HospitalInspections.org

Based on interviews and document review, the facility failed to comply with the Medicare provider agreement as defined in §489.20 and §489.24 related to Emergency Medical Treatment and Active Labor Act (EMTALA) requirements.

FINDINGS

1. The facility failed to meet the following requirements under the EMTALA regulations:

Tag A2406 - Medical Screening Examination
Based on interviews and document review, the facility failed to provide a Medical Screening Examination (MSE) for 2 of 11 patients who presented to the Emergency Department of the facility seeking care.

Based on interview and record review, the facility failed to provide a medical screening examination for patients who entered the emergency department seeking emergency medical treatment in 2 of 11 emergency department records reviewed (patients #11 and #20).

This failure created the potential for negative outcomes to patients as they did not receive a medical screening examination to rule out an emergent medical condition.

Findings:

POLICY

According to the policy, titled Emergency Services, all patients presenting to the Emergency Department will be evaluated. Only licensed physicians can perform medical screening exams to rule out emergent medical conditions.

1. The facility failed to ensure patients presenting at the emergency department seeking emergency medical care received a medical screening exam.

a) Review of Patient #11's Progress Note, dated 10/29/14 at 9:11 p.m., showed the patient presented to the emergency room for a "checkup because I need a pacemaker." The note stated the patient was scheduled to get a pacemaker at a different hospital in another city (approximately one hour away).

There was no documentation the patient received a medical screening exam.

Review of an email, dated 01/28/15, received from the Director of Quality, Risk and Compliance reported the Patient Advocate received a call on 12/31/14. The summary of events noted the patient had been asked to go to an ED (Emergency Department) by his/her nurse practitioner as there were concerning results from a cardiac monitor the patient was wearing. The patient chose the facility's ED as it was closer. The patient stated the ED was busy and s/he was taken back by a Registered Nurse (RN). The patient stated s/he was told by the RN there was nothing that could be done at the moment as the staff were in the process of transferring another patient and it would be better for the patient to drive to another city (approximately 50 miles away)

According to the email, on 01/07/15 Registered Nurse #1 (RN) provided a statement which reported s/he remembered the patient came in for a checkup and to get a pacemaker that day so s/he didn't have to drive to another city. The RN stated s/he probably told the patient s/he would have to check and see if the hospital did pacemakers and that if the facility did not, the patient would still have to drive to the other city. The RN noted perhaps the patient misunderstood what s/he was trying to say when told the facility did not do pacemakers and s/he would still need to drive to another city.

The patient left the facility prior to receiving a medical screening exam and had a family member drive him/her to another city. The lack of a medical screening exam created the potential for Patient #11 to experience an emergent cardiac event while traveling to another hospital in an unsafe and unmonitored manner.

2. Review of Patient #20's medical record showed s/he presented to the ED on 02/12/15 for nausea and vomiting.

Record review showed the patient received a triage assessment by a RN but did not receive a medical screening exam by the physician to rule out an emergent medical condition. Additionally the patient received Zofran (a medication for nausea) with no evidence s/he had received a medical screening exam.

Review of the facility charge ticket and unsigned patient rights form noted the patient left without being seen.

On 02/17/15 at approximately 3:00 p.m., the Interim Chief Executive Officer reviewed Patient #20's record and acknowledged there was no medical screening exam.