HospitalInspections.org

Based on staff interviews, review of the facility's diversion list document, facility Emergency Medical Treatment and Active Labor Act (EMTALA) policy and procedure, the facility's Emergency Department (ED) Central Log, email documents from the tele-emergency physician provider service, and review of Emergency Medical Service (EMS) Provider #2's ambulance run report document, the facility failed to comply with the responsibilities of the emergency department to provide an appropriate Medical Screening Exam (MSE) to an individual presenting to the emergency department for one (1) of one (1) confirmed patient arriving by ambulance.

Findings include:

Review of a document from Emergency Medical Services (EMS) Provider #2 referred to as a "Run Report," dated 12/04/2024 at 1:05 p.m. (EMS Response # 24-07527) revealed EMS Patient #1 (80-year-old female) arrived via ambulance to the facility's Emergency Department (ED) at 2:40 p.m. with bilateral lower leg pain and infected wounds on both legs. Report reveals EMS attempted to contact the facility to give a pre-hospital report but was sent to voicemail. On arrival EMS Patient #1 was unloaded and taken to triage and then told they could not see the patient and must transport the patient to another facility.

Quitman Community Hospital had no documentation of EMS Patient #1 arriving at the facility ED in the ED Central Log and no documented evidence of triage or a medical screening exam (MSE).

Review of the facility's, "Diversion List," dated 06/17/2024 to 12/04/2024 reveals 15 dates the facility was on diversion which included: four (4) diversions for internet service interruptions which prevents the facility from using the tele-emergent contract arrangement for physician services; three (3) diversions for no radiology technician available, one (1) diversions for imaging machines not in service; six (6) diversions for cardiac due to not having Troponin supplies (measures protein that is unique to heart muscle) in stock preventing cardiac workup; and one (1) diversion on 12/04/2024 due to tele-emergent contract arrangement for physician services terminated.

Interview on 12/09/2024 at 5:00 p.m. with the facility Administrator confirmed three (3) to five (5) patients presented to facility for services and were not logged into the ED's central log on 12/04/2024 after the facility went on diversion.

Interview with facility Administrator on 12/10/2024 at 10:45 a.m. confirms the facility's documentation of diversion status from 06/17/2024 - 12/04/2024.

Review of the facility's ED Central Log against the facility's Diversion List reveals no documentation of patients presenting to the ED for service in the ED Central Log from 12/04/2024 at 8:24 a.m. until 12/05/2024 at 1:11 p.m.

Review of the facility's EMTALA policy and procedure dated 06/18/2022, revealed " ...If an individual comes to the Emergency Department ...The Hospital will provide an appropriate medical screening examination within the capability of the Hospital's Dedicated Emergency Department ...to determine whether an emergency medical condition exists; and ....The Hospital will maintain a list of physicians from its medical staff who are on-call for duty after the medical screening examination to provide further medical examination and treatment as necessary to stabilize individuals who have been found to have an emergency medical condition ...As soon as practical after arrival, individuals who come to the Emergency Department should be triaged to determine the order in which they will receive a medical screening examination ...The Hospital shall provide a medical screening examination to any individual who comes to the Emergency Department ...The Hospital must maintain a central log of individuals who come to the emergency department and include in such log whether such individuals refused treatment, were refused treatment, or whether such individuals were treated, admitted, stabilized, and/or transferred or were discharged. The log must register all patients who present for examination or treatment, even if they leave prior to triage or MSE ...".

Cross Refer to 2405 and 2406.

Based on staff interviews, review of the facility's diversion report and Emergency Medical Treatment and Active Labor Act (EMTALA) policy and procedures, review of facility staff written statement of 12/04/2024 diversion event, review of Tele-emergency physician services contract termination email document, and review of Emergency Medical Service (EMS) Provider #2's ambulance run report document, the facility failed to document on the facility's Emergency Department (ED) Central Log on each individual who "comes to the emergency department," seeking assistance, for one (1) of one (1) confirmed patient arrival via ambulance.

Findings Include:

Interview on 12/09/2024 at 5:00 p.m. to 5:15 p.m. with facility Administrator confirmed three (3) to five (5) patients that presented to facility's ED for services were not logged into the ED's Central Log during diversion status on 12/04/2024 and that one (1) patient present via ambulance and the Nurse Practitioner (NP) #1 and Registered Nurse (RN) #1 told the EMT they were on diversion and did not accept the patient.

Interview on 12/11/2024 at 11:40 a.m. with Nurse Practitioner (NP) #1 confirmed he was the provider on duty 12/04/2024 when facility ED department diversion was initiated. He also confirmed a patient (EMS Patient #1) arrived by Emergency Medical Services (EMS) Provider #2 on a stretcher. The Emergency Medical Technician (EMT) reported he could not get an answer when he called the facility to give report during transport. NP #1 confirmed he could not exam a patient without a collaborating physician and refused to complete a medical screening exam on the patient. NP #1 also confirmed the patient was not signed into Emergency Department (ED) Central Log and did not have a medical screening.

Interview on 12/11/2024 at 12:00 p.m. with emergency department staff Registered Nurse (RN) #1 confirmed diversion status on 12/04/2024 related to telehealth contract being terminated and that she was there working as an ED staff nurse that shift. RN #1 reports notifying the EMS service of the diversion status by calling EMS Provider #1 around 2:00 p.m. to 2:30 p.m. RN #1 further confirmed a patient was brought in after that by EMS Provider #2 (an EMS provider from another county and company that the facility does not usually receive patients from) and the EMT driver was told of the facility diversion status. RN #1 reported the patient was not signed in on the facility ED Log and did not receive a medical screening exam, RN #1 further confirmed knowledge of EMTALA regulations.

Review of the written statement by the administrator dated 12/09/2024 revealed an ambulance did arrive on 12/04/2024 during diversion status and the nurse practitioner and staff nurse on duty told the EMT they were on diversion and did not accept patient.

Review of the Emergency Department Central Log dated 12/04/2024 - 12/05/2024 revealed the facility had no documented evidence of patients presenting to the ED during the diversion date 12/04/2024 with no entries noted from 12/04/2024 at 8:24 a.m. until 12/05/2024 at 1:11 p.m.

Surveyors are unable to determine the number and names of the individuals who presented to the ED for treatment and were refused a medical screening due to no documented evidence of the individuals in the facility's ED Central Log.

Review of the facility's EMTALA policy and procedure dated 06/18/2022, revealed "...The Hospital must maintain a central log of individuals who come to the emergency department and include in such log whether such individuals refused treatment, were refused treatment, or whether such individuals were treated, admitted, stabilized, and/or transferred or were discharged. The log must register all patients who present for examination or treatment, even if they leave prior to triage or MSE ...".

During Exit Conference on 12/11/2024 at 4:00 p.m. survey findings were discussed, and no further documentation was submitted for review.

Cross Refer to 2400 and 2406.

Based on facility staff interviews, review of written statement from the facility Administrator, and document review of Emergency Medical Services (EMS) Provider #2 ambulance service "run report," review of the facility's on-call schedule, email documents from the contracted facility providing provider Tele-emergency physician services, Emergency Medical Treatment and Active Labor Act (EMTALA) policy and procedures, and review of facility daily safety meeting minutes, the hospital failed to provide an appropriate medical screening examination (MSE) on a patient presenting to the Emergency Department (ED) by ambulance during diversion status for one (1) of one (1) confirmed patient.

Findings Include:

Review of a facility document, written statement by the Administrator dated 12/09/2024 revealed an ambulance did arrive on 12/04/2024 during diversion status. Nurse Practitioner (NP) #1 and Registered Nurse (RN) #1 were on duty and told the ambulance Emergency Medical Technician (EMT) the facility was on diversion and did not accept patient.

Review of EMS Provider #2 document referred to as a "Run Report," dated 12/04/2024 1:05 p.m. (EMS Response # 24-07527) revealed EMS Patient #1 (80-year-old female) arrived via ambulance to the facility's Emergency Department (ED) at 2:40 p.m. with bilateral lower leg pain and infected wounds on both legs. Report reveals EMS attempted to contact the facility to give a pre-hospital report but was sent to voicemail. On arrival EMS Patient #1 was unloaded and taken to triage and was then told they could not see the patient and must transport the patient to another facility.
No facility documentation available for review for EMS Patient #1 including documentation of triage or a medical screening exam (MSE).

An Interview on 12/09/2024 at 5:00 p.m. with the facility Administrator confirmed the facility's Emergency Department (ED) went on diversion status on 12/04/2024 at 10:00 p.m. and during diversion status three (3) to five (5) patients presented to facility's ED for treatment of a potential emergent medical condition and were not provided a medical screening exam, further interview revealed the patients who presented to the ED were not recorded in the ED central log on 12/04/2024 after going on diversion.

Interview on 12/11/2024 at 11:40 a.m. with Nurse Practitioner (NP) #1 confirmed NP #1 was the provider on duty 12/04/2024 when facility's diversion status was initiated. NP #1 also confirmed a patient arrived by Emergency Medical Services (EMS) on a stretcher and the Emergency Medical Technician (EMT) said he could not get an answer when he called the facility to give report during transport. NP #1 confirmed he could not exam a patient without a collaborating physician and refused to complete a medical screening exam on the patient. NP #1 further explained that the Administrator encouraged him to see the patient, but he pulled the EMT aside and told him he couldn't see the patient without a collaborating physician available. NP #1 also confirmed the patient was not recorded in the Emergency Department (ED) Central Log. When asked if he was knowledgeable about Emergency Medical Treatment and Active Labor Act (EMTALA) regulations, NP #1 confirmed he should have screened the patient but feels he was put in a position where he could not screen them.

Interview on 12/11/2024 at 12:00 p.m. with ED Registered Nurse (RN) #1 confirmed diversion status on 12/04/2024 related to the facility's telehealth contract being terminated and that she was working as an ED staff nurse that day. RN #1 reports notifying the EMS service of the diversion status by calling EMS Provider #1 around 2:00 p.m. to 2:30 p.m. RN #1 further confirmed a patient was brought in after 2:30 p.m. by EMS Provider #2. RN #1 further confirmed the EMT driver was told of the facility diversion status and that the patient was not recorded on the ED Central Log. RN #1 confirmed knowledge of EMTALA regulations and also confirmed the patient did not have a medical screening.

Review of the facilities Provider and On-call Schedule for December 2024 revealed the facility was staffed with one nurse practitioner and no physician on duty at facility or on call for 12/04/2024 until 10:00 a.m. on 12/05/2024.

Review of the Emergency Department Log dated 12/04/2024 - 12/05/2024 revealed the facility had no documented evidence of any patients presenting to the ED during the diversion and no entries noted from 12/04/2024 at 8:24 a.m. until 12/05/2024 at 1:11 p.m.

Surveyors are unable to determine the number and names of the individuals who presented to the ED for treatment due to no documented evidence of the individuals in the facility's ED Central Log.

Review of facility's daily safety meeting minutes for 12/04/2024 and 12/05/2024 revealed the facility had no Tele-emergency physician provider coverage and that staff were to continue to assess patients arriving to the facility seeking medical assistance.

Review of the email document dated 12/04/2024 at 10:57 a.m. from the contracted facility providing provider Tele-emergency physician services revealed the contract was terminated with the facility effective 11/29/2024.

Review of the email document titled "Notice of Termination and Educational Affiliation Agreement ..." dated 12/09/2024 from the Administrative Assistant III of the contracted facility revealed, " ...notice of termination as of midnight December 6, 2024, of the agreement due to ...breach of its terms."

Review of the facility's EMTALA policy and procedure dated 06/18/2022, revealed " ...If an individual comes to the Emergency Department ...The Hospital will provide an appropriate medical screening examination within the capability of the Hospital's Dedicated Emergency Department ...to determine whether an emergency medical condition exists; and ....The Hospital will maintain a list of physicians from its medical staff who are on-call for duty after the medical screening examination to provide further medical examination and treatment as necessary to stabilize individuals who have been found to have an emergency medical condition ...As soon as practical after arrival, individuals who come to the Emergency Department should be triaged to determine the order in which they will receive a medical screening examination ...The Hospital shall provide a medical screening examination to any individual who comes to the Emergency Department ...".

During Exit Conference on 12/11/2024 at 4:00 p.m. survey findings were discussed, and no further documentation was submitted for review.

Cross Refer to 2400 and 2405.