HospitalInspections.org

Based on review of documents, medical records and staff interview it was determined the facility failed to ensure staff complied with the regulations for EMTALA at 489.20 and 489.24. The facility failed to ensure the accuracy of the central log for individuals presenting to the emergency department (see tag 2405), the facility failed to ensure staff provided treatment prior to discharge (see tag 2408) and failed to ensure an appropriate transfer was enacted (see tag 2409).

Based on review of documents, medical records and staff interview, it was determined the facility failed to ensure the accuracy of the central log for each individual presenting to the emergency department (ED) in three (3) of twenty (20) medical records reviewed (#1, 4 and 9). This has the potential to negatively impact a patient's medical recorded by inaccurately listing the discharge disposition.

Findings include:

1. Patient #1 was brought to the ED on 2/20/14 for a medical clearance prior to a mental hygiene hearing for involuntary commitment to a psychiatric facility by law enforcement. The patient was then discharged to law enforcement and transported to a psychiatric facility. The ED log lists the patient as being transferred to a psychiatric facility.

2. Patient #4 was transported to the ED on 1/17/14 for a medical clearance prior to a mental hygiene hearing for involuntary commitment to a psychiatric facility by law enforcement. The patient was then discharged to law enforcement, taken for a mental hygiene hearing and transported to a psychiatric facility. The ED log lists the patient as being transferred to a psychiatric facility.

3. Patient #9 was transported to the ED on 11/7/13 for a medical clearance prior to a mental hygiene hearing for involuntary commitment to a psychiatric facility by law enforcement. The patient was then discharged to law enforcement, taken for a mental hygiene hearing and transported to a psychiatric facility. The ED log lists the patient as being transferred to a psychiatric facility.

4. These medical records were reviewed with the Director of ED and Acute Care Services at 1055 on 3/12/14 and she agreed with these findings.

Based on review of medical records and staff interview it was determined the facility failed to ensure a delay in treatment prior to discharge did not occur in one (1) of one (1) medical records reviewed for a delay in treatment (#1). This has the potential to negatively affect all patient's by leaving them with an untreated medical condition.

Findings include:

1. Patient #1 was brought to the ED on 2/20/14 by law enforcement for a medical clearance exam prior to a mental hygiene hearing. The ED physician documented the patient had gangrene and infection in both feet. He did not treat the patient, but discharged him back to the law enforcement for transport to the psychiatric hospital.

2. A telephone interview was conducted on 3/11/12 at 0900 with the ED physician who treated the patient. He stated the patient had gangrene and infection to both feet. He revealed the patient needed to be transferred to an acute care hospital for treatment. He also said his first intuition was to transfer the patient to an acute care facility for treatment, but he was pressured by the behavioral health counselor to discharge the patient. He stated the behavioral health counselor said the psychiatric hospital could treat the patient's feet.

A. Based on review of documents, medical records and staff interview it was determined the facility failed to ensure an appropriate transfer was enacted in five (6) of twenty (20) medical records reviewed for transfer (patients # 1,4, 10, 11, 15 and 16). This has the potential to negatively affect patient's with an emergency medical condition when transfer in a private owned vehicle (POV) is used instead of an ambulance.

Findings included:

1. Hospital Policy titled Emergency Medical Treatment and Active Labor Act states in part: "The physician certifies the level of medical care which is appropriate for the patient during transport. Private transport is never appropriate. An ambulance refusal form must be signed if the patient refuses ambulance transport. Medical devices should be removed for private transport."

2. Patient #1 was brought to the ED on 2/20/14 by law enforcement for a medical clearance exam prior to a mental hygiene hearing. The ED physician documented the patient had gangrene and infection in both feet. He did not treat the patient, but discharged him back to the law enforcement for transport to the psychiatric hospital.
There were no transfer froms in the medical record to indicate the patient was transferred.

3. Patient #4 presented to the ED on 1/17/14 with complaints of suicidal and homicidal ideation's. After the Medical Screening exam a behavioral health counselor was consulted to perform the mental health assessment. The patient was transferred by POV driven by the behavioral health counselor.

4. Patient #10 presented to the ED on 11/5/13 with complaints of suicidal ideation's. After the medical screening exam the patient was assessed by the consulted behavioral health counselor. The patient was transferred to a psychiatric facility via POV driven by the behavioral health counselor.

5. Patient #11 presented to the ED on 10/30/13 with complaints of suicidal ideation's. After the medical screening exam the patient was assessed by the consulted behavioral health counselor. The patient was transferred to a psychiatric facility via POV driven by the behavioral health counselor.

6. Patient #15 presented to the ED on 10/22/13 with complaints of command hallucinations and suicidal ideation's. After the medical screening exam the patient was assessed by the consulted behavioral health counselor. The patient was transferred to a psychiatric facility via POV driven by the behavioral health counselor.

7. Patient #16 presented to the ED on 10/7/13 with complaints of aggressive and violent behavior. After the medical screening exam the patient was assessed by the consulted behavioral health counselor. The patient was transferred to a psychiatric facility via POV driven by her father.

8. These medical records were reviewed on 3/12/14 at 1055 with the Executive Director of ED and Acute Care Services and she agreed with these findings.

B. Based on review of documents, medical records and staff interview it was determined the facility failed to ensure written consent for transfer was obtained in the transfer of three (4) of twenty (20) medical records reviewed (patients #1, 11, 15 and 16). This has the potential to negatively affect patients by leaving them unaware of their right to participate in care by signing consents for treatment or transfer.

Findings include:

1. Hospital Policy titled Emergency Medical Treatment and Active Labor Act, last reviewed/revised 4/13, states in part: "The EMTALA Form will be completed by the physician in it's entirety."

2. Patient #11 was transferred from the ED to a psychiatric facility on 10/30/13. There was no EMTALA Form completed by the physician in the medical record.

3. Patient #15 was transferred from the ED to a psychiatric facility on 10/22/13. There was no EMTALA Form completed by the physician in the medical record.

4. Patient #16 (a minor) was transferred from the ED to a psychiatric facility on 10/7/13. The EMTALA form was not filled out completely and did not contain the signature of the parent.

5. Patient #1 was brought to the ED on 2/20/14 by law enforcement for a medical clearance exam prior to a mental hygiene hearing. The ED physician documented the patient had gangrene and infection in both feet. He did not treat the patient, but discharged him back to the law enforcement for transport to the psychiatric hospital.
There were no transfer froms in the medical record to indicate the patient was transferred.

6. These medical records were reviewed on 3/12/14 at 1055 with the Executive Director of ED and Acute Care Services and she agreed with these findings.