HospitalInspections.org

Based on record review and interview the facility failed to follow to provide a thorough Medical Screening Exam for 1 of 20 patients (Patient #1) in a total sample of 20 medical records reviewed.

The facility failed to provide a Medical Screening Exam to a patient who presented to the Emergency Department and had a change in condition. See Tag 2406.

Based on record review and interview the facility failed to provide a thorough and complete Medical Screening Exam for 1 of 20 patients (Patient #1) who presented to the ED (Emergency Department) in a total of 20 medical records reviewed.

Findings Include:

A review of the facility's policy titled, "EMTALA (Emergency Medical Treatment and Labor Act) Policy" last revised 07/2024 revealed, "... Emergency Medical Condition (EMC): A condition manifesting itself by acute symptoms of sufficient severity that the absence of immediate medical attention could reasonably be expected to result in... with respect to an individual with psychiatric symptoms: a) that acute psychiatric... symptoms are manifested... or b) that individuals are expressing suicidal or homicidal thoughts or gestures and are determined to be a danger to self or others... Medical Screening Exam (MSE): A MSE is the process to determine, within reasonable confidence whether an Individual has an EMC... General Requirements: ... 1. Provide an appropriate MSE to the Individual within the capability of the hospital's DED (Dedicated Emergency Department) to determine whether or not an EMC exists..."

A review of Patient #1's medical record revealed that Patient #1 was a 42-year-old with a medical history of bipolar disorder and schizophrenia who presented to the facility with a family member on 11/30/2024 at 12:08 AM for suicidal ideation and cuts on her wrists. Patient #1 scored "high risk" on her suicide screening and was placed in a 1:1 observation status upon arrival. Review of the record revealed that ED MD (Medical Doctor) F assessed Patient #1's cardiovascular status, respiratory status, musculoskeletal status, neurological status and psychiatric status upon arrival to the facility on 11/30/2024 at 12:20 AM.

Further review of Patient #1's medical record revealed county crisis was notified for determination of the need for involuntary psychiatric inpatient placement. Patient #1 refused to speak with crisis staff, Patient #1's family member spoke with crisis, crisis determined Patient #1 did not meet criteria for an involuntary psychiatric hold requiring inpatient admission, a safety plan was agreed upon and Patient #1 was preparing for discharge. Prior to discharge, Patient #1 became agitated and aggressive, law enforcement was notified, and Patient #1 was placed under arrest and discharged in police custody on 11/30/2024 at 1:40 AM.

A review of Patient #1's medical record revealed the following notes:

11/30/2024 at 12:20 AM by ED MD F: "... Physical Exam: General: [Patient #1] is not in acute distress; Cardiovascular: ... Normal rate and regular rhythm ... Normal pulses ... Normal heart sounds. Pulmonary: ... Pulmonary effort is normal. Abdominal: General: Abdomen is flat ... Musculoskeletal: Comments: A few small scratches/abrasions on her B/L (bilateral) anterior (underneath) wrist from what she said she used. (A knife) very superficial. No suturing needed. The areas were cleaned and a 2*2 gauze placed and covered with tape ... Neurological: ... She is alert ... Psychiatric: She appeared a bit despondent (in low spirits) ... Assessment and Plan: Medical Decision Making: [Patient #1] did not speak with the provider from [Crisis Center], however, [Crisis Center] spoke with [Patient #1's boyfriend's cousin] ... [Patient #1] was cleared to go home by [Crisis Center] ... [Patient #1's boyfriend's cousin] says he feels safe and comfortable taking her home and having her follow up with Psychiatrist and Social Worker... However, it appeared as if the family member and the patient had a loud conversation in the room and then [Patient #1] became agitated and violent. [Patient #1] started throwing things in the room... She continued to be violent and hitting at the officer and going for her face and hitting at us ... then [Police Officer B] had to tase her a second time and then put the cuffs on... Due to her extreme violent behavior and assault to [Police Officer B] [Patient #1] was placed under arrest and escorted out to police car ..."

11/30/2024 at 1:12 AM by ED RN (Registered Nurse) G: "[Patient #1] became very agitated, throwing equipment, chairs. Swearing at staff, attempted to leave. Police contacted as patient was not safe to go home Patient yelling at police, threatening staff. Provider was hit in the face and glasses knocked off of face."

There was no evidence found of a repeat Medical Screening Exam on 11/30/2024 after 1:12 AM, when Patient #1 had a change in behavioral condition, to determine if an emergent psychiatric condition was present before she was discharged from the facility into police custody.