HospitalInspections.org

Based on interview and record review, Reagan Memorial Hospital failed to implement and enforce a policy to ensure a patients' right for emergency treatment or service when a patient's oxygen saturation and vital signs were not determined prior to discharge; the patient was treated in a vehicle where medical equipment was not available. (Patient #1)

Findings include:

Review of the Reagan Memorial Hospital Nurse's note, dated 12/10/20 at 7:33 pm reflected "Pt presents for telemed assessment with complaint of post covid dx of weakness, pt assessed in vehicle and respirations rapid and shallow, lung fields clear x 5, pt encouraged to deep breathe [sic] and slow her respirations. When pt complies oxygen sats raise to 88-89..."

During an interview, on the afternoon of 12/22/20, Reagan Memorial Hospital Staff #1, NP stated, "I treated the patient. She had tested positive for Covid the week before, we couldn't get a good pleth. (The pleth waveform corresponds to blood flow. A well-defined pleth suggests a strong pulse and good perfusion at the probe site.) If someone's hands are cold or if they are wearing nail polish it can prevent a good pleth. I don't know if it was her size. I was worried about her, she was 5 feet 6 inches and over 300 pounds and had shortness of breath on exertion."

During an interview, on the afternoon of 12/22/20, Staff #5, CNO confirmed the hospital did not have a policy or procedure for the monitoring or treatment of patients being treated in vehicles.

Review of Patient #1's Shannon Medical Center Medical Records reflected,
Date of Service: 12/11/2020 12:36 AM
Chief Complaint
SOB (shortness of breath), Hypoxia, COVID + 12/03/20(day 8), Seen in Biglake today given steroids and discharged.
Patient is 35-year-old female who comes in emergency department chief complaint of shortness of breath. Patient is COVID-19 positive. She reports she test positive on 12/03/2020. She reports the shortness of breath worsened today. She went to Big Lake for evaluation. She reports she got an oxygen level of 60% there. She reports she was given a steroid injection and discharge. Patient reports her shortness of breath continued to be severe so presents to the emergency department for evaluation.
ED Triage Vitals at 12:13 am
Temp 99.7, Heart Rate, 98 Resp 26, BP 120/70, SpO2 79% on room air
General: She is not in acute distress.
Pulmonary:
Effort: Respiratory distress present.
Comments: Can only speak few words per sentence at this time. Minimal air movement. Crackles throughout all lung fields.

Clinical Impressions as of Dec 11 0422
COVID-19 acute respiratory distress syndrome
COVID-19 viral pneumonia

X-ray Chest 1 View
Result Date: 12/11/2020
Narrative: Comparison: None. Views: AP view of the chest.
Impression: Findings/impression: Moderate to prominent bilateral infiltrates are demonstrated compatible with but not limited to Covid 19.

ED Provider Note
General comments: Patient needing escalating oxygen therapy. Just prior to removal up to the floor placed around high-flow nasal cannula due to oxygen at 86% on 6 L. Admitted to the COVID hospitalist for continued treatment.

Based on observation and interview, the facility failed to post the Emergency Medical Treatment and women in labor signage in the Main lobby.

Findings include:

An observation of the facility's main entrance, on the morning of 12/22/20, revealed there was no EMTALA signage.

During an interview on the morning of 12/22/20, in the facility's main entrance, Staff #5, CNO, confirmed patients come in to this entrance to be checked in and that the signage was missing.

Based on interview and record review, Reagan Memorial Hospital failed to medically stabilize Patient #1 when the patient's oxygen saturation and vital signs were not determined prior to discharge; the patient ultimately required hospitalization for Acute Respiratory Distress and Pneumonia.

Findings include:

Review of the Reagan Memorial Hospital Nurse's note, dated 12/10/20 at 7:33 pm reflected "Pt presents for telemed assessment with complaint of post covid dx of weakness, pt assessed in vehicle and respirations rapid and shallow, lung fields clear x 5, pt encouraged to deep breathe [sic] and slow her respirations. When pt complies oxygen sats raise to 88-89."

During an interview, on the afternoon of 12/22/20, Reagan Memorial Hospital Staff #1, NP stated, "I treated the patient. She had tested positive for Covid the week before, we couldn't get a good pleth. (The pleth waveform corresponds to blood flow. A well-defined pleth suggests a strong pulse and good perfusion at the probe site.) If someone's hands are cold or if they are wearing nail polish it can prevent a good pleth, I don't know if it was her size. I was worried about her, she was 5 feet 6 inches and over 300 pounds and had shortness of breath on exertion."

During an interview, on the afternoon of 12/22/20, Staff #5, CNO confirmed the discharge vital signs were missing.

Review of Patient #1's Shannon Medical Center Medical Records reflected,
Date of Service: 12/11/2020 12:36 AM
Chief Complaint
SOB (shortness of breath), Hypoxia, COVID + 12/03/20(day 8), Seen in Biglake today given steroids and discharged.
Patient is 35-year-old female who comes in emergency department chief complaint of shortness of breath. Patient is COVID-19 positive. She reports she test positive on 12/03/2020. She reports the shortness of breath worsened today. She went to Big Lake for evaluation. She reports she got an oxygen level of 60% there. She reports she was given a steroid injection and discharge. Patient reports her shortness of breath continued to be severe so presents to the emergency department for evaluation.
ED Triage Vitals at 12:13 am
Temp 99.7, Heart Rate, 98 Resp 26, BP 120/70, SpO2 79% on room air
General: She is not in acute distress.
Pulmonary:
Effort: Respiratory distress present.
Comments: Can only speak few words per sentence at this time. Minimal air movement. Crackles throughout all lung fields.

Clinical Impressions as of Dec 11 0422
COVID-19 acute respiratory distress syndrome
COVID-19 viral pneumonia

X-ray Chest 1 View
Result Date: 12/11/2020
Narrative: Comparison: None. Views: AP view of the chest.
Impression: Findings/impression: Moderate to prominent bilateral infiltrates are demonstrated compatible with but not limited to Covid 19.

ED Provider Note
General comments: Patient needing escalating oxygen therapy. Just prior to removal up to the floor placed around high-flow nasal cannula due to oxygen at 86% on 6 L. Admitted to the COVID hospitalist for continued treatment.

Based on observation, interview and record review, the facility delayed emergency treatment when Patient #1 came into the emergency room requesting treatment for shortness of breath and was denied entry. The patient was told to drive her vehicle to the back of the emergency room for assessment and treatment.

Findings include:

An observation, on the morning of 12/22/20, during a tour of the facility's emergency room entrance revealed, the automatic doors to the emergency room would not open until a staff member manually opened them. The facility had set up a computer to monitor temperatures and patients had to answer screening questions prior to entrance.

During an interview on the morning of 12/22/20, Staff 6, RN stated, "If a patient is positive we have them drive around back, if they can ...The goal is not to have them contaminate the hallways."
Staff #6 stated, the nursing staff will triage the patient after they have driven to the back of the ER. When asked if a nurse stays with the patient being treated in the vehicle, Staff #6 stated, "No."

Review of the facility provided policy, ADMISSION OF PATIENT TO EMERGENY DEPARTMENT (dated January 2020) reflected, "3. The triage assessment will be conducted prior to the patient being seen by an Emergency Department Clerk for the purposes of registration."

Review of the facility provided policy Covid-19 Procedure & Protocol (undated and unapproved) reflected,
"Screening at ER - walk-up, no call (non-emergent)
1. Registration screens patient with the screening form and gets the patient's demographics
2. Once registration has completed the screening form, registration will register patient as
an emergency room visit.
3. Registration will inform the patient of billing and phone visit with provider.
a. If patient refuses telemedicine visit due to billing, patient refusal must be documented on account.
4. Once registration has completed their processes, registration will give the screening for [sic] to
a nurse.
5. The nurse will complete the medical screening."

During an interview on the morning of 12/22/20, in the facility conference room, when asked about the facility's practice of obtaining consents prior to the medical screening, Staff #4, CEO stated, "We had patients getting angry when they were billed for the telemedicine, they thought it was free."