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Based on interview and record review the hopital failed to to comply with ?489.24 by not providing an appropriate medical screening exam to 1 of 20 sampled patients (Patient 18).

Findings include:

Patient 18 is 14 years old and arrived to the emergency department with her mother on April 28, 2010 with a chief complaint of "overdose on Ibuprofen." Patient 18 received a urinalysis, HCG test (test for pregnancy), complete blood cell count (test for bleeding, a potential complication with an ibuprofen overdose), CMP (test for electrolytes and kidney function, another potential complication with an ibuprofen overdose), ETOH (alcohol), and amylase (test of pancreas function). Under "PMHx" (past medical history) "suicidal gestures" was documented, however there was no evidence that during the screening that Patient 18 was screened for a psychiatric emergency medical condition. (Cross reference A2406).

Based on interview and document review, the hospital failed to maintain a central log on each individual who comes to the emergency department seeking assistance by not documenting whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged pursuant to the Federal Regulations.


Findings include:

On May 6, 2010, the Central Log was reviewed for the dedicated emergency department of the Kayenta Indian Health Center. The Chief Nurse for the emergency department stated that the log was electronic, however he was able to print out dates upon request. The following dates were selected at random for review, May 1, 2010, April 30, 2010, April 28, 2010, March 14, 2010, February 28, 2010, February 27, 2010, January 14, 2010 and December 30, 2009. A review of these printouts revealed seven columns of information, the date and time of patient arrival, the patient's name, their chart number, their date of birth, their treating physician, and their "primary diagnosis" The column titled, "primary diagnosis" had information relating to the patient's health concern. Upon reviewing this coulmn it was noted the information was cut off, sometimes in mid word. The Information Technology Manager was asked at 10:00 A.M. on May 6, 2010 if there were more columns on the log and was the paper cutting the words off to which he replied, "No other columns are missing." The clerk who enters the log stated that the system does not allow to her to completely enter the "primary diagnosis." The log did not provide information on whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged pursuant to the Federal Regulations. The Chief Nurse was asked if there was a policy for the central log, to which he replied, "no."

Valente, Kelly
Based on interview, policy review and record review, the hospital failed to provide an appropriate medical screening examination to 1 of 20 patients (Patient 18). For Patient 18, the hospital failed to screening the patient for a psychiatric emergency medical condition after she intentionally overdosed on pain medication.

Findings include:

On May 6, 2010, Patient 18 record was reviewed. Patient 18 is 14 years old and arrived to the emergency department with her mother on April 28, 2010 with a chief complaint of "overdose on Ibuprofen." Patient 18 received a urinalysis, HCG test (test for pregnancy), complete blood cell count (test for bleeding, a potential complication with an ibuprofen overdose), CMP (test for electrolytes and kidney function, another potential complication with an ibuprofen overdose), ETOH (alcohol), and amylase (test of pancreas function). Under "PMHx" (past medical history) "suicidal gestures" was documented, however there was no evidence that during the screening that Patient 18 was screened for a psychiatric emergency medical condition. The Clinical Director stated that she would expect the Patient 18 should have been screened for behavioral health concerns. A review of Patient 18's discharge instructions stated, "follow up with family physician or psychiatric services." A review of the policy titled, "Medical Screening Exam (MSE)" Under "Procedure...What is an emergency medical condition under EMTALA? ... A patient is considered to have an emergency medical condition if he or she expresses suicidal or homicidal thoughts or gestures, or it is determined to be dangerous to self or others."