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Based on interview and record review, the facility failed to comply with the conditions of participation outlined in §489.20 and related requirments at 489.24: refer to Appendix V. The facility failed to maintain a central log on each individual who comes to the emergency department, seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for one patient (#1); and the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists for one patient (#1).


Findings include:

Review of facility policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)", dated revised 5/2021, showed: " ...2. An MSE and stabilizing treatment will be provided regardless of an individual's race, ethnicity, religion, national origin, citizenship, age, sex, preexisting medical condition, physical or mental handicap, insurance status, economic status, or ability to pay for medical services. St. Patrick Hospital will not delay the provision of a MSE, further medical examination and treatment, or appropriate transfer in order to inquire about the individual's method of payment or insurance status ...F. Patients presenting with psychiatric issues, signs, and symptoms of substance abuse, or individuals expressing suicidal or homicidal thoughts or gestures will receive an MSE through the ED ...2. At minimum, documentation will include assessment of suicide or homicide attempt or risk, orientation, grave disability, or violent behavior that indicates danger to self or others."

Patient #1 was transported to the facility ED on 07/02/2023 by law enforcement staff. Patient #1 was suicidal and requested to be evaluated and treated at the ED. Record review of facility documents and interviews with facility staff showed the patient was never entered onto the ED log (Refer to C-2405) subsequently, patient #1 was told the facility did not have any available beds and patient #1 did not receive a Medical Screening Examination (Refer to C-2406).

Based on interview and record review, the facility failed to maintain a central log on all individuals who present to the emergency department seeking assistance, and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for 1 (#1) of 20 sampled patients.

Findings include:

During an interview on 09/06/2023 at 2:32 p.m., NF1 stated patient #1 was brought to the detention center on 07/02/2023 because he was suicidal, stated he wanted to kill himself, and had discharged a firearm in his home. NF1 stated patient #1 requested to go to the emergency room; he repeated that he needed help and stated he would go voluntarily. Patient #1 was not under arrest or detained by law enforcement at that time.

During a telephone interview on 09/08/2023 at 11:47 a.m., NF3 stated she transported patient #1 from the detention center to St. Patrick Hospital ED on 07/02/2023. She stated patient #1 was suicidal and requested treatment. NF3 stated she called the ED fifteen minutes prior to their arrival. NF3 stated she arrived at the facility with patient #1 and entered through the front entrance. She stated she was directed to take patient #1 to the ambulance entrance on the side of the building. NF3 stated she was approached by two facility personnel, one being the facility Mental Health Professional. NF3 stated the facility Mental Health Professional spoke to patient #1, at which time patient #1 stated he was suicidal and needed help. NF3 stated the Mental Health Professional said the facility did not have any beds, and stated, "We likely won't keep him." NF3 stated patient #1 did not receive a Medical Screening Examination. NF3 stated, "I didn't know what to do." She stated she was concerned about patient #1. She decided to take him to another hospital for evaluation, since it appeared St Patrick Hospital would not see him.

Review of the facility ED log on 09/06/2023 showed there was no record of patient #1 arriving at the facility ED on 07/02/2023.

Based on interview and record review, the facility failed to provide an appropriate Medical Screening Examination for 1 (#1) of 20 sampled patients. This deficiency caused a suicidal patient to seek medical care at another hospital, seventy-seven miles away. Findings include:

During a telephone interview on 09/06/2023 at 2:32 p.m., NF1 stated patient #1 was brought to the detention center on 07/02/2023 by local law enforcement. NF1 stated patient #1 was suicidal, and he had discharged a firearm in his home. NF1 stated patient #1 repeatedly asked for help, he stated he wanted to kill himself, and he asked to be taken to St. Patrick ED for evaluation and treatment.

During an interview on 09/07/23 at 4:59 p.m., NF2 said he was the deputy working when patient #1 discharged his firearm at his residence. NF2 spoke with patient #1 and he expressed he was suicidal and wanted help. NF2 said patient #1 had access to firearms and he believed patient #1 was capable of hurting himself, so he brought him to the detention center while they figured out what to do for him. Patient #1 was very cooperative with NF2 and kept repeating he needed help.

During a telephone interview on 09/08/2023 at 11:47 a.m., NF3 stated she transported patient #1 from the detention center to St. Patrick Hospital ED on 07/02/2023. She stated patient #1 was suicidal and requested treatment. NF3 stated she called the ED fifteen minutes prior to their arrival. NF3 stated she arrived at the facility with patient #1 and entered through the front entrance. She stated she was directed to take patient #1 to the ambulance entrance on the side of the building. NF3 stated she was approached by two facility personnel, one being the facility Mental Health Professional.NF3 said the Mental Health Professional seemed irritated that NF3 brought the patient into the ambulance enterance. NF3 stated the facility Mental Health Professional spoke to patient #1, at which time patient #1 stated he was suicidal and needed help. NF3 stated the Mental Health Professional said the facility did not have any beds, and stated, "We likely won't keep him," and walked back into the emergency room. NF3 said she and patient #1 where left in the ambulance enterance alone. NF3 stated patient #1 did not receive a Medical Screening Exam. NF3 stated, "I didn't know what to do." She stated she was concerned about patient #1, so she decided to take him to another hospital for evaluation, since it seemed St Patrick Hospital would not see him.

During a telephone interview on 09/06/2023 at 3:54 p.m., staff member F stated she was the Mental Health Professional who worked on 07/02/2023. She stated she recalled patient #1 arriving at the ED with a law enforcement officer. Staff member F stated she did not talk to patient #1. She stated patient #1 was sitting quietly in the back of the car. Staff member F stated the officer had a letter from a judge stating patient #1 was a voluntary admission and the patient was to go to the ED because he was suicidal. Staff member F stated she did not bring the patient into the ED for evaluation and patient #1 did not receive a Medical Screening Examination.

During a telephone interview on 09/06/2023 at 4:06 p.m., staff member C stated she was the charge nurse assigned to work on 07/02/2023. She stated she did not recall patient #1 arriving to the ED, or the incident. Staff member C stated all patients who arrive at the ED seeking treatment should receive a medical screening examination.