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Based on review of facility policy, medical record review, review of facility electronic media documentation, and interviews, the facility failed to provide a complete and accurate Medical Screening Examination and failed to provide stabilizing treatment for one patient (Patient #1) who presented to the Emergency Department (ED) after a motor vehicle accident. This affected one of 34 patients reviewed.

The findings included:

Patient #1 was brought to the ED at Hospital A by the local police department on 6/6/2020 at 1:16 AM, for blood alcohol testing and medical clearance for incarceration after being involved in a Motor Vehicle Accident (MVA). The patient was triaged and scored a 4 on the Emergency Severity Index (ESI), indicating no emergent needs. A Medical Screening Examination was performed at 2:00 AM and no diagnostic testing was completed for the patient after the MVA. He was discharged in the custody of the local police department at 2:50 AM. On 6/6/2020 at 6:17 PM, the patient was admitted to Hospital B's ED with complaints of pain to his neck, chest, and back. Diagnostic radiological testing showed a left 5th rib fracture with a pneumothorax, which required a chest tube. The patient was admitted to Hospital B and discharged on 6/9/2020.

Refer to A-2406 and A-2407

Based on review of facility policy, review of the Emergency Department (ED) logs, medical record review, review of facility electronic media documentation, and interviews, the facility failed to provide an accurate and complete Medical Screening Examination (MSE) for one patient (Patient #1), who presented to the ED after a Motor Vehicle Accident (MVA). This affected 1 of 34 patients reviewed.

The findings included:

Review of the facility's policy titled "EMTALA," (Emergency Medical Treatment and Active Labor Act) last reviewed 9/8/2019, showed "...it is the policy...to provide a MSE [medical screening examination] within its capability to all individuals who present to a DED [dedicated emergency department] for examination or treatment of any medical condition, whether emergent or nonemergent. An examination performed by a Qualified Medical Professional (QMP) to reach with reasonable clinical confidence the point at which it can be determined whether an emergency medical condition does or does not exist..."

Review of the ED Logs showed Patient #1 was admitted to the ED of Hospital A on 6/6/2020 at 1:16 AM for a medical clearance after he was involved in an MVA. He was discharged at 2:56 AM in custody of the police department.

Medical record review of an ED Nursing Triage record dated 6/6/2020 at 1:32 AM showed Patient #1 was brought to the ED by the local police department after an MVA. His vital signs were as follows: blood pressure 101/62, Pulse 76, Respirations 18, and Oxygen Saturations 92% on room air.

Medical record review of an ED Nursing Assessment dated 6/6/2020 at 1:34 AM showed Patient #1 was triaged using the Emergency Severity Index (emergency triage severity and resource scoring) as a 4, indicating nonemergent needs.

Medical record review of an ED Physicians Medical Screening Exam dated 6/6/2020 at 2:00 AM showed "...found driving car...needs clearing to incarcerate..." Further review showed no laboratory or radiological diagnostic testing was performed after the patient was involved in an MVA.

Medical record review of the Discharge Instructions showed the patient was discharged into police custody on 6/6/2020 at 2:44 AM.

Medical record review showed the patient presented to Hospital B's ED on 6/6/2020 at 6:17 PM (16 hours and 27 minutes after the patient was discharged from Facility A). He was admitted to Hospital B. He was discharged home on 6/9/2020.

Medical record review of an ED Provider in Triage record at Hospital B dated 6/6/2020 at 6:17 PM showed the patient presented to the ED with a chief complaint of a motor vehicle accident which had occurred early in the morning on 6/6/2020. He was taken to jail and continued to have chest, back, and right knee pain. He complained of tenderness to palpation to his lumbar spine and tenderness over the left ribs. Diagnostic laboratory and radiology testing was ordered and completed. His vital signs were as follows: Blood pressure 125/91, Pulse 89, Respirations 18, Pulse Oximetry 98% on room air. Trauma services was consulted, and the patient was evaluated and admitted.

Medical record review showed the following diagnostic radiology tests were performed on 6/6/2020 at Hospital B:
1. 6:51 PM Chest X-ray: left 5th rib fracture, prominent soft tissue emphysema (lung disease) about the left hemithorax (one side of the chest), mild in size pneumothorax (collapsed lung due to air entering cavity around lung, causing pain and difficulty breathing).
2. 8:25 PM CT Chest: mild in size pneumothorax, left 5th rib fracture

Medical record review of a Trauma History and Physical from Hospital B dated 6/6/2020 at 8:13 PM showed "...involved on MVA last evening around 900 PM-9:30 PM. Reports he ran off the road. He was detained by police on scene and kept in custody overnight. On his release he came to the ED for evaluation. He reports severe chest pain on the left side since the accident. He reports shortness of breath and lumbar back pain as well..." His physical examination showed back pain, tenderness, and crepitus (grating sound) over his left chest. He was admitted to the medical/surgical unit.

Medical record review of a Chest Tube Procedure Note from Hospital B dated 6/6/2020 at 10:18 PM showed a #14 french tube Pigtail catheter (chest tube) was inserted to the left anterior 5th rib space and connected to suction.

Medical record review of a Discharge Summary from Hospital B dated 6/9/2020 at 12:44 PM showed the patient was involved in a MVA on 6/5/2020 between the hours of 9:00-9:30 PM where he ran off the road, airbags deployed, and the windshield broke. After his release from Hospital A on 6/6/2020 "...presented to the ED with complaints of left-side chest wall pain, shortness of breath, and lumbar back pain. Trauma scans revealed left 5th rib fracture with pneumothorax...a pigtail catheter was placed in the ED and he was admitted to the Med/Surg floor with continuous pulse oximetry for chest tube management, pain control and aggressive pulmonary hygiene..." He was discharged home in stable condition.

Review of an Electronic Media (email) dated 3/3/2021 at 3:17 PM from the Risk Manager to the ED Medical Director revealed, "...pt. is litigious...[ED physician #1] did complete medical screening and release the patient to jail, patient after leaving jail next day went to [Hospital B] where he was found to have left 5th rib fracture and a small pneumothorax where he got a pigtail-hospitalized 6/6/2020-6/9/2020..."

During a telephone interview on 4/14/2021 at 8:30 PM, Patient #1 stated he was involved in a single vehicle MVA on 6/6/2020 where he lost control of his car, ran off the road, and hit a guardrail. He stated he lost consciousness after the accident. He stated he was placed in a hallway bed; his blood was drawn by a nurse, and no one evaluated him while he was in the ED. He stated "...a nurse came in the room and told me I was cleared to go to jail...they did not do any blood work or x-rays...I did not see a doctor at [Facility A]. He continued to have shortness of breath and his daughter took him to [Hospital B] for evaluation on 6/6/2020 around 12:30 PM. X-rays were completed at [Hospital B] which showed he had 3 broken ribs and a "...punctured and collapsed lung..." He stated "...they just ignored me and wanted to get me out of there...they treated me like I was a drunk and didn't take me serious...they did not do anything for me..."

During an interview on 4/15/2021 at 12:25 PM, the Director of Risk Management stated the patient had contacted her related to his care at (Hospital A) on 6/6/2020. The patient stated he was brought to the ED after a motor vehicle accident by the local police department. He stated he had shortness of breath and chest pain, and no one evaluated his injuries, they drew his blood, and said he was medically cleared to go to the jail. His daughter took him to Hospital B for treatment. His x-rays at Hospital B showed rib fractures and a pneumothorax. They had to insert a chest tube, he was admitted and stayed there for 3-4 days. He stated he was neglected at Hospital A, and no one took him seriously.

During an interview on 4/15/2021 at 1:45 PM, the ED Physician at Hospital A stated the patient had good breath sounds, he did not palpate any abnormalities to the patient's chest wall, and his vital signs were stable. The ED Physician confirmed no laboratory or radiological testing was performed for Patient #1 while at Hospital A.

Based on review of facility policy, medical record review, review of facility electronic media documentation, emergency department logs, and interviews, the facility failed to provide stabilizing treatment for one patient (Patient #1) who presented to the Emergency Department (ED) after a motor vehicle accident (MVA). This affected 1 of 34 patients reviewed.

The findings included:

Review of the facility's policy titled "EMTALA," (Emergency Medical Treatment and Active Labor Act) last reviewed 9/8/2019, showed "...it is the policy...to provide a MSE [medical screening examination] within its capability to: all individuals who present to a DED [dedicated emergency department] for examination or treatment of any medical condition, whether emergent of nonemergent; all individuals presenting on hospital property..." Further review showed "...the examination must include all ancillary services routinely available to the ED...in the judgment of the emergency physician or other treating physician are necessary to screen and/or stabilize an individual with an Emergency Medical Condition...A patient will be deemed stabilized if the treating physician attending to the patient in the Emergency Department/hospital had determined, within reasonable clinical confidence, that the emergency medical condition has been resolved..."

Review of the ED Logs showed Patient #1 was admitted to the ED of Hospital A on 6/6/2020 at 1:16 AM for a medical clearance after he was involved in an MVA. He was discharged at 2:56 AM in custody of the police department.

Medical record review of an ED Nursing Triage record dated 6/6/2020 at 1:32 AM showed Patient #1 was brought to the ED by the local police department after an MVA. His vital signs were as follows: blood pressure 101/62, Pulse 76, Respirations 18, and Oxygen Saturations 92% on room air.

Medical record review of an ED Physicians Medical Screening Exam dated 6/6/2020 at 2:00 AM showed "...found driving car...needs clearing to incarcerate..." Further review showed no laboratory or radiological diagnostic testing was performed after the patient was involved in an MVA.

Medical record review of the Discharge Instructions showed the patient was discharged into police custody on 6/6/2020 at 2:44 AM.

Medical record review showed the patient presented to Hospital B's ED on 6/6/2020 at 6:17 PM (16 hours and 27 minutes after the patient was discharged from Facility A) with pain to his neck, chest, and back. He was admitted to Hospital B and discharged home on 6/9/2020.

Medical record review of an ED Provider in Triage record at Hospital B dated 6/6/2020 at 6:17 PM showed the patient presented to the ED with a chief complaint of a motor vehicle accident which had occurred early in the morning on 6/6/2020. He was taken to jail and continued to have chest, back, and right knee pain. He complained of tenderness to palpation to his lumbar spine and tenderness over the left ribs. Diagnostic laboratory and radiology testing was ordered and completed. His vital signs were as follows: Blood pressure 125/91, Pulse 89, Respirations 18, Pulse Oximetry 98% on room air. Trauma services was consulted, and the patient was evaluated and admitted.

Medical record review showed the following diagnostic radiology tests were performed on 6/6/2020 at Hospital B:
1. 6:51 PM Chest X-ray: left 5th rib fracture, prominent soft tissue emphysema (lung disease) about the left hemithorax (one side of the chest), mild in size pneumothorax (collapsed lung due to air entering cavity around lung, causing pain and difficulty breathing).
2. 8:25 PM CT Chest: mild in size pneumothorax, left 5th rib fracture

Medical record review of a Trauma History and Physical from Hospital B dated 6/6/2020 at 8:13 PM showed "...involved on MVA last evening around 900 PM-9:30 PM. Reports he ran off the road. He was detained by police on scene and kept in custody overnight. On his release he came to the ED for evaluation. He reports severe chest pain on the left side since the accident. He reports shortness of breath and lumbar back pain as well..." His physical examination showed back pain, tenderness, and crepitus (grating sound) over his left chest. He was admitted to the medical/surgical unit.

Medical record review of a Chest Tube Procedure Note from Hospital B dated 6/6/2020 at 10:18 PM showed a #14 french tube Pigtail catheter (chest tube) was inserted to the left anterior 5th rib space and connected to suction.

Medical record review of a Discharge Summary from Hospital B dated 6/9/2020 at 12:44 PM showed the patient was involved in a MVA on 6/5/2020 between the hours of 9:00-9:30 PM where he ran off the road, airbags deployed, and the windshield broke. After his release from Hospital A on 6/6/2020 "...presented to the ED with complaints of left-side chest wall pain, shortness of breath, and lumbar back pain. Trauma scans revealed left 5th rib fracture with pneumothorax...a pigtail catheter was placed in the ED and he was admitted to the Med/Surg floor with continuous pulse oximetry for chest tube management, pain control and aggressive pulmonary hygiene ..." He was discharged home in stable condition.

Review of an Electronic Media (email) dated 3/3/2021 at 3:17 PM from the Risk Manager to the ED Medical Director revealed, "...pt. is litigious...[ED physician #1] did complete medical screening and release the patient to jail, patient after leaving jail next day went to [Hospital B] where he was found to have left 5th rib fracture and a small pneumothorax where he got a pigtail-hospitalized 6/6/2020-6/9/2020..."

During a telephone interview on 4/14/2021 at 8:30 PM, Patient #1 stated he was involved in a single vehicle MVA on 6/6/2020 where he lost control of his car, ran off the road, and hit a guardrail. He stated he lost consciousness after the accident. He stated he was placed in a hallway bed; his blood was drawn by a nurse, and no one evaluated him while he was in the ED. He stated "...a nurse came in the room and told me I was cleared to go to jail...they did not do any blood work or x-rays...I did not see a doctor at [Facility A]. He continued to have shortness of breath and his daughter took him to [Hospital B] for evaluation on 6/6/2020 around 12:30 PM. X-rays were completed at [Hospital B] which showed he had 3 broken ribs and a "...punctured and collapsed lung..." He stated "...they just ignored me and wanted to get me out of there...they treated me like I was a drunk and didn't take me serious...they did not do anything for me..."

During an interview on 4/15/2021 at 12:25 PM, the Director of Risk Management, stated the patient had contacted her related to his care at Hospital A on 6/6/2020. The patient stated he was brought to the ED after a motor vehicle accident by the local police department. He stated he had shortness of breath and chest pain, and no one evaluated his injuries. He stated they drew his blood and said he was medically cleared to go to the jail. His daughter took him to Hospital B for treatment. His x-rays at Hospital B showed rib fractures and a pneumothorax. They had to insert a chest tube, he was admitted and stayed there for 3-4 days. He stated he was neglected at Hospital A, and no one took him seriously.

During an interview on 4/15/2021 at 1:45 PM, ED Physician #1 stated the patient had breath sounds, he did not palpate any abnormalities to the patient's chest wall, and his vital signs were stable. The ED Physician confirmed no laboratory or radiological testing was performed for the patient.