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Based on review of patient records, hospital policies and procedures, and staff interviews, the hospital failed to comply with all requirements of 489.24.

Refer to citations and examples at:

A 2402 (489.20(q)) Posting of Signs - the hospital failed to ensure that signs identifying the rights of individuals with emergency medical conditions and women in labor were posted in waiting areas and treatment rooms where patients and visitors could see them.

A 2406 (489. 24(r) and 489.24(c)) Medical Screening Exam - the hospital failed to ensure that persons coming to the emergency room with a possible medical emergency were provided a medical screening exam to rule out or confirm a medical emergency.

Based on observation and staff interview, the hospital failed to ensure that signs identifying the rights of individuals to examination and treatment for emergency medical conditions and women in labor were posted in Emergency Department and Obstetrical Department waiting areas and treatment rooms.

Findings:

A tour with administrative staff on 2/3/2015 at 2 p.m. of the hospital Emergency Department and Obstetrical Department revealed that required signage notifying individuals of their rights to treatment were not posted in the waiting areas or treatment rooms of either Department. The required signage (in a form as specified by the Secretary) was seen at the entrances of both Departments, but not where patients, family members, or other visitors were waiting and would be able to see and read their rights under Federal law.

Administrative staff agreed the required signage was not posted in waiting areas or treatment rooms.

Based on record review, staff interviews, and the complaint allegation, the hospital failed to provide a medical screening exam to rule out an emergency medical condition for 4 of 25 patients reviewed who came to the hospital emergency department (Patient #'s 1,2,3,4).

Findings:

A report was received that, on January 18, 2015 the Toppenish Hospital Emergency Department sent a parent and his/her 3 children to Yakima to be tested for carbon monoxide poisoning without first providing medical screening exams to rule out a medical emergency.

A report filed by the Yakima County Fire Department dated 1/18/2015 related to this event was reviewed. It showed that the family's carbon monoxide alarm sounded after the home's furnace malfunctioned. The Fire Department arrived and found the family outside, and the house with windows open and aired out. No injuries were identified and no aid was rendered at the scene. Per interview with Toppenish hospital staff and information in the Yakima hospital medical records, the Fire Department recommended the family go to the hospital emergency room to get checked out. The parent declined ambulance service and drove themselves and the 3 children (ages 5, 8 and 10) to the Toppenish Emergency Room.

Interview with Toppenish hospital staff revealed that their staff told the family that Toppenish Hospital didn't have the equipment to run the carboxyhemoglobin test to determine carbon monoxide poisoning and "gave the family the option to go to Yakima" where the test could be run on site. Toppenish staff documented in the 4 patients' medical records, "Patient stated they are leaving due to felt better and decided to leave."

Review of the hospital policy/procedure "EMTALA-Medical Screening/Stabilization" Revision No. 2 dated September 2013 read, "All individuals presenting on Hospital property requesting emergency medical services...shall receive an appropriate Medical Screening Examination and Stabilization services as required by the Emergency Medical Treatment and Active Labor Act..."

The Yakima hospital patient records of the 4 family members identified in the complaint were reviewed. Documentation identified 2 of the 4 family members (Patient #1was the parent and #4 was the 5 year old child, the youngest of the 3 children) had some degree of carbon monoxide poisoning. The parent complained of a headache, chest pain, and reported passing out at home prior to getting outside. The parent reported the 5 year old had a headache and passed out at home during exposure to the carbon monoxide. The child's blood level was 14 percent on arrival (adult normal is 2.3 percent). "Placed on pediatric NRB (non-rebreathing) mask" at 10 liters of oxygen. After treatment the blood level returned to 1 percent. The child was diagnosed with carbon monoxide poisoning.

Failure to provide a medical screening exam to all patients presenting to the Toppenish Hospital emergency department risked patient health and safety, and in this case, endangered the general public as the parent drove themselves and the 3 children 18 miles to a Yakima hospital.