The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

MONTGOMERY COUNTY MEMORIAL HOSPITAL 2301 EASTERN AVENUE RED OAK, IA 51566 April 24, 2017
VIOLATION: COMPLIANCE WITH 489.24 Tag No: C2400
I. Based on document review and staff interview, the Critical Access Hospital's (CAH) administrative staff failed to ensure the CAH staff followed the CAH's policies when the staff failed to enter 1 of 31 patients (Patient #31) selected for review into the CAH's central emergency department (ED) log. The CAH's administrative staff identified an average of 423 patients per month who presented to the CAH's ED and requested emergency medical care.

Failure to follow the CAH's policy and include all patients in the central ED log resulted in the CAH staff failing to provide an evaluation or care for Patient #31 which resulted in the need for Patient #31 to seek care at another hospital because a CAH staff member told Patient #31 the CAH staff could not help Patient #31.

Findings included:

1. Review of the policy " EMTALA - Screen and Transfer of Patient," reviewed 1/2017, revealed in part, " A central log shall be maintained as to each individual who comes to the Emergency Department..."

2. Review of the emergency department's central log for 4/11/17 revealed 15 patients presented to the dedicated emergency department and requested emergency medical care. The central log did not include Patient #31. The facility staff did not create a medical record for Patient #31.

3. During an interview on 4/19/17 at 4:40 PM, Registrar A stated Patient #31 presented to the ED registration desk and requested the CAH staff perform an alleged sexual assault examination on Patient #31. Registrar A spoke with the staff in the ED and informed Patient #31 that the CAH staff could not perform an alleged sexual assault examination on Patient #31 due to the length of elapsed time between the alleged sexual assault and when Patient #31 presented to the hospital.

Please refer to C-2405 for additional information concerning the CAH's failure to ensure the CAH staff placed all patients on the central ED log.

II. Based on document review and staff interview, the CAH's administrative staff failed to ensure 1 of 2 alleged sexual assault victims, who presented to the CAH between 10/1/16 and 4/19/17 and requested emergency medical care, received a medical screening examination. The administrative staff identified an average of 423 patients per month who presented to the emergency department and requested a medical screening examination.

Failure to provide an alleged sexual assault victim with a medical screening exam could potentially result in the patient suffering life threatening injuries during the alleged assault and the CAH staff would not identify the injuries. Additionally, the failure to perform a medical screening exam could potentially result in the CAH staff failing to collect evidence needed for the criminal case resulting from the alleged sexual assault.

Findings Included:

1. Review of the policy, "EMTALA - Screen and Transfer of Patient," reviewed 1/2017, revealed in part, "If an individual or someone acting on the individual's behalf, arrives on the hospital campus seeking medical examination/treatment ... [they are] entitled to a screening examination. ... Any individual ... requesting an examination or treatment for a medical condition will be provided these services within the capabilities of the hospital."

2. During an interview on 4/19/17 at 7:15 PM, Patient #31 stated they experienced an alleged sexual assault during the early morning hours of 4/10/17. Witness C convinced Patient #31 to seek medical care for the alleged sexual assault after work on 4/11/17. Patient #31 and Witness C went to Montgomery County Memorial Hospital (MGMH) and requested a sexual assault examination for Patient #31. Registrar A started registering Patient #31, heard Patient #31's name, and then went back to the ED and spoke with the ED staff. When Registrar A returned to Patient #31, Registrar A told Patient #31 that the CAH ED staff could not do the exam, due to the length of time following the alleged sexual assault. Patient #31 stated they went to another hospital to seek care and receive an alleged sexual assault examination.

3. Review of the policy "EMTALA - Screen and Transfer of Patient," revised 1/2017, revealed in part, "Any individual ... requesting an examination or treatment for a medical condition will be provided these services within the capabilities of the hospital."

Please refer to C-2406 for additional information concerning the CAH's failure to ensure Patient #31 received a medical screening examination.
VIOLATION: EMERGENCY ROOM LOG Tag No: C2405
Based on document review and staff interview, the administrative staff failed to ensure the registration staff included 1 of 2 patients on the critical access hospital's (CAH's) emergency department log who presented to the dedicated emergency department following an alleged sexual assault and requested treatment. The administrative staff identified an average of 423 patients who presented to the emergency department each month and requested care. The administrative staff identified 2 patients who presented to the critical access hospital's dedicated emergency department following an alleged sexual assault between 10/1/16 to 4/19/17.

Failure to include all patients who requested a medical screening exam on the central log could potentially result in the administrative staff being unable to identify all patient needs for the community.


Findings included:

1. Review of the policy " EMTALA - Screen and Transfer of Patient," reviewed 1/2017, revealed in part, " A central log shall be maintained as to each individual who comes to the Emergency Department..."

2. Review of the emergency department's central log for 4/11/17 revealed 15 patients presented to the dedicated emergency department and requested emergency medical care. The central log failed to include Patient #31. The facility staff failed to create a medical record for Patient #31.

3. During an interview on 4/19/17 at 4:40 PM, Registrar A stated Patient #31 presented to the emergency department after a possible sexual assault. Patient #31 allegedly had contacted the police, and the police told Patient #31 not to undergo a sexual assault exam as Patient #31 reported the assault to them over 24 hours after the assault occurred. Patient #31 and a friend presented to the hospital and inquired about a sexual assault exam for Patient #31. Registrar A began the registration process for Patient #31. During the registration process, Registrar A spoke with Physician's Assistant (PA-C) B, who verified the sexual assault exam could only occur within 24 hours after the assault occurred.

Registrar A told Patient #31 what PA-C B said. Patient #31 became upset and left the critical access hospital. Registrar A deleted Patient #31's registration information. Registrar A stated if she did not save Patient #31's registration information, Patient #31's name would not show up on the central emergency department log.

4. During an interview on 4/24/17 at 10:45 a.m. PA-C B identified the registration person would not address me. The registration desk staff mainly spoke to the nursing staff.

5. During an interview on 4/24/17 at 4:00 PM, the Emergency Department Director acknowledged Patient #31 did not appear on the critical access hospital's central emergency department log. The Emergency Department Director stated Registrar A should have included Patient #31 on the central emergency department log.
VIOLATION: MEDICAL SCREENING EXAM Tag No: C2406
Based on document review and staff interview, the facility's administrative staff failed to ensure 1 of 2 alleged sexual assault victims, who presented to the critical access hospital (CAH) between 10/1/16 and 4/19/17 and requested emergency medical care, received a medical screening examination. The administrative staff identified an average of 423 patients per month who presented to the emergency department and requested a medical screening examination.

Failure to provide an alleged sexual assault victim with a medical screening exam could potentially result in the patient suffering life threatening injuries during the alleged assault and the CAH staff would not identify the injuries. Additionally, the failure to perform a medical screening exam could potentially result in the CAH staff failing to collect evidence needed for the criminal case resulting from the alleged sexual assault.

Findings included:

1. Review of the policy, "EMTALA - Screen and Transfer of Patient," reviewed 1/2017, revealed in part, "If an individual or someone acting on the individual's behalf, arrives on the hospital campus seeking medical examination/treatment ... [they are] entitled to a screening examination. ... Any individual ... requesting an examination or treatment for a medical condition will be provided these services within the capabilities of the hospital."

2. During an interview on 4/19/17 at 7:15 PM, Patient #31 stated they experienced an alleged sexual assault during the early morning hours of 4/10/17. Witness C convinced Patient #31 to seek medical care for the alleged sexual assault after work on 4/11/17. Patient #31 and Witness C went to Montgomery County Memorial Hospital (MGMH) and requested a sexual assault examination for Patient #31. Registrar A started registering Patient #31, heard Patient #31's name, and then went back to the ED and spoke with the ED staff. When Registrar A returned to Patient #31, Registrar A told Patient #31 that the CAH ED staff could not do the exam, due to the length of time following the alleged sexual assault. Patient #31 went to another hospital to seek care and receive an alleged sexual assault examination.

3. During an interview on 4/19/17 at 8:00 PM, Witness C stated Patient #31 went to the CAH and requested care following an alleged sexual assault. Patient #31 spoke with Registrar A and their driver's license and insurance cards to Registrar A. Registrar A was initially very caring and compassionate towards Patient #31, but Registrar A's demeanor changed when Registrar A heard Patient #31's name. Registrar A suddenly got up and went to the emergency department. Registrar A stated the CAH staff could not treat Patient #31, due to the length of time between the alleged sexual assault and Patient #31's presentation to the CAH. Witness C then requested the CAH staff to evaluate Patient #31 for a sexually transmitted disease. Registrar A told Witness C that the CAH staff could not help Patient #31, due to the length of time between the alleged sexual assault and Patient #31's presentation to the CAH. After Registrar A told Patient #31 and Witness C that the CAH staff could not help Patient #31, Witness C told Patient #31 they would go to another hospital.

4. Review of the staffing schedule for 4/11/17 revealed PA-C B worked as the medical provider in the CAH's emergency department all day.

5. During an interview on 4/24/17 at 10:45 AM, Physician's Assistant (PA-C) B stated the CAH lacked a nurse with specialized training in assisting victims of an alleged sexual assault. PA-C B stated because the CAH lacked the specialized nursing staff, PA-C B must perform an alleged sexual assault examination to assess the patient and collect the evidence. PA-C B stated the CAH had an alleged sexual assault collection kit and the alleged sexual assault evidence collection kit contained instructions and all of the supplies necessary to perform an alleged sexual assault examination. PA-C B then described the process for performing an alleged sexual assault examination. PA-C B stated that even if the CAH staff could not collect evidence for a criminal case, the CAH staff should examine victims of an alleged sexual assault to determine if they suffered any injuries during the alleged assault.

6. During an interview on 4/24/17 at 4:00 PM, the Emergency Department Director stated the CAH staff should have provided a medical screening examination to Patient #31 when they requested the CAH staff provide assistance following an alleged sexual assault.