HospitalInspections.org

Based on staff interview and record review, the facility failed to comply with the provider agreement as defined in 489.20 and 489.24. Findings include:

The hospital failed to enter a patient into the ER log, failed to provide a medical screening examination, failed to provide stabalizing treatment, and failed to ensure the patient was appropriate for transfer for 1 (#34) of 34 sampled patient records reviewed. Patient #34 had come to the emergency department in labor, but was turned away and sent to another hospital because the OB unit of the hospital was closed. The patient was not treated as an ER patient.

Based on staff interview and review of the Emergency Room Logs, the facility failed to maintain a log of each individual who comes to the emergency department. One (#34) of 34 sampled patients was not included on the emergency department log. Findings include:

During interview with staff member A, the Clinical Services Administrator, on 7/6/11 at 8:45 a.m., the staff member stated patient #34 came to the emergency department of Sidney Medical Center on 6/4/11. The patient was in labor. The patient was told the OB unit was closed and that she would need to seek care in Williston, ND. The patient was never entered in the log. The nurse who was working in the emergency room that night was "inexperienced," according to the staff member and treated this patient as an OB patient, not as an ER patient. The faility did have a physician in the ER at the time of the patient's arrival.

The facility did an investigation after being contacted by the North Dakota hospital, and determined the incident did occur. The facility provided EMTALA training for the nursing staff and physicians, with special focus on the OB patient.

Staff member A stated this was an isolated incident because the facility was unable to find staff to cover the OB unit following the unexpected resignation of one of the nurses. Staff member A stated it was the first time in the 30 years she has been with the facility that they were unable to find staff.

Upon review, patient #34 was not listed in the ED log on the date of the incident.

Based on staff interview and review of the Emergency Room Logs, the facility failed to provide a medical screening examination for one (#34) of 34 sampled patients who came to the emergency department with a medical emergency. Findings include:

During an interview with the staff member A, Clinical Services Administrator, on 7/6/11 at 8:45 a.m., the administrator stated patient #34 came to the emergency department of Sidney Medical Center on 6/4/11. The patient was in labor. The patient was told the OB unit was closed and that she would need to seek care in Williston, ND. The patient was not taken into the ER or seen for a medical screening examination. The patient's name was not entered in the ER log. The nurse who was working in the emergency room the night of the incident was "inexperienced" and treated this patient as an OB patient, not as an ER patient according to staff member A. Staff member A stated the facility did have a physician in the ER at the time of the patient's arrival. Staff member A stated the facility's usual procedure when an OB patient comes in to the ER, is to enter the patient's name in the ER log, and then send the patient to the OB unit for triage.

The facility did an investigation after being contacted by the hospital in North Dakota. The investigation showed the incident did occur. The facility completed EMTALA training with their nursing staff and physicians, with special focus on the OB patient.

Staff member A stated this was an isolated incident as the facility was unable to find staff to cover the OB unit, following the unexpected resignation of one of the nurses. Staff member A stated it was the first time in the 30 years she has been with the facility that they were unable to find staff.

Based on staff interview, the facility failed to provide stabilizing treatment for one (#34) of 34 sampled patients who came to the emergency department with a medical emergency or provide arrangements for transfer following the EMTALA regulations. Findings include:

During an interview with staff member A, the Clinical Services Administrator, on 7/6/11 at 8:45 a.m., the staff member stated patient #34 came to the emergency department of on 6/4/11. The patient was in labor. The patient was told the OB unit was closed and that she would need to seek care in Williston, ND. The patient was not taken into the ER, entered in the ER log, or seen for a medical screening examination. No stabilizing treatment was done prior to the patient being sent to the other hospital. The nurse who was working in the emergency room, the night of the incident, was "inexperienced" and treated the patient as an OB patient, not as an ER patient, according to staff member A. The facility did have a physician in the ER at the time of the patient's arrival. Staff member A stated the usual procedure when an OB patient comes into the ER is to enter the patient's name in the ER log, and then send the patient to the OB unit for triage.

The facility did an investigation after being contacted by the hospital in North Dakota. The investigation showed the incident did occur. EMTALA training was provided to the nursing staff and physicians, with special focus on the OB patient.

Staff member A stated this was an isolated incident because the facility was unable to find staff to cover the OB unit following the unexpected resignation of one of the nurses. Staff member A stated it was the first time in the 30 years she has been with the facility that they were unable to find staff to cover.

Based on staff interview, the facility failed to provide a medical screening examination or stabilizing treatment for one (#34) of 34 sampled patients who came to the emergency department with a medical emergency. Findings include:

During an interview with the Clinical Services Administrator on 7/6/11 at 8:45 a.m., the administrator stated patient #34 came to the emergency department of Sidney Medical Center on 6/4/11. The patient was in labor with her first child, and the contractions were approximately 10 minutes apart. The patient was told the OB unit was closed and that she would need to seek care in Williston, ND. The patient was not taken into the ER, entered in the ER log, seen for a medical screening examination, or provided arrangements for transfer following the EMTALA regulations. No stabilizing treatment was provided prior to the patient being sent to the other hospital, and the receiving hospital was not notified the patient was being transferred for treatment. The nurse who was working in the emergency room that night was "inexperienced," according to staff member A, and treated this patient as an OB patient, not as an ER patient. The facility did have a physician in the ER at the time of the patient's arrival. Staff member A stated their usual procedure in the ER when an OB patient comes in is to enter the OB patient on the ER log, and then send the patient to the OB unit for triage.

The facility did an investigation after being contacted by the hospital in North Dakota. The facility investigation showed the incident did occur. The facility had completed EMTALA training with the nursing staff and physicians, with special focus on the OB patient.

Staff member A stated this was an isolated incident due to the facility being unable to find staff to cover the OB unit following the unexpected resignation of one of the nurses. Staff member A stated it was the first time in the 30 years she has been with the facility that they were unable to find staff to cover shifts.

Williston, ND is 46 miles from Sidney, MT. At the time of this incident, the roads were clear.