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Based on interview and review of documents it was determined there was a failure to ensure compliance with the requirements at 42 CFR 489.24 in violation of providers agreement with the Center for medicare and Medicaid Services (CMS).
Findings:

Cross Refer to A 2406

Based on interviews and review of 1 of 20 emergency department records the facility failed to conduct a medical screening exam to determine if an emergency medical condition existed for a patient presenting in a van in the facility parking lot.
Findings:

1. A brief medical screening was conducted by personnel #21(RN) which reflected patient #1, a 61 year old male presented to the facility in an SUV in the parking lot on 4/27/2011 at 9:15 am. The patient remained in the SUV and patient's caretaker got out to request admission for the patient. " Per caretaker, the patient was unable to move his left leg since 0300, had overdosed on Xanax, fell and hit his head. He started foaming from the mouth at 0430 ."
Pulse: 71 B/P 128/75 Resp:18
Disposition of the patient: Personnel #25 called doctor for directions considering the patient's situation from the parking lot. Doctor said to call 911."

2. Per interview with personnel #21 at 3:30 pm on 5/9/2011, the security guard came into the intake office saying a man was in an SUV in the parking lot who had overdosed. Personnel #21 stated the patient's caretaker was in the hospital lobby as she and personnel #25(RN) were going out to the SUV to assess the patient. Personnel #21 stated the caretaker told her the patient had left sided weakness and could not move his left leg. Personnel #21 stated that even though the patient's vital signs were normal, she thought the patient may have had a cardiovascular incident (CVA). Personnel #21 stated the other RN(#25) called 911. Personnel #21 stated she stayed out by the SUV until 911 arrived.

3. Personnel #25, RN,(Intake Department Supervisor) was interviewed on 5/16/2011 at 9:20 am. Per personnel #25, the patient had overdosed on Xanax and although the vital signs were normal, his speech was slurred and unintelligible and he almost fell getting out of the SUV. Personnel #25 stated he called the doctor on his cell phone who ordered to call 911. He stated that after he called 911 he went back into the hospital. He did not stay with the patient.

4. The patient's caretaker was interviewed at 10:20 am on 5/23/2011. Per caretaker, although she told hospital staff the patient could walk but needed assistance, no one helped the patient into the hospital.
Per caretaker, she was not told 911 had been called until they arrived .Caretaker then told the RN she wanted the patient to stay there but the RN said the patient couldn't because he has fallen and we can't take him.

5.. After interviews and review of the clinical record the patient did not receive a medical screening exam that was appropriate for the patients condition. Personnel #21 and 25 stated they thought the patient may have had a CVA. However, both RN's did not stay with the patient There was no attempt to escort the patient inside the hospital for a medical exam nor was there any attempt to get a physician to come out to the SUV to assess the patient. Instead, they depended on 911.

Based on interviews and review of 1 of 20 emergency department records West Oaks Hospital failed to provide an appropriate transfer for a patient in an emergent medical condition by failing to certify risks and benefits of transfer and failing to secure acceptance from the receiving hospital
Findings:

1. Record review reflected the patient, a 61 year old male, presented to West Oaks Hospital in an SUV in the parking lot on 4/27/2011 at 9:15 am. The patient remained in the SUV and patient's caretaker got out to request admission for the patient. " Per caretaker, the patient was unable to move his left leg since 0300, had overdosed on Xanax, fell and hit his head. He started foaming from the mouth at 0430 ."
A brief medical screening was conducted by RN #21
Pulse: 71 B/P 128/75 Resp:18
Disposition of the patient: RN #25 called doctor for directions considering the patient's situation from the parking lot. Doctor said to call 911."

2. Per interview with RN #21 at 3:30 PM on 5/9/2011, the security guard came into the intake office saying a man was in an SUV in the parking lot who had overdosed. RN #21 stated the patient's caretaker was in the hospital lobby as she and personnel RN#25 were going out to the SUV to assess the patient. RN #21 stated the caretaker told her the patient had left sided weakness and could not move his left leg. RN #21 stated that even though the patient's vital signs were normal, she thought the patient may have had a cardiovascular incident (CVA). RN #21 stated the other RN(#25) called 911. RN #21 stated she stayed out by the SUV until 911 arrived.

3. RN #25, ,(Intake Department Supervisor) was interviewed on 5/16/2011 at 9:20 am. Per RN#25, the patient had overdosed on Xanax and although the vital signs were normal, his speech was slurred and unintelligible and he almost fell getting out of the SUV. RN#25 stated he called the doctor on his cell phone who ordered to call 911. He stated that after he called 911 he went back into the hospital. He did not stay with the patient.

4. The patient's caretaker was interviewed at 10:20 am on 5/23/2011. Per caretaker, although she told hospital staff the patient could walk but needed assistance, no one helped the patient into the hospital.
Per caretaker, she was not told 911 had been called until they arrived .Caretaker then told the RN she wanted the patient to stay there but the RN said the patient couldn't because he has fallen and we can't take him.