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.

NORTH METRO MEDICAL CENTER 1400 BRADEN STREET JACKSONVILLE, AR 72076 Dec. 2, 2016
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of documents and interview it was determined the entry in the emergency room Daily Log for Patient #21 who presented to the emergency room (ER) for treatment on 10-05-16 was not complete. Incomplete information on the emergency room Daily Log prevented the patient's care being accurately assessed for treatment. This failed practice affected Patient #21 that was named in the Self Report and had the potential to affect all patients that presented to the emergency room requesting emergency treatment. Findings follow:

A. Review of the emergency room Daily Log October 2016 did reveal the name of Patient #21 which was the minor Patient named in the Self Report. Review of the emergency room Daily Log revealed Patient #21 presented on [DATE] to the emergency room and a medical record number was generated at that time. There was no disposition listed for Patient #21 nor was there documentation of why Patient #21 presented to the emergency room .

B. On 12-01-16 at 1215 the Surveyor talked with the Administrator and requested the medical record for Patient #21 that presented to the emergency room . The Administrator on 12-02-16 at 1345 stated there was no medical record for Patient #21 available for review it had been deleted.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of policies and procedures, Medical Staff Bylaws, Emergency Daily Log, interview and Self Report, it was determined Patient #21 presented on [DATE] requesting emergency services and did not receive a medical screening exam. Failure to conduct a medical screening exam did not give the physician enough information to determine if an emergency medical condition existed. This failed practice affected Patient #21 and had the likelihood of affecting any patient that presented to the emergency room requesting emergency services. Findings follow:

A. Patient #21 presented on [DATE]. There was no medical record for the Surveyor to review to determine if a medical screening exam was conducted.

B. Review of the Medical Staff Bylaws on 11-30-16 at 1215 revealed no documentation who could perform a medical screening exam. The Director of Quality and the Chief Nursing Officer verified at 1440 on 11-30-16 there was no evidence in the Medical Staff Bylaws of who could perform the medical screening exam, however a policy titled "Admission of Patient to Emergency Department" Number: ER-A8.0 II. Policy: C. reflected A physician must do a medical screening on each patient to determine if an emergency exists ...".

C. Review of the Emergency Daily Log revealed Patient #21 presented at 2347 on 10-05-16. emergency room physician documented on the Daily Log as Dr. (Named). The Self Report that was submitted regarding Patient #21 revealed an interview by the Chief Nursing Officer, conducted 10-13-16, with the emergency room Physician on duty. The emergency room physician "was interviewed and asked if he recalled Patient #21 coming into the emergency room . He said "I do not."...

D. The Self Report submitted by the Facility revealed an interview conducted by the Chief Nursing Officer, with the nurse on duty when Patient #21 presented, on 10-13-16 which stated "...I spoke with the patient's (Patient #21) mother and informed her of options of going to (Named) hospital or being treated here. I did state several times that we would be glad to treat here. The mother and grandmother then decided to take the patient (Patient #21) elsewhere...".

E. The Surveyor requested the medical record for Patient #21. The Administrator on 12-02-16 at 1530 verified there was no medical record available for review. There was no evidence a medical screening exam was provided to Patient #21.
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
Based on clinical record review and interview, it was determined the Facility failed to fully disclose the risks and benefits of transfer specific to the condition of transferred patients. Failure to fully disclose the risks and benefits did not allow four (Patients #3, #4, #6 and #14) of four (Patients #3, #4, #6 and #14) transferred patients to make an informed decision regarding the need for the transfer along with associated risks and benefits particular to the patient's medical condition. The failed practice was likely to affect Patients #3, #4, #6 and #14. Findings follow:

A. Review of the clinical records of Patients #3, #4, #6 and #14 revealed no evidence of the risks and benefits specific to the condition for which the patient was being transferred. For example:
1) Patient #3 presented 09-30-16 at 0929 with laceration to the fourth and fifth finger of left hand. Review of a form (no name) in the clinical revealed "Risks of transfer - worsening of condition. Benefits of transfer- orthopedic care".
2) Patient #4 presented 08-23-16 at 2225 with right lower quadrant pain. Review of a form (no name) in the clinical record revealed "Risks of transfer - motor vehicle accident. Benefits of transfer- pediatric surgeon".
3) Patient #6 presented 11-02-16 at 2238 with gun shot wound. Review of a form (no name) in the clinical record revealed "Risks of transfer - worsening of condition. Benefits of transfer - eval (evaluation) and treatment of gsw (gun shot wound)".
4) Patient #14 presented 11-26-16 at 1805 with red irritated area on back. Review of a form (no name) in clinical record revealed "Risks of transfer- worsening of condition. Benefits of transfer- surgical cover".

B. The above findings were verified by the emergency room Nurse Manager at 1220 on 08/02/16.