HospitalInspections.org

Based on observation, record review and interviews, this hospital failed to ensure compliance with 42 CFR 489.24 in 2 of 7 required areas (A2402 Posting of Signs and A2406 Medical Screening Exam).

Findings include:

1. This facility failed to ensure Emergency Medical Treatment and Labor Act (EMTALA) signs are posted in places likely to be noticed by all individuals entering the Emergency Department in 1 of 1 ED area observed. See tag 2402.

2. This facility failed to complete an appropriate medical screening exam (MSE) for 1 of 1 patient (Patient #1) who presented to the ED. See tag 2406.

Based on observation and interview this facility failed to ensure Emergency Medical Treatment and Labor Act (EMTALA) signs are posted in places likely to be noticed by all individuals entering the Emergency Department (ED) in 1 of 1 ED area observed (ED). This deficiency potentially affects all Emergency Department patients seeking emergency medical treatment at this facility.

Findings include:

Observations of the ED entrance, patient waiting room and registration area were conducted on 4/19/2022 at 11:10 AM with RN Lead D. No EMTALA signage was noted at the entrance or in the patient waiting room. One EMTALA sign was noted at the registration desk area, but beyond the view of individuals sitting at the desk when being registered. When asked, RN Lead D stated, "I don't know what happened to them. It looks like they were replaced by patient billing rights signs. They were here just two weeks ago." RN Lead D indicated an area directly inside the ED entrance and a pillar in the waiting room where he/she stated the EMTALA signs had been. Observations of the ED patient care area revealed appropriate EMTALA signage present in each of the 9 ED exam rooms.

In an interview with Chief Nursing Officer B on 4/19/2022 at 11:32 AM, Chief Nursing Officer B agreed EMTALA signage was missing and stated, "They must have replaced them."

Based on record review and interview this facility failed to complete an appropriate medical screening exam (MSE) for 1 of 20 patients (Patient #1) who presented to the Emergency Department (ED) with a medical issue.

Findings include:

A review of facility Policy #950-220, "Inter-Hospital Patient Transfer (EMTALA Compliance)" last revised 7/2/2018 revealed, "1. Policy...1.1.1...A person who presents anywhere on the hospital campus and requests emergency services, or who would appear to a reasonably prudent person to be in need of medical attention, must be handled under EMTALA...3. Responsibilities 3.1. ED Providers - responsible for completing the Medical Screening Examination (MSE) and timely care and transfer of a patient who presents to the hospital campus as defined above...5. Procedure...5.1.1. Indications for Medical Screening. Individuals entitled to Medical Screening Examination (MSE) -- any individual who comes to HFM (Holy Family Memorial) and on whose behalf a request for examination or treatment for a medical condition is made receives a MSE within the capabilities of this hospital, including essential services routinely available to Emergency Department, to determine if whether or not an emergency medical condition exists...5.1.2. Consent or Refusal of Examination...Individual Refuses - if the patient or authorized representative refuses the medical screening examination after being informed of the risks and benefits of such screening, Emergency Department personnel document the risk and benefits of the recommended examination and/or treatment, the refusal and the attempt to obtain informed refusal, in writing on the Release from Screening: Hospital Emergency Department (15150-40A)...5.1.3. Request for transfer...An appropriate transfer is the movement of a patient with an emergency medical condition, from HFM, to another medical facility only after the completion of medical screening examination and under the following circumstances: The emergency medical condition has been stabilized such that no deterioration during transport is likely to occur...Appendix E Release From Screening: Federal regulations require all hospitals offering emergency services to provide a medical screening examination (MSE) for all persons presenting to the Emergency Department if suffering an illness or injury. You have subsequently declined to accept a screening examination by hospital personnel. Please indicate your understanding of this refusal by marking and signing on the appropriate lines below...I have presented to the Emergency Department at Holy Family Memorial and now decline any screening examination by the physician/practitioner on duty. I fully understand that without this examination and any indicated treatment I may suffer further complications from my injury or illness..."

A review of Patient #1's medical record revealed Patient #1 arrived to the facility's ED at 14:07 (2:07 PM) on 3/10/2022. "Patient Summary Report...Arrival Mode Private Vehicle, Reason for Visit Foreign object in rectum, Disposition Left Without Being Seen LOS (length of stay) 00:19 (19 minutes)."

A review of Patient #1's medical record revealed "Emergency Documentation...ED Note - Nursing" authored by Paramedic M and dated 3/10/2022 at 14:33 (2:33 PM). "...Patient presents with a (foreign object) that disappeared into his/her rectum. He/She is not able to reach it and everytime he/she coughs he/she states it goes further up his/her rectum. [Physician L] wanted me to be upfront with the patient and state we do not have a GI (gastroenterologist) doctor available today and give the pt (Patient #1) the ability to go to another facility...Pt (Patient #1) also agreed to sign a release from screening and left for [initials of another facility]."

A review of Patient #1's medical record revealed "Release from Screening" signed by Patient #1 and dated 3/10/2022 at 14:26 (2:26 PM).

A review of physician on-call lists revealed the list for Gastroenterology marked as "**DIVERT**" for the time period 3/1/2022-3/19/2022 with no physician indicated as available.

An interview was conducted on 4/19/2022 at 11:40 AM with Registered Nurses (RNs) F and G. When asked if they would ever direct a patient in the waiting room to go to another facility due to lack of available services at this facility's ED, RN F stated they would "never tell a patient that before a medical screening examination were done. That way there are options for the patient. It would be Plan A or Plan B." RN G agreed by shaking his/her head "yes".

An interview was conducted on 4/19/2022 at 12:16 PM with Physician E. When asked what he/she does when there is a patient in the waiting room waiting to be seen, but requires services not available at this facility, Physician E stated, "I would never ask a staff member to go out to the waiting room to tell the patient that services would not be available. I would not even know exactly what the patient would need without doing a medical screening exam first. I could then decide if the patient were able to be discharged and could be set up with outpatient appointments. If it were something more serious and the patient needed treatment right away, I would arrange transfer to another facility."

Interviews could not be conducted with Physician L or with Paramedic M as they were unavailable at the time of this survey.