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Based on a tour of the facility and staff interview conducted on April 15, 2014 at approximately 9:40 AM, it was determined that the facility failed to conspicuously post signage specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment of emergency medical conditions and women in labor or information indicating whether or not the hospital participates in the Medicaid program.

Findings include:

1. Observation of the main entrance to the ED (Emergency Department) revealed no signage pertaining to EMTALA law.

2. Observation of the main ED waiting area revealed no signage pertaining to EMTALA law.

3. Observation of "Closeview 16," which includes Bays #16, #17, #18 and #19, revealed no signage pertaining to EMTALA law.

4. Observation of the fast track area revealed no signage pertaining to EMTALA law.

5. Observation of G-004 (Minor Treatment Room) in the Pediatric ED revealed no signage posted pertaining to EMTALA law.

6. Observation of the triage area in the Pediatric ED revealed no signage posted pertaining to EMTALA law.

7. Observation of the seven treatment rooms in the Pediatric ED revealed no signage posted pertaining to EMTALA law.

8. Observation of Triage Rooms in Labor and Delivery, revealed no signage posted in Rooms #387 and #388, pertaining to EMTALA law.

9. Observation of the main hospital entrance revealed no signage posted pertaining to EMTALA law.

10. The above findings were confirmed by Staff #1.

Based on a review of the ED on call lists, it was determined that the facility failed to ensure that a physician on call list that identifies the name of an individual physician on call for all specialties, was maintained.

Findings include:

1. Review of the on call list for a hand specialist, revealed that a physician group was listed as on call for April 2014.

2. Review of the on call list for a vascular specialist, revealed that a physician group was listed as on call for April 2014.

3. The above findings were confirmed by Staff #2.

Based on review of medical records, review of the Emergency Department Log (EDL), and staff interview, it was determined that the facility failed to ensure that all entries in the log are accurate.

Findings include:

1. Medical Record #13 states the final disposition of the patient as admitted to a 'Telemetry' bed.

a. The EDL states that Patient #13 had a final disposition of 'Observation.'

2. Medical Record #23 states the diagnosis of the patient as 'subchorionic hematoma.'

a. The EDL states the diagnosis of Patient #23 as 'subarachnoid hemorrhage.'

3. Medical Record #24 states the final disposition of the patient as 'Discharged.'

a. The EDL states that Patient #24 had a final disposition of 'Observation.'

4. Medical Record #10 states the final disposition of the patient as admitted to 'med-surg [medical - surgical] unit.'

a. The EDL states that Patient #10 had a final disposition of 'Observation.'

5. During review of the EDL, it was noted that all patients had greet times and triage times that were exactly the same.

a. None of the 33 medical records reviewed had the same greet time and triage time.

b. These are inaccurate entries in the EDL.

6. These findings were confirmed by Staff #3.

A. Based on a review of medical records, review of facility policies and procedures and staff interview, it was determined that the facility failed to ensure that all patients receive a medical screening exam without delay.

Findings include:

Reference #1: Facility policy "TRIAGE PROCEDURE - EMERGENCY DEPARTMENT" ... (b) Priority code as documented in the priority section of the triage form. ... 2) Level 3: Patients that need to be treated and/or reassessed within 60 minutes to 2 hours of their arrival to the Emergency Department. ...

Reference #2: Facility policy "EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) COMPLIANCE" states, "... Requirements: 1. All patients presenting to the ED [Emergency Department] for emergency medical treatment will be provided with an MSE [medical screening examination] by qualified personnel within four hours of presenting to the emergency department. ..."

1. Review of Medical Record #8 revealed the following:

a. The patient presented to the ED 14:30 on 4/4/14.

b. The patient was triaged at 14:41 and assigned a Triage Level 3 Urgent.

c. The patient was registered at 16:05.

d. The patient is documented as leaving without being seen (LWBS) at 17:23, 2 hours and 57 minutes after arriving at the ED.

e. There was no evidence that the patient was treated and/or reassessed within 60 minutes to 2 hours of their arrival to the Emergency Department.

2. Review of Medical Record #16 revealed the following:

a. The patient presented to the ED 23:23 on 4/5/14.

b. The patient was triaged at 23:37 and assigned a Triage Level 3 Urgent.

c. The patient was registered at 23:53.

d. The patient is documented as LWBS at 02:28, 3 hours and 5 minutes after arriving at the ED.

e. There was no evidence that the patient was treated and/or reassessed within 60 minutes to 2 hours of their arrival to the Emergency Department.

3. Review of Medical Record #11 revealed the following:

a. The patient presented to the ED 17:58 on 4/4/14.

b. The patient was triaged at 18:32 and assigned a Triage Level 3 Urgent.

c. The patient was registered at 19:37.

d. The patient is documented as LWBS at 22:13, 4 hours and 15 minutes after arriving at the ED.

e. There was no evidence that the patient was treated and/or reassessed within 60 minutes to 2 hours of their arrival to the Emergency Department.

f. There was no evidence that the patient was provided with an MSE by qualified personnel within four hours of presenting to the emergency department

4. These findings were confirmed by Staff #3.


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B. Based on a review of facility forms and staff interview, it was determined that the ED pre-registration information request form for ambulatory patients, may deter a patient from seeking medical treatment.

Findings include:

1. On 4/15/14 at approximately 10:15 a.m., a tour of the ED was conducted. Staff #6 indicated that when a patient arrives to the ED, they are asked to fill out a form.

2. The questions on the Emergency Department Sign-in form include:

a. The patient's name, date of birth, time of arrival, social security number, family doctor's name and complaint.

3. Staff #6 indicated that he/she then provides the patient with a packet of information which includes a cover sheet that the patient is asked to begin filling out while waiting to be triaged.

4. Questions on the cover sheet, the patient is asked to fill out, include:

a. Patient Information: name, date of birth, social security number, address, home and cell phone number, race/ethnicity, religion and marital status.

b. Employment Status: full time, part time, unemployed, retired, self employed, disabled, active duty, occupation, employer name and address and work phone number.

c. Insurance Holder Information: name, date of birth, social security number, address, home phone, relation to patient, employers name and address and work phone number.

d. Emergency Contacts: names, relationship to patient, address, home and work phone numbers.

5. These findings were confirmed by Staff #6.