HospitalInspections.org

Based on review of facility documents and staff interviews (EMP), it was determined that the facility failed to comply with ?489.24 and failed to adopt and enforce a policy to ensure compliance with the requirements of ?489.24.

Findings include:

1) During interviews on January 27, 2010, with EMP22 and on January 28, 2010, with EMP10, EMP11, EMP12, EMP13, EMP14, and EMP15, all were asked where the EMTALA policy could be found. All reported that the policy could be found in the Emergency Department Policy Manual.

2) A request was made for any comprehensive facility or Emergency Department policy reflecting the requirements of ?489.24 and the related requirements at ?489.20.

3) Interview with EMP1 on January 28, 2010, at approximately 11:50 AM confirmed that the facility does not have a comprehensive policy reflecting the requirements of ?489.24 and the related requirements at ?489.20 and revealed "We do have those components in other policies but we don't have an actual EMTALA policy."

4) Interview with EMP7 on January 28, 2010, at approximately 1:00 PM confirmed that the facility does not have a comprehensive policy reflecting the requirements of ?489.24 and the related requirements at ?489.20 and revealed "We don't have an EMTALA policy ... We have never had any EMTALA allegations against us."

5) Review of "Bylaws of The Washington Hospital Medical Staff" and "Appendix A Rules and Regulations of The Medical Staff" revealed no documented evidence reflecting the requirements of ?489.24 and the related requirements at ?489.20.

Correspondence with EMP7 on January 29, 2010, at 2:38 PM revealed "... we did a search on the text of the medical staff bylaws and did not find the term EMTALA or medical screening exam."

Based on observations, review of facility policy, review of medical records (MR), and staff interviews (EMP), it was determined that facility staff failed to post conspicuously in the emergency department or in places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination and treatment in areas other than the traditional emergency departments, a sign (in a form specified by the Secretary) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; and to post conspicuously (in a form specified by the Secretary) information indicating whether or not the hospital participates in the Medicaid program under a State plan approved under Title XIX.

Findings include:

Review of "Emergency Room Triage/Transportation of Obstetrical Patients ... Revised: ... 8/09" revealed "The following groups of Obstetrical patients are to be admitted directly to the Labor and Delivery Unit 1. >20 Weeks with c/o [complaints of] the following: ..."

1) A review of the Labor and Delivery Log for patients presenting to the Labor and Delivery area, from August 2009 to January 2010 was performed. A random sample of 20 records were selected from the log for review.

Review of MR22, MR23, MR24, MR25, MR26, MR27, MR28, MR29, MR30, MR31, MR32, MR33, MR34, MR 35, MR36, MR37, MR38 and MR39 (90% of the records reviewed) revealed these patients presented unscheduled, as outpatients, to the Labor and Delivery area for treatment of emergency medical conditions.

2) During a tour of the Labor and Delivery area on January 27, 2010, at approximately 1:30 PM, observation revealed no EMTALA signs in the Labor and Delivery area, including no EMTALA signs in Triage room #1 and Triage room #3.

Interview with EMP8 on January 28, 2009, at approximately 9:20 AM confirmed the above findings and revealed "No, we don't have any EMTALA signs [in the Labor and Delivery Area]."

Based on review of facility documents, review of medical records (MR), and staff interviews (EMP), it was determined that the facility failed to maintain a central log on 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 two of two patients (PT1 and PT2).

Findings include:

Review of "Emergency Department Medical Record And Registration Log ... Reviewed: ... 6/08" revealed "Emergency Department Log/Express Care Log 1. All patients who are treated in the Emergency Department are registered in the Emergency Department or Express Care Log."

1) A request was made to the facility for any documentation that PT1 presented to the facility's Emergency Department on December 20, 2009, and that PT2 presented to the facility's Emergency Department on January 1, 2010.

2) Interview with EMP5 on January 27, 2010, at approximately 10:30 AM revealed "We don't have anything on [PT2] registering ... We do have that [PT1] registered on December 20, 2009."

Review of the corresponding document, provided by EMP5 during the interview, concerning PT1's registration, revealed that the patient was registered by EMP9 on December 20, 2009, at 9:25 PM.

3) Interview with EMP13 on January 27, 2010, at approximately 11:40 AM, revealed "... patients are not put into the [Emergency Room Register] log until [they] are registered."

4) Review of the "Emergency Room Register (log)" revealed no documented evidence that PT1 came to the emergency department on December 20, 2009. Further review of the"Emergency Room Register" revealed no documented evidence that PT2 came to the emergency department on January 1, 2010.

Interview with EMP3 on January 28, 2010, at approximately 9:10 AM confirmed the above findings and revealed "They are not in the log."

5) Telephone interview with EMP9 on January 28, 2010, at approximately 10:50 AM, confirmed that PT1 presented to the Emergency Department on December 20, 2009.

6) Telephone interview with PT2 on January 28, 2010, at approximately 12:05 PM confirmed that they presented to the Emergency Department on January 1, 2010.

7) Telephone interview with PT1 on January 29, 2010, at approximately 9:10 AM confirmed that the patient presented to the Emergency Department on December 20, 2009.

Based on review of facility policy, facility documents, interview with patients (PT), and interview with staff (EMP), it was determined that the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists for two of two patients (PT1 and PT2).

Findings include:

Review of "Admission To The Emergency Department ... Reviewed: ... 3/08" revealed "Policy Statement: Any individual who presents to the Emergency Department requesting treatment will receive a medical screening examination regardless of the individual's race, religion, sex, sexual orientation or ability to pay for services rendered ... Guidelines: 1. All patients admitted to the Emergency Department will have a medical record initiated and will be seen by a physician or a physician extender. 2. A nurse will assess all patients initially. 3. Any patient seen in the Emergency Department will have a complete initial assessment, which includes chief complaint, pain level, smoking status, TB exposure/symptoms, environment safety, functional/nutritional status, lift status, past medical history, allergy history, medication history, immunization history (as appropriate), and the name of family physician and/or applicable consulting physician."

Review of "Management Of Patient - Priority Of Care ... Reviewed: ... 3/08" revealed "Management of Patient: I. The triage nurse will be responsible for obtaining the patient's chief complaint. II. The triage nurse is responsible for completing the initial nursing assessment on patients who arrive by ambulatory."

Review of "Triage ... Reviewed: ... 3/08" revealed "Purpose: The triage system of The Washington Hospital will provide the patient arriving via the ambulatory entrance of the Emergency Department immediate assessment by a Registered Nurse ... Guidelines: 1. The triage nurse is responsible for assessing all patients who present to the ambulatory entrance of the Emergency Department ... Triage Assessment ... V. EMTALA Considerations A. All patients must receive a medical screening exam."

Review of "Emergency Department Medical Record And Registration Log ... Reviewed: ... 6/08" revealed "1. An Emergency Department Record must be initiated on all patients who seek treatment in the Emergency Department ... 5. The nurse responsible for the initial nursing assessment is responsible for initiating the ED Record and Nurse Assessment Record."

1) A request was made to the facility for any documentation that PT1 presented to the facility's Emergency Department on December 20, 2009, and that PT2 presented to the facility's Emergency Department on January 1, 2010.

2) Interview with EMP5 on January 27, 2010, at approximately 10:30 AM revealed "We don't have anything on [PT2] registering ... We do have that [PT1] registered on December 20, 2009."

Review of the corresponding document, provided by EMP5 during the interview, concerning PT1's registration, revealed that the patient was registered by EMP9 on December 20, 2009, at 9:25 PM.

3) A request was made to the facility for any medical records for PT1 from December 20, 2009, and for PT2 from January 1, 2010.

4) Interview with EMP6 on January 27, 2010, at approximately 12:40 PM confirmed that there were no medical records for PT1 and PT2 and further revealed "There are no ED records on these specific dates [for PT1 and PT2]."

5) Telephone interview with EMP9 on January 28, 2010, at approximately 10:50 AM, confirmed that PT1 presented to the Emergency Department on December 20, 2009, with an Emergency Medical Condition.

6) Telephone interview with PT2 on January 28, 2010, at approximately 12:05 PM confirmed that they presented to the Emergency Department on January 1, 2010.

7) Telephone interview with PT1 on January 29, 2010, at approximately 9:10 AM confirmed that they presented to the Emergency Department on December 20, 2009.