HospitalInspections.org

Based on review of facility policy, review of the Emergency Department (ED) logs, review of law enforcement documents, medical record review, and interviews, the facility failed to provide a Medical Screening Examination (MSE) for one (1) of 31 Emergency Department (ED) patients reviewed, (Patient #1).

Findings include:

Please refer to A-2406 for failure to provide a Medical Screening Examination.

Based on review of facility policy, review of law enforcement documents, medical record review, and interviews, the facility failed to provide a Medical Screening Examination (MSE) for one (1) of 31 Emergency Department (ED) patients reviewed, (Patient #1).

The findings included:

Review of facility policy, Emergency Medical Treatment and Patient Transfer Policy dated 12/1/98 revealed "...for the purpose of the EMTALA policy...with respect to an individual requesting examination and treatment means the individual is on the Hospital Property (including parking lot, campus, ambulance bay, and other departments of the Hospital)...includes the entire main campus, including the parking lot, sidewalk, and driveway...when an individual comes to the Emergency Department of the Hospital, or to any location of the Hospital campus...and a request is made on the individuals behalf for a medical examination or treatment, an appropriate Medical Screening Examination, within the Capabilities of the department...shall be provided to determine whether an Emergency Medical Condition exists..."

Review of a law enforcement dispatch record dated 8/20/19 at 7:57 PM revealed the Sheriff's Department received a call from a crisis hotline that stated Patient #1 was threatening to overdose on medication. Continued review revealed the patient alleged she was in her vehicle in the parking lot at Hospital A. Further review revealed "...the location of the patient was [Hospital A's]...front Plot [parking lot]...[Hospital A ED called] Adv [advised]...no room for patient...10 minute ETA [estimated time of arrival] to [Hospital B]..."

Review of a law enforcement Incident Report dated 8/20/19 at 7:57 PM revealed "...on 8/20/19 at approximately 7:57 PM officers responded to [Hospital A's parking lot] in reference to a suicidal female. Once on scene officers made contact with [Patient #1] who stated she was suicidal...the victim had messages on her cell phone that stated she was ready to die and she was going to overdose on pills. The victim was transported to [Hospital B] for evaluation..."

Review of a 911 audio recording of the dispatcher call to Hospital A's ED dated 8/20/19 revealed the following:
* Hospital A ED staff: "...Emergency this is [Registered Nurse #4]..."
* 911 dispatcher: "...this is [named dispatcher]...we are right down the street with a lady who is threatening 10/60 [attempted suicide] that is combative. Are you all able to take her for a mental eval [evaluation]..."
*Hospital A ED staff: "...hold on just a minute...I have been told by my charge nurse we are not allowed to say no but we do not have a special room for that patient if they are combative or what not..."
*911 Dispatcher: "...Ok, thank you..."

Medical record review revealed Patient #1 was admitted to the ED at Hospital B on 8/20/19 at 9:04 PM with Suicidal Ideation and was discharged home on 8/21/19 at 11:34 AM.

Medical record review of a Physician's Record at Hospital B dated 8/20/19 at 9:13 PM revealed "...[Patient #1] presents to ED via PD [police department] for evaluation of suicidal ideation onset today...PD says pt. [patient] was found in parking lot of [Hospital A]...dispatch called that ER [emergency room] while pt. was in PD custody in the parking lot at [Hospital A]. [Hospital A] ER staff said they did not have a room, they could not see her there...PD brought the patient here for eval..."

Medical record review of a Nursing Triage Record at Hospital B dated 8/20/19 at 9:57 PM revealed "...[Patient #1] was brought in by [law enforcement] in handcuffs from [Hospital A's] hospital parking lot...[911 dispatcher] called [Hospital A] to see if the patient could be seen...charge nurse in the ED [at Hospital A] told [ED staff] to tell dispatch we can't technically say no or refuse pt, but we don't have room for her...pt. was brought to [Hospital B] ER for mental eval..."

Telephone interview with Registered Nurse (RN) #3 from Hospital B on 9/11/19 at 4:30 PM revealed Patient #1 presented to Hospital B's ED by law enforcement on 8/20/19. Continued interview revealed the patient presented with Suicidal Ideations and was found by the Sheriff's Officer in her car in [Hospital A's] parking lot. Further interview revealed "...the officer stated that dispatch had called [Hospital A] to see if the patient could be seen in the ED and the charge nurse [at Hospital A] had told the unit secretary [at Hospital A] that they could not technically say no or refuse the patient but they did not have a room for her. They brought the patient to our ED for treatment and psychiatric evaluation..."

Telephone interview with Law Enforcement Officer #1 on 9/12/19 at 10:30 AM revealed he responded to a call on 8/20/19 regarding Patient #1's text to the suicide hot line and the report she was in [Hospital A's] parking lot. Further interview revealed "...at 7:57 PM I found her vehicle. The vehicle was located in the front side of [Hospital A's] parking lot...I notified my dispatch to call [Hospital A] ED and see if they could handle the patient related to she was known to be aggressive and combative. My dispatch notified me the ED had said they could not refuse the patient but it would be better if we took her somewhere else. I took the patient to [Hospital B]..."

Telephone interview with RN #4 at Hospital A on 9/12/19 at 4:45 PM confirmed she spoke with the dispatcher on 8/20/19. Continued interview revealed "...I remember something about a special room, but do not remember the patient...I asked the charge nurse and told the dispatcher that we could not technically say no, but we did not have a special room for a combative patient..."