HospitalInspections.org

Based on observation, interview, and record review, the facility failed to maintain a complete Emergency room log when Patient #1 presented to the emergency room and was not logged in.

Findings Include:

Review of Providence Memorial provided training titled "Fundamentals of EMTALA" (undated) reflected, "The Emergency Medical Treatment and Labor Act, known as EMTALA, requires hospitals and physicians to provide medical screening and stabilizing care for medical emergencies without regard to patient's ability to pay ...EMTALA obligations start when a patient comes to a hospital's Emergency Department and requests care, EMTALA applies.
- A request on the patient's behalf counts, too.
- Even if General Hospital is on diversion, ...comes to the hospital, EMTALA still applies."

During a telephone interview, on the morning of 11/14/22, Staff #4, El Paso Police Sergeant stated, "The officers went to Providence Memorial, with patient #1, they had contacted the Emergency Management Resource (EMR) and were informed the facility was not on diversion for psychiatric patient admissions. When the officers arrived, advised by front desk intake personnel that they were refusing the Officers emergency detention because the hospital was at capacity for psychiatric patients. We checked later and found out they did not have anyone on an Emergency Detention; this isn't the first time this has happened. The facility cameras should show the officers in the lobby for 6 minutes... I would like to add that the El Paso Police Department's CIT supervisors frequently attended our Inter Facility Task Force (IFTF) meetings which consists of leaders from El Paso's mental health facilities, local law enforcement, local fire department and all of the area's hospitals. We have repeatedly addressed issues with our hospitals, and we continue to have occurrences on a regular basis."

During an interview, on the afternoon of 11/15/22, in the administrative conference room, when asked if she was working in the emergency room the day patient #1 came to the emergency room and asked what happened, Staff #19, Registration Clerk stated, "Yes, the officers didn't come straight to the window, they wanted to speak to the charge nurse; Normally I would hand them clip boards to sign-in. The officer was arguing with the charge nurse. Another officer came in and I heard one (officer) say, 'Don't give them your badge number.'" When asked if the patient was registered, Staff #19 stated, "No, I didn't have her name."

Review of Providence's Emergency Room logs dated 10/10/22 reflected Patient #1 was not listed nor was an unidentified female at the time indicated by the police officers and staff #19.

Based on observation, interview, and record review, the facility failed to provide an Emergency Screening Examination for (2) out of (6) patients presenting to Providence Memorial's Emergency Department requesting emergency stabilization treatments (Patients #1 and #21). The facility was turning away patients on an Emergency Detention Order, these orders are initiated by the police to detain and seek treatment for a person with a psychiatric or medical condition; this practice places patients requesting treatment at risk of delayed treatent, worsening conditions, and possibly death.

Findings include:

Review of Providence Memorial provided training titled "Fundamentals of EMTALA" (undated) reflected, "The Emergency Medical Treatment and Labor Act, known as EMTALA, requires hospitals and physicians to provide medical screening and stabilizing care for medical emergencies without regard to patient's ability to pay ...EMTALA obligations start when a patient comes to a hospital's Emergency Department and requests care, EMTALA applies.
- A request on the patient's behalf counts, too.
- Even if General Hospital is on diversion, ...comes to the hospital, EMTALA still applies."

Review of Patient #1's medical record, dated 10/10/22 at 4:04 pm, reflected a 20-year-old-female admitted to Acute Care Hospital #2, for Suicidal Ideations, laceration of left forearm, and depression; the patient was accompanied by El Paso Police officers. Patient #1 was assessed and transferred to Inpatient Behavioral Hospital #3.

During an interview, on the morning of 11/14/22, at Acute Care Hospital #2, in the administrative office, Staff #2, Chief Nursing Officer (CNO) stated, "The boarder rack takes our facility information and uses it to get a status update of availability, it is definitely not used to turn patients away. They want to know how many patients we are holding in the ER; how many people are in our ER; there is no limit to how many we can hold."

During an interview, on the afternoon of 11/14/22, in the Providence Memorial Emergency Room, when asked who from their facility attends the Inter Facility Task Force (IFTF) meetings, which consists of leaders from El Paso's mental health facilities, local law enforcement, local fire department and all of the area's hospitals, Staff #1, ED Director stated, "I do." When asked if the subject of hospitals turning away psychiatric patients had been discussed, Staff #1 stated, "Yes, but they did not mention Providence." When asked who determines if the hospital is on diversion, Staff #1 stated, "The decision can only be made by Administration."

During a telephone interview, on the morning of 11/14/22, Staff #4, El Paso Police Sergeant stated, "The officers went to Providence Memorial, with patient #1, they had contacted the Emergency Management Resource (EMR) and were informed the facility was not on diversion for psychiatric patient admissions. When the officers arrived, (on 10/10/22 around 4 pm), advised by front desk intake personnel that they were refusing the Officers emergency detention because the hospital was at capacity for psychiatric patients. We checked later and found out they did not have anyone on an Emergency Detention; this isn't the first time this has happened. The facility cameras should show the officers in the lobby for 6 minutes... I would like to add that the El Paso Police Department's CIT supervisors frequently attended our Inter Facility Task Force (IFTF) meetings which consists of leaders from El Paso's mental health facilities, local law enforcement, local fire department and all of the area's hospitals. We have repeatedly addressed issues with our hospitals, and we continue to have occurrences on a regular basis."

Review of Providence's Emergency Room logs dated 10/10/22 reflected Patient #1 was not listed nor an unidentified female. When the officers arrived, they were advised by front desk intake personnel that they were refusing the Officers' emergency detention because the hospital was at capacity for psychiatric patients. Patient #1 did not receive an Emergency Medical Screening Examination and was not safely transferred to another hospital.

Review of the Providence Memorial Hospital provided EMR listing for 10/10/22 status reflected:
"2:37 pm- Caution, No OR No CATH LAB
15:17 pm- Caution, Specialty Limitation No Cath Lab
11:59 pm- Open"

During an interview, on the afternoon of 11/14/22, in the administrative conference room, Staff #18, Patient Access Emergency Room Supervisor stated, "I spoke to Staff #19, she was there that day, she remembers. Staff #8 was the triage nurse."

During an interview, on the afternoon of 11/15/22, in the administrative conference room, when asked if she was working in the emergency room the day patient #1 came to the emergency room and asked what happened, Staff #19, Registration Clerk stated, "Yes, the officers didn't come straight to the window, they wanted to speak to the charge nurse; Normally I would hand them clip boards to sign-in. The officer was arguing with the charge nurse. Another officer came in and I heard one (officer) say, 'Don't give them your badge number.'" When asked if the patient was registered, Staff #19 stated, "No, I didn't have her name."

During an interview, on the afternoon of 11/15/22, in the administrative conference room, Staff #8, Providence RN, Charge Nurse stated, "I would never tell anyone we were on diversion." When asked who could place the facility on diversion, Staff #8 stated, "I thought it was the AOD (Administrator on Duty)." When asked if she was the one who had talked to the police officers on 10/10/22, Staff #8 stated, "I don't recall the incident. I like to go out there and see what the EOD (emergency detention order) is for ...A couple of months ago a nurse told the officers we don't have any rooms; they interpreted it as we are turning them away."

During an interview, on the afternoon of 11/14/22, in the facility's emergency room department, when asked how the EMR system works, Staff #1, ER Director, explained that all the local hospitals put their current bed status into the system. The system is meant to help the EMS and police in determining which hospital to take the patients. If there isn't a service available, they won't delay treatment to patients by having to wait or being transferred. The hospitals put their own information into the system; under comments they can free text the services not available. When asked who can place the hospital on diversion, Staff #1 stated, "We do not put the hospital on diversion."

During a telephone interview, on the afternoon of 11/14/22, Staff #27, El Paso Police Sergeant, stated, "Earlier this year, in March, police officers transported a patient for treatment, after making the officer and patient wait in a full lobby for over an hour and 45 minutes later, the facility said they were on diversion. The patient was not stable and became agitated by the other people staring at her. The facility put the officer and other patients at risk when they left them in the lobby; they should have taken them to the back. The hospital placed themselves on diversion after we were already there."

Review of the Providence Memorial Hospital provided EMR listing for 3/20/22 status reflected:
6:16 pm- Specialty limitation No Peds Neurosurgery, Caution EDO's
7:24 pm- ED Overload, Emergency Detention Patients
7:27 pm- ED Overload, Emergency Detention patients, edo diversion.
7:38 pm- ED Overload, Emergency Detention Patients, General ED volume above capacity
8:36 pm- ED Overload, Emergency Detention Patients, General ED volume above capacity

Review of Patient #21's Medical record dated 3/20/22 reflected an arrival time at 6:30 pm and a discharge time of 8:25 pm, "Nursing Note: Officer requesting to speak to charge nurse and AOD, spoke to officer, wanted pt. to be brought in now, advised him of EOD overload status, asked to speak to AOD, called and informed her of situation, came to speak to officer, officer decided to take pt. elsewhere due to waiting time."

The patient did not receive a medical screening exam and was not stabilized and transferred to another facility.