HospitalInspections.org

Based on staff interviews and policy reviews, it was determined the hospital failed to ensure that the patient received a medical screening examination when the patient presented at the hospital. This was found for patient #1.


Findings include:


Staff # 2, the Director of the Emergency Department (ED) stated during an interview conducted at 11:30 AM on October 8, 2013 that once the ED is notified by the emergency medical service (EMS) of an impending arrival of a patient, the emergency department physician on duty sometimes asks the ambulance crew a series of questions to determine the patient's complaint and medical condition. Staff #2 further stated based on the paramedic's responses the ED physician sometimes instructs the ambulance crew to transport the patient to another hospital.

During an interview conducted with Staff #6, a Unit Clerk in the ED stated on October 9, 2013 at 3:40 PM that on September 21, 2013 at approximately 5:00 PM the voluntary ambulance crew in Pennsylvania notified her that patient #1 had fallen in a nursing home in Pennsylvania and that the patient may have sustained a fracture of a long bone. Staffs #3 who was the ED physician instructed her to "divert" the patient to another Medical Center because this hospital did not have an orthopedist on call. This message was relayed to a dispatcher who stated that they would notify the ambulance crew. The ambulance presented to the ED on 9/21/13. Upon arrival to the hospital the ED staff was informed that the patient refused to be brought into the ED.

Staff #3, the ED physician stated during an interview conducted on October 9, 2013 at 12:18 PM that the ambulance crew informed him that the patient was in the ambulance.

Staff # 7, the ED Technician was interviewed on 10/9/13 at 2:20 PM. Staff # 7 stated that she recalled that the paramedic returned into the ED and appeared frustrated and asked her to intervene. She stated she went into the back of the ambulance and spoke to the patient, the wife was also in the ambulance, but the patient refused to come into the ED. The patient stated if there was no orthopedic specialist at this hospital he did not want to go inside. She stated someone called another Hospital in New Jersey to determine if they had an orthopedist on call and they were informed that the hospital did have an orthopedist on-call.

The ED staff was informed that the patient would be taken to an ED in New Jersey approximately 30 to 35 minutes away

During an interview conducted on October 9, 2013 at approximately 10:45 AM, Staff #1, the Vice President of Patient Services stated that none of the registered nurses, the physician or the mid-level practitioner went to the ambulance to assess or encourage the patient to come into the ED. The ED Staff did not document any communication with the Ambulance personnel, the patient or the patient's wife. The patient left the hospital on September 21, 2013.

Review of the Emergency Room log on October 8, 2013 did not find any record of the patient ' s encounter with the ED staff on 9/21/13. The ED staff did not complete a pre-triage form, take vital signs, or perform a medical screening exam to determine if the patient had an emergency medical condition. There was no evidence that the risk and benefits of leaving AMA (Against Medical Advice) were explained to the patient. The ED staff did not communicate with the recipient facility to ensure that its staff would be aware of the patient's arrival.

The hospital's EMTALA policy last reviewed in 7/11 states "a physician, in conjunction with other staff, must certify the patient's non-emergency status with vital signs just prior to the transfer." This policy further states "the physician or other practitioner will contact the receiving medical care facility to confirm (a) the facility has the space and personnel to treat the patient; and (b) the facility agrees to accept the patient."