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.

AMERY HOSPITAL & CLINIC 265 GRIFFIN STREET EAST AMERY, WI 54001 Aug. 12, 2014
VIOLATION: COMPLIANCE WITH 489.24 Tag No: C2400
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview this facility failed to ensure compliance with all EMTALA requirements under 42 CFR 489.20 and 42 CFR 489.24 in 1 of 20 (#1) patients who presented to the emergency department seeking emergency medical care.

Findings include:

Pt #1 (MDS) dated [DATE] at 10:30 PM, accompanied by Family Member D, seeking treatment for a febrile seizure. This facility failed to ensure a medical screening exam was done prior to collecting Pt #1 insurance and payer source which delayed treatment. (Reference C2408).
VIOLATION: DELAY IN EXAMINATION OR TREATMENT Tag No: C2408
Based on record review and interview this facility failed to provide a timely medical screening examination prior to collecting insurance and payer source data in 1 of 20 ( #1) records reviewed. This deficient practice has affected Pt #1 and has the potential to affect all patients seeking emergent treatment at this facility.

Findings include:

Per phone interview on 8/11/14 at 12:00 PM with Pt #1's Family Member D, Family Member D stated Pt #1 and Family Member D spent 10-15 minutes at the registration desk which delayed care to Pt #1. Family Member D stated Pt #1 had a seizure prior to arrival at the ED and had vomited. Family Member D had concerns about Pt #1 breathing and stated this to the registration clerk. The registration clerk stated they needed to give more information before being seen. Family Member D stated they were asked to provide name, date of birth, current concerns, allergies and insurance information. Family Member D stated she asked the clerk if she could finish the paperwork after Pt #1 was seen and the clerk said "no". Per Family Member D, the clerk proceeded to take copies of the insurance cards and have Family Member D sign the consent to treat and HIPPA forms before a medical exam took place.

Per review on 8/11/14 at 3:45 PM, accompanied by Clinical Manger B, noted documentation of Pt #1 arriving in ED at 10:30 PM on 6/13/14 and registration completed at 10:41 PM (11 minutes for registration). MD C documented "begin physician exam" at 10:42 PM.

Per interview on 8/12/14 at 9:40 AM with Registrar E, accompanied by Director of Pt Financial Services G, Registrar E stated she called back to the ED and informed them of the patients arrival and concerns. At that time Registrar E was advised to continue with the registration process. Registrar E stated "I kept a close eye on the child". Registrar E stated a second call was placed to the ED staff to inform them the computer system was locked up and they instructed me to continue registration and would be out. Registrar E stated a third call was placed when the registration was complete and then ED staff came out to get Pt #1.

Per review on 8/11/14 at 12:45 PM of facility policy titled EMTALA dated July 2012, it states "1.2 ARMC (Amery Regional Medical Center) will not delay providing the medical screening examination in order to inquire about the individual's method of payment or insurance status..."

Per review on 8/11/14 at 12:40 PM of facility document titled "Symptoms Indicating Need for Triage" dated February 2014, it lists under "Red. Emergency" ... "seizures". Per interview with Registrar F at the time of document review, Registrar F stated "if someone presents with a problem on the Red List (Emergent List) we call back to ED right away and they come get the patient." Per Registrar F, insurance information would then be collected back in ED if the patient is able or it is noted on their clipboard to have the patient come back to registration before they leave.