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Based on medical record review, hospital policy and procedure review, review of Medical Staff Rules and Regulations, and staff interviews, the hospital failed to ensure a Medical Screening Exam (MSE) had been provided by a Qualified Medical Personnel (QMP) for 9 of 20 patients reviewed who presented to the hospital's Emergency Department with a medical complaint. (Patients #1, #2, #3, #8, #10, #11, #12, #16, and #18).

The findings include:

Cross Refer to A2406.

Based on interviews, record reviews, hospital Medical Staff Bylaws, on-call physician schedule, and review of facility Emergency Medical Treatment and Labor Act (EMTALA) policy, the hospital failed to provide a Qualified Medical Professional (QMP) to do a Medical Screening Exam (MSE) for 9 of 20 patients who presented to the Emergency Care Center (ECC) for an MSE. (Patient #1, #2 , #3, #8, #10, #11, #12, #16, and #18)

The findings are:

Review on 8/27/24 at 10:08 AM of the hospital's Medical Staff Bylaws, dated 5/6/24, revealed Appendix B Medical Staff Rules and Regulations, that included information under Emergency Services that stated, " .... Qualified Medical Person. The following professionals with the documented competency to perform a medical screening examination in the Emergency Department are the following: a. Certified Nurse Midwife to do medical screening examination of obstetrical patients, greater than twenty (20) weeks gestation, who present to the Emergency Department. b. A Registered Nurse who has been certified competent by the Director of Obstetrics, two (2) other Obstetricians and the Director of the Women's Center to do medical screening examination of obstetrical patients, greater than twenty (20) weeks gestation, who present to the Emergency Department ...". Nurse Practitioners (NP's) and Physician Assistants (PA's) who were working in the Emergency Care Center (ECC) were not listed as qualified to perform a MSE (Medical Screening Exam).

1. Record review on 8/27/24 from 10:20 AM through 2:26 PM revealed the following patients had received a medical screening exam (MSE) from an advanced practice provider (NP (Nurse Practitioner) or PA (Physician Assistant)) that had not been designated by the governing body to be a Qualified Medical Person (QMP) to perform medical screening exams:

Patient #1 came to the Emergency Care Center (ECC) on 7/16/24 after a fall with shoulder pain and swelling. The patient received an MSE from Physician Assistant #2.

Patient #2 came to the ECC on 7/22/24 with leg swelling. The patient received an MSE from Physician Assistant #3.

Patient #3 came to the ECC on 7/19/24 after a fall and Urinary Tract Infection (UTI) The patient received an MSE from Nurse Practitioner #3.

Patient #8 came to the ECC on 8/06/24 for groin and flank pain, abdominal pain also noted. The patient received an MSE by Nurse Practitioner #4. Patient # 8 left Against Medial Advice (AMA) and filled out AMA paperwork.

Patient #10 came to the ECC on 08/12/24 with pain to the right leg. The patient received an MSE from Physician Assistant #2.

2. Record review on 8/28/24 from 9:18 AM through 12:26 PM revealed the following patients had received a medical screening exam from an advanced practice provider (NP or PA) that had not been designated by the governing body to be a Qualified Medical Person (QMP) to perform medical screening exams:

Patient #11 came to the ECC on 5/18/24 for a fall with head laceration. The patient received a MSE from Physician Assistant #1.

Patient #12 came to the ECC for a rash on 4/13/24 and received an MSE from Nurse Practitioner #3.

Patient #16 came to the ECC on 8/24/24 after a fall. The patient received a MSE from Nurse Practitioners #1 and #2. The patient was transferred to another hospital for a higher level of care.

Patient #18 came to the ECC on 6/26/24 for a rabies vaccine. The patient received a MSE from Nurse Practitioner #2.

Review on 8/28/24 at 1:17 PM of the Medical Staff Roster provided by the hospital revealed (8) Advanced Practice Providers (APP's) had been listed under the group Advanced Emergency Physicians. The APP's were Physician Assistants (PA's) #1, #2, #3, and #4; and Nurse Practitioners (NP's) #1, #2, #3, and #4.

During an interview on 8/29/24 at 8:05 AM, the ECC Medical Director verified the Medical Staff Bylaws and Rules and Regulations did not list the ECC Physician Assistants (PA's) or Nurse Practitioners (NP) as QMP's to perform MSE. The ECC Medical Director stated the APP's (Advanced Practice Providers) were capable and have been performing MSE's appropriately, but governing body/medical staff are now working on changing the verbiage in the Medical Staff Bylaws to include the ECC PA's and NP's.

During an interview on 8/29/24 at 9:30 AM, the ECC Medical Director and ECC Director of Nursing were present. They reviewed the ECC medical records for Patient's #11, #12, #16, and #18. They verified the record showed the MSE had been conducted by Nurse Practitioners #1, #2, #3; and Physician Assistant #1.



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