HospitalInspections.org

Based on staff interview, review of medical records and hospital policies, it was determined the hospital failed to provide an appropriate medical screening exam to 1 of 32 patients (refer to Tag 2406) and to conspiculously post signs specifying the rights of individuals under section 1867 of the Social Security Act (refer to Tag 2402).

Based on observation and interview it was determined that the hospital failed to post a sign or signs, in a place or places likely to be noticed by all individuals entering the emergency department (ED), and by all those waiting for examination and treatment, which specified the rights of individuals with respect to examination and treatment of emergency medical conditions and women in labor, and which further reflected that this hospital participates in the State of Oregon Medicaid program. Findings include:

During a tour of the ED registration area, waiting areas, and the ED itself on 07/15/2010 at approximately 1100, it was observed that there was an absence of a sign or signs which contained the required content. During the tour, the Director of Nursing Services and the ED registration staff person on duty each stated that the hospital used to have those signs posted and they were not sure what happened to them.

What was observed on the window of the "Admitting Office", which was located on the opposite side of the lobby from the ED registration office, was an 8.5 inch by 14 inch sign which, based on the content and verbiage, was intended as a tool to remind staff about the EMTALA requirements. The sign stated "EMTALA Compliance is mandatory, * Communicate with the patient and receiving facilities * Document all treatments and patient requests, consents, refusals * Educate staff on current regulations". The sign included bullet points under the categories of "Screening exam", "Stabilizing treatment", "Transferring or discharging requirements", and "Certification requirements for transfer or discharge". Those bullet points were brief reminders to staff about the EMTALA requirements. For example: Under "Stabilizing treatment" one of the three bullet points was "Continues through transfer or discharge"; and under "Certification requirements for transfer or discharge" one of the four bullet points was "Patient is advised of benefits and risks, and signs consent or refusal". One more of these signs was observed during the tour and that one was posted in the ED medication room. Language at the bottom of the sign reflected that it was prepared by Oregon's Medicare Quality Improvement Organization and that "The contents presented do not necessarily reflect CMS policy".

This information was shared with the Administrator at the exit conference on 07/15/2010 at approximately 1330 who stated that the hospital had the required signs posted at one time.

Based on interview and documentation in one of 32 ED records reviewed (Patient #8), it was determined that the hospital failed to provide an appropriate medical screening examination, which included evaluation of the results of laboratory and diagnostic tests routinely available in the hospital, to determine whether or not an emergency medical condition existed. Findings include:

The review of documentation on the ED Medical Record form and the dictated Emergency Room Report for Patient #8 reflected that the 82 year-old patient was brought in to the ED by his/her daughter and son-in-law on 06/02/2010 at 1940. The patient reported to ED staff that approximately an hour before he/she had experienced an episode of incontinence, numbness of first two fingers on right hand, a movement problem to the right side, and slight slurring of his/her speech. The ED RN noted that the patient's ambulatory gait was steady, that grips and foot push were equal, that the patient swallowed water easily, and speech was strong and slightly slurred. The record reflected that the patient's vital signs, oxygen saturation level, and heart rate and rhythm were monitored.

An MD conducted an examination at 2005 during which the MD documented that the patient was not exhibiting symptoms. The examination included a "History of Present Illness...Current Medications...Past Medical History...Habits...Social History...Review of Systems...Physical Examination". The MD's "Assessment" was "Probable transient ischemic attack, without history of previous stroke." There was no evidence that laboratory work or other diagnostic tests were ordered or conducted.

The patient was discharged at 2045 with orders for aspirin, orders to continue current anti-hypertensive medications, and information about signs/symptoms that would require prompt follow-up.

The RN recorded that at the time of discharge the patient was ambulatory with a cane, his/her gait was steady, and his/her speech was strong and "more clear".