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A. Based on review of Hospital policies, ED central log, and staff interview, it was determined, that for 1 of 27 Emergency Department (ED) patient visits (Pt. #1), the Hospital failed to ensure the ED central log included each patient who presented to the ED (A-2405) and failed to ensure the provision of a medical screening exam for each presenting patient (A-2406).

A. Based on review of Hospital policies, Emergency Department (ED) central log, and staff interview, it was determined, that for 1 of 27 patient records reviewed (Pt. #1), the Hospital failed to ensure the ED central log included each patient who presented to the ED.

Findings include:

1. Hospital policies titled "Emergency Department Services" and "Nursing Documentation in the Emergency Department" were reviewed on 8/9/11 at 3:10 PM. Both policies required a medical record for all patients entering the Emergency Department. Neither policy included registration in a central log. There was no Hospital policy that addressed the ED central log.

2. On survey date 8/9/11, the Emergency Department (ED) Log was reviewed. Pt. #1 ' s name was included in the Log on 8 dates in 2011 (2/14, 3/11, 3/17, 3/23, 5/4, 5/6, 7/10, and 7/25), but not on 6/10/11.

3. On 8/9/11 at 11:35 AM, a phone interview was conducted with a Registered Nurse (E #1) who worked in the Emergency Department (ED) on 6/10/11 from 8:00 PM until 6/11/11 at 7:00 AM. E #1 stated that on 6/10/11 at approximately 11:00 PM, while Pt. #1 sat in the car in the Hospital parking lot, E #1 spoke with Pt. #1 ' s wife, in the triage area regarding Pt. #1's depression and need for counseling. However, Pt. #1 refused to enter the ED and later was driven to another Hospital for examination and treatment. Pt. #1's visit was not recorded in the ED central log.

4. This finding was confirmed by the Director of Quality during an interview on 8/10/11 at 2:30 PM.

A. Based on review of Hospital policy and staff interview, it was determined, that for 1 of 27 patient records reviewed (Pt. #1), the Hospital failed to ensure the provision of a medical screening exam.

Findings include:

1. Hospital policy titled "Campus Medical Emergency (DMERT)" was reviewed on 8/9/11 at 3:05 PM. The policy required, "I. Purpose: To establish a procedure for DCH personnel to respond to the aid of non-hospitalized individuals in need of emergent medical assistance on and around DCH property boundaries." The policy indicated that Security and other personnel could be called to aid individuals requiring assessment and treatment.

2. On 8/9/11 at 11:35 AM, a phone interview was conducted with a Registered Nurse (E #1) who worked in the Emergency Department (ED) on 6/10/11 from 8:00 PM until 6/11/11 at 7:00 AM. E #1 stated that on 6/10/11 at approximately 11:00 PM, while Pt. #1 sat in the car in the parking lot, E #1 spoke with Pt. #1's wife, in the triage area. Pt. #1 was depressed because he had lost his job and his house. E #1 told the wife to bring Pt. #1 into the Hospital ED for examination. The wife told E #1 that Pt. #1 didn't know why he had been driven to the Hospital and did not want to enter. E #1 asked the wife if Pt. #1 was suicidal or had been drinking and his wife answered, "No". E #1 stated that she could not physically pull anyone out of the car, unless suicidal or intoxicated. Pt. #1's wife told E #1 that she was going to visit her mother at another Hospital and would take Pt. #1 there. Pt. #1's wife left triage and drove away from the Hospital grounds with Pt. #1.

3. The Surveyor asked E #1 had she heard from the other Hospital. E #1 stated that she received a phone call from the other Hospital ' s Charge Nurse. The Charge Nurse accused E #1 of an EMTALA violation for sending a suicidal and intoxicated patient away from the Hospital.

4. The Surveyor asked E #1 if she should have gone out to the car to assess the patient. E #1 stated that there was no policy or practice for going out to the car and she had not experienced any other situation like this.

5. On 8/9/11 at 11:45 AM, a phone interview was conducted with the ED Physician (E #2) on duty on 6/10/11. E #2 stated that E #1 had informed him about Pt. #1 waiting in the car. E #2 was informed that Pt. #1 was depressed but was not suicidal and could not be removed from the car against his will.

6. The Surveyor asked E #2 if the Nurse (E #1) should have gone to the parking lot to assess the patient. E #2 stated that it "depended on the situation. If there was a possibility of harm to the Nurse, security should go with the Nurse when she goes out to the parking lot."

7. These findings were confirmed by the Director of Quality during an interview on 8/9/11 at
11:50 AM.

8. On 8/11/11, Pt. #1's clinical record from the receiving Hospital was reviewed. The record indicated that P.#1 arrived by ambulance and was triaged on 6/11/11 at 12:42 AM, with a complaint of Depression. A laboratory test for Alcohol dated 6/11/11 at 12:30 AM, included 210 mg/dl "Ethanol elevated, above legal limit." A psychological assessment in the ED on 6/11/11 at 5:20 AM included Pt.#1's diagnoses as Suicidal Ideation and Severe Depression. Pt. #1 was admitted to the receiving Hospital on 6/11/11