HospitalInspections.org

Based on a review of facility policy and documents, a review of facility surveillance video and staff interviews (EMP), it was determined that the facility failed to meet the requirements of the Emergency Medical Treatment and Labor Act (EMTALA) and failed to follow policy to ensure compliance with the requirements of 42 CFR 489.24.

Findings include:

A review of the facility policy "EMTALA/Medical Screening Examinations, Stabilizing Treatment and Appropriate Transfers" last revised June 4, 2015, revealed, "Any individual who presents to the ED and requests emergency treatment, or who would appear to a reasonably prudent person to be in need of medical attention, will be provided Emergency Services. 'Emergency Services' include an appropriate medical screening examination and evaluation within the capability of TJUH, including ancillary services routinely available to the ED, and treatment necessary to stabilize any identified emergency medical condition. 'Presenting to the ED' includes arriving at an emergency department... A Medical Screening Examination ("MSE"), or in the case of a psychiatric EMC, a Psychiatric Screening Examination ("PSE"), is the process used to reach, with clinical confidence, the point at which it can be determined whether an emergency medical condition does or does not exist. ... ."

A review of facility documentation revealed that on February 22, 2016, at approximately 5:00 AM a gentleman presented to the emergency room appearing disheveled with a blanket over his head. The gentleman approached a security guard asking for "psych." The security guard told the gentleman about a crisis center at another hospital and then provided the man with directions.

A review of the emergency room log for February 22, 2016, with EMP8 revealed that the person who presented to the emergency department with a psychiatric concern was not listed on the log.


A review of the facility's emergency department surveillance video recording of February 22, 2016, at 5:00 AM, which lasted two minutes and nineteen seconds, revealed a person with a blanket over the head, face and body go through the revolving door and then stand at the security desk. The recording showed the person interact with security personnel and then leave the emergency department.

An interview conducted on March 7, 2016, at 9:15 AM with EMP5 revealed that the facility's internal investigation determined that three security guards on staff in the emergency department on February 22, 2016, felt they were being helpful by giving the person who presented to the emergency department directions to the nearest crisis center.

A phone interview conducted on March 7, 2016, at 9:40 AM with Security Officer EMP9 confirmed that EMP9 was the security officer who spoke with the person who presented to the emergency department on February 22, 2016, at 5:00 AM. The interview also confirmed that EMP9 directed the gentleman to the local crisis center and not the facility's emergency department for treatment.

An interview conducted on March 7, 2016, at 10:00 AM with Security Guard EMP10 revealed that EMP10 was on duty with EMP9 and EMP11 when the person presented to the emergency department on February 22, 2016, at 5:00 AM. EMP10 confirmed that EMP9 did not direct the person into the emergency department when the person asked to see a psych doctor.

An interview conducted on March 7, 2016, at 10:15 AM with Security Guard EMP11 revealed that EMP11 was on duty with EMP9 and EMP10 when the person presented to the emergency department on February 22, 2016, at 5:00 AM. EMP11 confirmed that EMP9 did not direct the person into the emergency department when the person asked to see doctor.

An interview conducted on March 7, 2016, 1:00 PM with EMP8 confirmed that a person presented to the emergency department with a psychiatric concern on February 22, 2016, at 5:00 AM and was not added to the emergency room log. Further interview confirmed that the person did not receive a medical screening examination in the emergency department as required by the Emergency Medical Treatment and Labor Act.