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Based on record review, review of policies and procedures, review of Medical Staff Bylaws, Rules and Regulations and staff interviews, it was determined the Hospital failed to ensure that 1 patient (Patient #1) in a total sample of 31 patients, was provided with an appropriate medical screening examination after presenting to the emergency department (ED) seeking treatment and that a medical record was created for Patient #1, and that the ED had policies and procedures regarding Emergency Medical and Treatment and Labor Act (EMTALA).

Findings include:

1.) The Hospital's Medical Staff Bylaws Rules and Regulations indicated that a medical screening evaluation is required to be conducted and that an appropriate medical record shall be kept for every patient receiving emergency medicine.


2.) The Hospital did not generate a medical record for Patient #1.


3.) The Hospital's ED Policy and Procedure Manual indicated there were no ED policies and procedures that referred to EMTALA requirements/regulations.


4.) The Emergency Medical Service (EMS) ambulance trip record, dated 4/12/14, indicated Patient #1 complained of left upper chest pain. The electrocardiogram (EKG), taken by EMS staff before Patient #1 was brought to Hospital #1, indicated an abnormal tracing (a lack of oxygen to the heart muscle) and the report was transmitted to Hospital #1. Patient #1 was administered oxygen and nitroglycerin (a medication to decrease chest pain and increase oxygen to the heart muscle). The EMS trip record indicated Patient #1 was brought to Hospital #1 and the ED Attending Physician met the ambulance at the ED ambulance door. The ED Attending Physician requested a diversion to Hospital #2 because the cardiac catheterization laboratory (cath lab) staff were busy caring for another patient. The EMS trip record indicated Patient #1 remained stable enough to continue to Hospital #2.


5.) The Surveyor interviewed the ED Charge Nurse at 11:10 A.M., on 4/23/14. The ED Charge Nurse said he received a call from the EMS ambulance paramedics and the paramedics reported they were bringing a 50 + year old patient with chest pain to the ED. The ED Charge Nurse said the EMS paramedics sent Patient #1's EKG to the ED via an electronic transmission. The ED Charge Nurse said he noticed the abnormalities on the EKG and handed the EKG to the ED Attending Physician.


6.) The Surveyor interviewed the Attending ED Physician at 10:15 A.M., on 4/23/14. The ED Attending said he looked at Patient #1's EKG and then showed it to the Interventional Cardiologist (IC), who was in the ED, caring for another patient. The ED Attending Physician said the IC said that the patient would need a cardiac cath, but he was taking another patient to the cath lab. The ED Attending said he went to the ambulance bay area and met the ambulance. The ED Attending said Patient #1 was awake, alert and in no distress lying on the ambulance stretcher. The ED Attending said time was a factor in preventing further heart muscle damage. The ED Attending said he spoke with the paramedics and got a report about the patient. The ED Attending said after talking with the paramedics, it was in Patient #1's best interest to get him as quickly as possible to a cath lab. The ED Attending staff at Hospital #1 called Hospital #2. The ED Attending said the IC at Hospital #2 accepted the patient and was able to take Patient #1 to the cath lab after he arrived. The ED Attending said he did not document his assessment of Patient #1 nor did he complete the required transfer forms.


7.) The Cardiac Cath lab Registered Nurse (RN) was interviewed on 4/23/14. The Cardiac Cath lab RN said he also worked at Hospital #2 as a cath lab nurse. The Cardiac Cath lab RN said after hearing about Patient #1, who was yet to arrive, he called the IC working at Hospital #2. The Cardiac Cath lab RN said the IC at Hospital #2 informed him he was available, would accept the patient and would activate their cardiac cath lab staff. The Cardiac Cath lab RN said he called the ED Charge Nurse at Hospital #2 and gave her a report about Patient #1.


8.) The ED Charge Nurse said he tried to call the EMS staff back to let them know the Cardiac Cath lab staff were busy with another patient and that the IC at Hospital #2 would be available. The ED Charge Nurse said while he was on the phone waiting to speak with EMS paramedics, he heard the ambulance backing into the bay area. The ED Charge Nurse said he and the ED Attending went out to the ambulance bay, opened the back doors of the ambulance and saw Patient #1 sitting up, awake and alert and receiving oxygen. The ED Charge Nurse said the EMS staff reported that Patient #1's vital signs were stable. The ED Charge Nurse said he explained to the ambulance staff that Patient #1 needed to go to Hospital #2 because the Cath lab staff at Hospital #1 were caring for another patient needing a cardiac cath and the IC at Hospital #2 was able cath the patient. The ED Charge Nurse said that he and the ED Attending Physician closed the doors of the ambulance and they left for Hospital #2.

9.) See Tags A 2407 & A 22409

Based on record review and staff interview, for one Patient, (Patient #1), of 31 sampled patients, Hospital #1 failed to ensure that stabilizing treatment for an emergency medical condition was provided, the care was documented, prior to sending Patient #1 to Hospital #2.

Findings include:

1.) The Emergency Medical Service (EMS) ambulance trip record, dated 4/12/14 indicated Patient #1 complained of left upper chest pain and was brought to Hospital #1.

2.) The Surveyor interviewed the Attending ED Physician at 10:15 A.M., on 4/23/14. The ED Attending said Patient #1 was awake, alert and in no distress, lying on the ambulance stretcher. The ED Attending said Patient #1 had received oxygen and nitroglycerine from the paramedics.

3.) Hospital #1 did not create a medical record for Patient #1 and therefore there was no documentation that stabilization care was provided by Hospital #1, for Patient #1 who had an emergency medical condition. No medical screening examination was performed, no assessment of Patient #1's cardiac or respiratory status and no documentation that transfer arrangements were made.

Based on record review and staff interview, the Hospital failed to ensure one patient (Patient #1) of 31 patients sampled, was appropriately transferred.

Findings include:

1.) The Emergency Medical Service (EMS) ambulance trip record, dated 4/12/14 indicated Patient #1 brought to Hospital #1 with an emergency medical condition.

2.) The Surveyor interviewed the Attending ED Physician at 10:15 A.M., on 4/23/14. The ED Attending said he looked at Patient #1's EKG and then showed it to the Interventional Cardiologist (IC). The ED Attending Physician said the IC said that the patient would need a cardiac catheterization. The ED Attending said he did not complete the required transfer forms.

3.) Patient #1 had an emergency medical condition that was not assessed and monitored for resolution and thus the required documentation for an appropriate transfer of a patient with an emergency medical condition (under the Emergency Medical Treatment and Labor Act) was not completed.

4.) Patient #1 was transferred to Hospital #2 without his/her consent. ED physician #1 said he transferred Patient #1 because the patient needed a cardiac catherization and the cardiac cath lab at Hospital #1 was busy. Physician #1 said he did not discuss these circumstances with the patient.