Medicaid program.

3. During an interview at the time of the observation, the Director of Patient Care Services confirmed that there was no such signage.
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Based on interview, record review, and review of hospital policies and procedures and medical staff bylaws, the hospital failed to 1) ensure that the medical staff bylaws identified the qualifications for physicians, mid-level providers, and registered nurses who performed medical screening examinations in the hospital's emergency department and obstetrical unit; and 2) ensure that the hospital's staff training program included educating staff regarding who was authorized to perform medical screening examinations.

Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death.

Reference: 42 CFR 482.55(b)(2) - "The hospital must staff the emergency department with the appropriate numbers and types of professionals and other staff who possess the skills, education, certifications, specialized training and experience in emergency care to meet the written emergency procedures and needs anticipated by the facility."

Findings included:

1. Review of the hospital's policy and procedure titled "EMTALA", policy #4416807 revised 12/17, showed that patients presenting to the hospital's emergency department (ED) would be assessed by a physician. Patients presenting in labor or false labor who had been assigned to a physician who had examined her and followed her during her pregnancy could be assessed for labor by a labor and delivery nurse.

2. Review of the hospital's policy and procedure titled "Medical Screening Exam", policy #6264799 revised 04/19, showed that patients presenting to the hospital's emergency department would be assessed by the on-duty ED physician.

3. On 09/04/19 at 2:40 PM during an interview with the investigator, a registered nurse who was working in the ED (Staff #2) stated that physician assistants worked in the ED and performed medical screening examinations.

4. Review of the hospitals' medical staff bylaws dated as approved and adopted in June 2015 showed that the bylaws did not include the qualifications for physicians, mid-level providers, and nurses who performed medical screening examinations in the hospital's emergency department and Family Birth Center.

5. Review of the hospital's annual EMTALA online training curriculum showed the training did not include who was authorized to perform medical screening examinations.

6. On 09/05/19 at 8:20 AM during an interview with the investigator, the hospital's Director of Patient Care Services (Staff #1) confirmed that the bylaws and training program did not identify the qualifications for physicians, physician assistants, and nurses who performed medical screening examinations.
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