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On the days of the EMTALA investigation based on observations, interview, record reviews and review of hospital policies and procedures, the facility failed to provide a medical screening examination to determine the existence of an emergency medical condition for one of twenty-one patient records reviewed. (Patient #21)

The findings are:


Cross Reference to A2405: The hospital failed to ensure that the Emergency Department(ED) system for maintaining a central log included all individuals presenting to the ED for treatment for 1 of 21 patients that presented to Emergency Department for treatment and was not found on the ED's central log. (Patient #21)

Cross Reference to A2406: The facility failed to provide a medical screening examination to determine the existence of an emergency medical condition for one of twenty-one patient medical records reviewed. (Patient #21)

On the days of the EMTALA investigation based on observation, interviews, review of facility and patient records, and review of hospital policies, the hospital failed to ensure that the Emergency Department(ED) system for maintaining a central log included all individuals presenting to the ED for treatment for 1 of 1 patients that presented to Emergency Department for treatment and was not found on the ED's central log. (Patient #21)


The findings include:


On 11/21/11 at 1200, a tour was conducted of the Emergency Department with the Director. Upon entering the ED through the door, random observations revealed a desk with a security officer and a nurse. Observations also revealed a sign in log for visitor registration and a sign in log for Emergency Department patient registration. There were no persons seeking assistance at the time. A large window behind the desk overlooked the triage room.

On 11/21/11 at 1240, the Director of the ED explained that he/she wasn't on duty on 10/26/11, but had received a complaint on 10-27-11 from the husband of Patient #21 who reported that his wife had not been seen in the the hospital's Emergency Department on 10/26/11 which resulted in the patient leaving the hospital's ED to seek treatment at another hospital. The ED Director revealed that the name of Patient #21 was not in the ED's central log in the computer. The Director reported that he/she reviewed the visitor log located at the Greet Desk to see if the patient had signed on the visitor log instead of the ED's Central log but Patient 21's name was not on that log either. The ED Director revealed that a review of the ED's security video dated 10/26/11 showed a couple that matched the description that the husband had given in his complaint. The security video showed the couple at the front greet desk and the security officer looked into the triage window. The ED Director reported that the security video showed the couple sat down in the waiting area chairs in a blind spot from the desk and triage room.

On 11/21/11 at 1430, a review of the ED's central log revealed that Patient 21 who had presented to the Emergency Department on 10/26/11 requesting treatment but had not been registered on the hospital's central log.

On 11-21-11, via a telephone interview, Triage Nurse #1 revealed he/she learned of the incident that night (10/26/11) after the patient had left the Emergency Department. Triage Nurse #1 reported that he/she didn't remember the time but Security Officer #1 said that a patient was in the lobby and had left without being seen. There was nothing I could do about it. Security said there was a man in the lobby who had left and went to Summerville or Charleston. I didn't know if he waited 2 minutes or 2 hours. There was no paper work on the patient, and I doubt the officer even knew the name. I found out a couple of days later that it was an incident. At the time of this incident, the Emergency Department didn't have a sign in log sheet.

Review of facility policy, approved 05-21-09 and reviewed 04-2010, titled, EMTALA-Central Log Policy, reads, "....Purpose: To establish guidelines for tracking the care provided to each individual seeking care in a dedicated emergency department(DED) for a medical condition or seeking care in areas on hospital property....Policy: The hospital will maintain a Central Log containing information on each individual who comes to the DED seeking assistance, whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged....Procedure: 1. All hospitals must maintain the central Log in an electronic format...3. The logs must contain at a minimum, the name of the individual and whether the individual: refused treatment, was refused treatment, was transferred, was admitted and treated, was stabilized and transferred, or was discharged....".

Review of facility policy approved 03/2010, titled, Nursing Assessment/Reassessment, reads, "...Policy: A Registered Nurse will do assessment of the patient entering the Emergency Department...Responsibilities of the Assessment Nurse: 1. Assessment will be performed by a Registered Nurse. 2. All patients will be assessed within 5-15 minutes of their arrival; emergent patients will be assessed immediately upon arrival...4. Perform inquiry to determine patient's reason for seeking care. All patients, regardless of presenting complaint, demographics, or payor status will be assessed upon arrival before any financial information is obtained. 6. Medical history, medication list, and assessment including a full set of vital signs will be documented. 7. A chart will be generated on all persons evaluated in the Emergency Department...9. Orient the patient to the waiting room and the expected time of wait for the physicians, and keep patient informed on a continuing basis....10. Reassessment of patients should be at a minimum of every one hour but could be more frequent based on the acuity of the patient, physician order, change in current patient status, and/or responses to interventions prior to the medical screening exam....".

On the days of the EMTALA investigation based on interviews, record reviews, security video, and review of facility policies and procedures, the Hospital lacked an effective system to ensure that an individual coming to the Emergency Department requesting an examination or treatment of a medical condition was provided an appropriate medical screening examination that was within the capability of the hospital's emergency department to determine whether or not an emergency medical condition exists for 1 of 21 patients reporting to the hospital's Emergency Department requesting an examination. (Patient #21)


The findings include:


On 11/21/11 at 1240, an interview with the Director of Emergency Department explained that he/she wasn't on duty on 10/26/11, but had received a complaint on 10-27-11 from the husband of Patient #21 who reported that his wife was not seen in the hospital's ED which resulted in the patient leaving the hospital's ED to seek treatment at another hospital. The ED Director revealed that the name of Patient #21 was not in the ED's central log in the computer. The Director reported that he/she reviewed the visitor log located at the Emergency Department's Greet Desk to see if the patient had signed into the visitor log instead of the ED's Central log but Patient 21's name was not on that log either. The ED Director revealed that a review of the ED's security video dated 10/26/11 showed a couple that matched the description that the husband had given in his complaint and validated the the couple (patient #21) had been in the ED on 10/26/11. The security video showed the couple at the front greet desk and showed the security officer looked into the triage window. The ED Director reported that the security video showed the couple sat down in the waiting area in chairs located in a blind spot from the ED's Greet Desk and the triage room. The ED Director stated, "I am assuming the triage nurse was busy when the security officer called the ED desk to tell them there was a patient to be seen. The ED Director reported that on 10/26/11, the ED desk was busy with patient's presenting with high acuity levels.

On 11/21/11 at 1545, via a telephone interview with Security Officer #1, he/she revealed that he recalled that it was busy that night. Security Office #1 reported "our job is to notify the triage nurse that someone wanted to be seen, and Triage Nurse #1 was notified by telephone by Security Officer #2 that a person needed to be seen. Security Officer #1 reported,"After waiting about 30 minutes, the gentleman came up to the greet desk. I assured him we would get to him as soon as possible, and it wouldn't be much longer. He looked satisfied and sat down again". Security Officer #1 reported that other people were still coming in to the Emergency Department to be seen. After another 20 minutes, the gentleman was visibly upset. He said he was going to leave, was going to Charleston. I said, "Are you sure, it shouldn't be much longer, and Charleston is a long way. He was very unhappy and left. Last thing I said was long drive, good night. He took it the wrong way. My job is to control visitor traffic, and to determine if they are here for a visit or need medical services and letting triage nurse know they want to be seen. Ever since the new system was put in place in July at the security desk, sometimes, the nurses stay in the back processing patients.

On 11-21-11, via a telephone interview, Triage Nurse #1 revealed he/she learned of the incident that night (10/26/11) after the patient left the Emergency Department. Triage Nurse #1 reported that he/she didn't remember the time but Security Officer #1 said that a patient was in the lobby and had left without being seen. There was nothing I could do about it. If I am away from the triage room, I go to greet desk and ask security if there is anybody else to be seen. Security said there was a man in the lobby who had left and went to Summerville or Charleston. I didn't know if he waited 2 minutes or 2 hours. There was no paper work on the patient, and I doubt the officer even knew the name. I found out a couple of days later that it was an incident. At the time of this incident, the Emergency Department didn't have a sign in log sheet. The facility failed to ensure that an effective system was in place for patients presenting to the emergency department requesting an examination and treatment of a medical condition was provided a medical screening examination to determine whether or not an emergency medical condition existed on 10/26/2011 for patient #21.

On 11-22-11 at 0850, an interview with Security Officer #2 revealed that on the night of the incident, the Emergency Department was very busy so both security officers were there. Security Officer #2 explained that he/she recalled a couple coming in. The waiting room area was very crowded. The officer reported that he used the house phone to call triage, and talked to the Unit Clerk in the Emergency Department, who said, "Another one for ED." Security Officer #2 stated he/she heard the Unit Clerk say "one more" over the phone. Security Officer #2 reported the other officer told the couple to sit down. Security Officer #2 reported that the man came up one more times and said that 2 or 3 people had come in and were taken back. My partner discussed it with him. I didn't realize the gentleman was leaving. Security Officer #2 reported that he didn't know what the other officer said to him. I think the other officer told the triage nurse that the couple had left without being seen.

Review of hospital policy approved date 05-21-09 and review date 04-2010, titled, EMTALA-Medical Screening Examination(MSE) and Stabilization, reads, ".... Policy: An EMTALA obligation is triggered when an individual comes to a dedicated emergency department(DED) and : 1. a request is made by the individual or on the individuals' behalf for an examination or treatment of a medical condition.....3. b. Definition of MSE. An MSE is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether the individual has an Emergency Medical Condition(EMC) or not. It is not an isolated event. The MSE must be appropriate to the individuals' presenting signs and symptoms and the capability and capacity of the hospital...".