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Based on reviews of medical records, Policies and Procedures, and staff interview, the facility failed to provide a medical screening examination for 2 ( #11 and #16) of 35 patients in the Emergency Room (ER) to determine whether or not an emergency medical condition existed. Refer to findings at A-2406.


Based on record reviews and staff interviews, the facility failed to provide stabilizing treatment for 2 (#11 and #16) of 35 patients when they presented to the Emergency Room (ER) for treatment. Refer to findings at A-2407.

Based on reviews of medical records, policies and procedures, Emergency Department Logs, and staff interviews, the facility failed to document 1 (# 16) of 33 emergency room patients on the central log to indicate that the patient presented to the emergency room (ER) in need of a medical screening examination.

The findings include:

Review of facility self-reporting information of possible EMTALA revealed that Patient #16 presented to the emergency room on 2/27/12 with a sewing needle lodged in her right great toe. Review of the central log revealed that the patient was not listed on the log on 2/27/12 to indicate that Patient #16 presented to the emergency room in need of care.

Review of the policy and procedure for the Emergency Room Patient log dated December 2010 revealed that the purpose of the log was to to register all patient visits to the Emergency Department (ED). The log was maintained by the ED to identify all patients seeking Emergency care.

Interview with the Director of the Emergency Room on 4/2/12 at 10:30 am confirmed that the patient was not on the log. The ED Director did not understand why the patient did not show up on the Central ED log. The emergency room medical record was presented on Patient #16 that indicated the patient presented to the ER with a " needle in toe."

Interview with the Vice President of Nursing 4/3/12 at 8:05 am revealed that the patient should have been on the log.

Based on reviews of medical records, Policies and Procedures, and staff interview, the facility failed to provide a medical screening examination for 2 ( #11 and #16) of 35 patients in the Emergency Room (ER) to determine whether or not an emergency medical condition existed.


The findings include:


1. Review of the closed medical record for Patient #11 revealed that the patient presented to the ER on 3/12/12. The patient was seen in triage on 3/12/12 at 2:16 pm complaining of " IV (Intravenous- needle inserted into veins through which fluids and/or medications could be administered)) in my thigh. " The patient had a history of diabetes and eye surgery 2 weeks prior to the visit on 3/12/12. Nursing assessment was completed in triage but there were no notes in the medical record to indicate that the patient had a medical screening examination by a physician.

2. Review of the Emergency Medical Record for Patient #16 revealed that the patient was seen at an Urgent Care Center on 2/27/12 for a " needle in toe "and was advised to go to the Emergency Room for surgical consult. Patient #16 presented to the Emergency Department (ED) on 2/27/12 complaining of a "needle in toe" and was triaged at 2:01 PM. The Staff Nurse documented that vital signs were stable and that Patient #16 had already had X-Rays, sutures and an antibiotic. There were no medical clinical notes on the medical record to indicate that Patient #16 had a medical screening examination by a physician.

Review of the policy and procedure for Emergency Screening, stabilization & Transfer dated 11/3 with an effective date of March 2012 revealed that," it was the policy of the hospital to comply with all applicable laws and regulations relating to the provision of emergency services. Every individual who comes to the ED and requests examination or treatment for a medical condition will be provided an appropriate medical screening examination and necessary stabilizing treatment as required by the Emergency Access laws."

Interview with the Manager of the ER on 4/3/12 at 1:15 pm revealed that they were working on throughput and looking at Performance Improvement measures such as patient arrival to bed times, bed to physician and other metrics such as physician to discharge. She stated that the goal was 20 minutes.

The facility failed to provide medical screening examinations that were within the capabilities of the facility for patient #11 and patient #16.

Based on record reviews and staff interviews, the facility failed to provide stabilizing treatment for 2 (#11 and #16) of 35 patients when they presented to the Emergency Room (ER) for treatment.

The findings include:

1. Record Review of the Emergency Room record for Patient #11 revealed that the patient had a history of diabetes and was hospitalized and discharged from Baptist Medical Center with an intravenous access on 3/12/12. The patient presented to the ER on 3/12/12 complaining of "IV in my thigh." The patient was seen in triage and assessed by the Registered Nurse on 3/12/12 at 2:16 PM. There were no notes seen in the emergency medical record that the physician saw the patient or that the patient received stabilizing treatment in the ER when he presented for care. Further review of the medical record revealed that the Director of the ER documented on 3/12/12 at 7:00pm that she spoke to the patient by telephone and instructed him to return to the ER for removal of the triple lumen catheter.

Interview with the Emergency Room Director on 4/2/12 at 10:30 am did not reveal why the patient did not have a medical screening or stabilizing examination done when Patient # 11 first presented to the Emergency Room.

2. Review of the emergency record for Patient #16 revealed that she stepped on a needle that went into her right great toe. The patient went to an urgent care center. Patient #16 was referred to the ER by the physician at the urgent care center for surgical services. Patient #16 presented to the Emergency Room and was triaged at 2:01PM. There were no notes on the emergency room medical record that indicated the patient was offered stabilizing medical care.

Interview with the Director for the Emergency Room on 4/2/12 at 10:30 am revealed that Patient #16 was not on the Emergency Room log. There was no explaining why this patient did not receive medical screening or stabilizing treatment. The Emergency Room Director reviewed the patient's emergency room record and indicated that the patient presented to the ER with a needle in toe.

The facility failed to provide further examination and stabilizing treatment that was within the capabilities of the facility for patient #11 and patient #16.