HospitalInspections.org

Based on document review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to maintain a cental log on each individual who comes to the hospital seeking emergency services (see A-2405); the failure to provide a medical screening exam to a patient who presented to the Emergency Department (ED) (see A-2406); and failure to ensure that adequate medical screening exams were performed by qualified medical professionals as determined in the Hospital Bylaws or Rules and Regulations (see A-2406).

Based on document review and interview, the facility failed to maintain a central log of all patients who presented to the emergency department with emergency medical conditions, including obstetric (OB) patients, and patients who left without being seen (LWBS). Findings include:

Review of the facility's central log provided on 1/26/15 at approximately 1500, revealed that patients' dispositions did not designate those patients who presented to the Emergency Department (ED) and/or Obstetrics Department (OB) without being medically screened. Interview with the Administrative Director ED/OB, on 1/26/15 at approximately 1600, revealed that, "IT (information technology department) provides data regarding the logs." The surveyor requested a comprehensive log with patients who LWBS at that time. A comprehensive log with patients who presented, but who were not seen, was not provided during the two-day survey.

Based on document review and interview, it was determined that the facility failed to ensure a medical screening exam (MSE) was performed on 1 (#12) of 30 patients presenting to the Emergency Department (ED) for an emergency medical condition, and failed to ensure that 5 (#2, #5, #11, #22, #27) of 28 OB patients had a medical screening examination done by a Qualified Medical Professional as designated in the Hospital bylaws or Rules and Regulations. Findings include:

Review of the facility "First-Net Mini-Reg Patient Label" revealed that patient #12 presented to the ED on 1/14/15 between 1806 and 1839. There was no registration label, just a last name written on the sheet. Interview with the Administrative Director Emergency Services/Obstetrics, on 1/26/15 at approximately 1500, revealed that the patients without registration labels most likely went to specific departments for screening and treatment.

Document review, computer review, and interview with the Obstetrics Manager #L, on 1/27/15 at approximately 0900, revealed that patient #12 was not registered in OB. Interview with OB Nurse #Q, on 1/27/15 at approximately 1030, revealed that she recalled patient #12, stating "I remember her because she was arguing with the registration clerk". There was no record that patient #12 had been registered or had a medical screening exam in the ED or OB departments.

On 1/26/15 at approximately 1030, interview with Physician Assistant #K, revealed that she examined obstetrical patients over 16 weeks gestation who present to the OB department. Interview with Physician Assistant #P, on 1/27/15 at approximately 1000, revealed that she also examined patients who presented to OB over 16 weeks gestation. She verified that she was on duty the day of 1/14/15, but did not recall specifics of that day.

Review of the Hospital Bylaws and Rules and Regulations, on 1/26/15 at approximately 1300, revealed no documentation of which providers were "qualified" to conduct medical screening exams. Review of the facility policy and procedure titled, "EMTALA-Emergency Medical Treatment and Labor Act", dated 11/30/14, #2 ED 156, H, specified that "Qualified Medical Person or Qualified Medical Personnel means an individual or individuals determined qualified by Hospital bylaws or rules and regulations (and consistent with state licensure) to perform a Medical Screening Examination." Those individuals had not been specified. Interviews with the Quality Director #F and the Corporate Manager Compliance #N, on 1/26/15 at 1300 and 1330 respectively, verified that Physician Assistants were not specified in the Hospital Bylaws or Rules and Regulations. The Corporate Manager Compliance stated, "We were working on that before...."

Later, on 1/27/15 at approximately 1400, The Corporate Manager Compliance stated that, "the PAs just do H and Ps (history and physicals) not the screening exam". A re-review of the five ED to OB cases (#2, #5, #11, #22, #27) with OB Manger #L and the ED Administrative Director verified that the PAs did the medical screening exams for each of the five patients. On 1/27/15 at approximately 1445, OB Manager #L stated, "Yes they were the only ones involved in the medical screening exam".