HospitalInspections.org

Based on interview and record review, the HCA Houston Healthcare West failed to maintain an accurate ED Central Log. Patient #1 was transported via ambulance on 6/23/2022 11:40 p.m. to HCA Houston Healthcare West and was not recorded in the facility's ED Central Log.

Findings included:

TX00423325

Record review 7/1/22 of a facility policy titled "EMTALA - Texas Central Log", last approved date 01/2020, stated "The hospital will maintain a central log containing information on each individual who comes to the hospital campus requesting assistance or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment ...".

Review of the facility's emergency department surveillance tapes dated 6/23/2022 11:40 p.m., along with interview of ED Director staff ID 55 revealed Patient #1 arrived to the facility via Houston Fire Department Ambulance 86 but was told by ED staff RN ID#62 that they "should not come there because they don't have cath lab." The sign-in sheet and intake log did not have Patient #1's name.

Record review on 7/1/22 at 10:45 a.m. of the HCA Houston Healthcare West Central Log for 6/23/22 and 6/24/22, failed to reveal documentation of registration of P1 on the central log.

Record review on 7/1/22 at 09:20 a.m. of the HCA Houston Healthcare West Emergency Department EMS Call Logbook revealed the facility received a pre-notification call during 6/23/22 evening (blank time on log sheet) which stated "HFD 86 47 male CP 1 hour, Nitro 0.4, ASA 324, 109/80, 82, ST (with up arrow), Code possible. ETA 5 min."

During a telephone interview on 7/1/22 5:00 p.m. with Staff 64 (HFD Paramedic), he stated he was bringing Patient 1 with chest pain 10/10 and ST elevation findings on EKG to HCA Houston Healthcare West on 6/23/22 at approximately 1140 p.m. He said the EMS crew was told "you can't come here, we don't have cath lab" by Staff RN 62. He stated he got on his radio and notified base station and requested next hospital with facilities to care for patient.

Interview on 7/1/22 3:40 p.m. with ED Nursing Director Staff ID #55, she confirmed that Patient ID#1 was located on the HCA Houston Healthcare West Emergency Department call logbook as a pending arrival on evening of 6/23/22. She confirmed he was not located on ED Central Logbook. She confirmed it is facility EMTALA policy (see above) to register all patients who come to ED seeking care into central log.

TX#00423325

Based on record review and interview, HCA Houston Healthcare West failed to provide a medical screening examination (MSE) for Patient #1 who arrived by ambulance on 6/23/2022 with chest pain. The patient was subsequently brought by Houston Fire Department paramedics to Houston Methodist West ED for screening, evaluation, and care.

Findings include:

Record review 7/1/22 of the facility policy "EMTALA - Texas Medical Screening Examination and Stabilization," last approved 05/2022, revealed the following:
"Procedure: When an MSE is Required: A hospital must provide an appropriate MSE within the capability of the hospital's emergency department, ..., to determine whether an EMC (emergency medical condition) exists ... An MSE is required when:
An individual comes to a dedicated emergency department of a hospital and requests is made by the individual or on an individual's behalf for examination or treatment for a medical condition."

Review of the facility's surveillance tapes on 7/1/22 with ED Director Staff #55 of video footage dated 6/23/2022 at 11:40 p.m. along with interview of Staff #55 revealed Patient #1 arrived via Houston Fire Department #86 ambulance for evaluation but was not taken inside. The ambulance was met outside by Staff RN #62 who waived them off.

Record Review 7/5/22 of Audio Recording radio call from Houston Fire Department Medic 86 upon arrival to HCA Houston Healthcare West 6/23/2022 at 11:40 p.m.
Dispatch: "86 command 4, go ahead."
Medic: "We arrived to West Houston and they met us out in the bay and said they don't have cardiac lab, they're on closure."
Dispatch: "Standby"
Medic: "Is memorial city open or Methodist west?"
Dispatch: "Standby. Methodist west is showing to be open. Memorial city is on ER saturation."
Medic: "Methodist west is where we're going now."
Dispatch: "Received, I will give them a call."

Record Review 7/1/22 of Houston Fire Department Hospital/Patient PCR (official patient care record of ambulance encounter) dated 6/23/22 for Patient #1 stated: "Type of transport delay: Other." "West Houston cath lab closed, we were turned away after arrival at West Houston HCA H."

Interview via telephone 7/1/22 5:00 p.m. with Staff#65 HFD Paramedic/Engineer "When we pull into hospital--I exited the ambulance and opened the back doors. As soon as I am basically taking the patient out of the unit-half the wheels are already out: a nurse comes out says 'Stop, stop stop-put him back- y'all can't come here-our Cath lab is down.' I said: 'Are you serious-you have to be kidding me.'"
"I told XXX (Paramedic Staff ID #64) to get on the radio and tell them they're not letting us come in. I put the patient back in the unit. Her asked on radio: what's open Memorial City or Methodist West? Memorial City was on ER saturation -basically divert and Methodist West was the only one open."

Interview 7/1/22 08:35 a.m. with Chief Medical Officer Staff #54 he stated that irrespective of closed or limited services due to staffing, it was their "policy to triage, stabilize and transfer, if indicated, any patient who accessed the system" via ED.

Interview 7/1/22 1:22 p.m. with ED Medical Director Staff #61, he stated that "we should see and stabilize patient and then transfer if needed" once patients arrived to the facility. He stated he was the lead provider for the night shift 6/23/22. He denied screening, examining, or treating Patient#1. He stated he had been told by Staff RN #62 that Patient #1 was en route via ambulance and he said he replied to her, "do they know we don't have cath lab?"