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.

MILFORD HOSPITAL, INC 300 SEASIDE AVENUE MILFORD, CT 06460 Aug. 24, 2016
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
Based on a review of the clinical records, facility documentation, facility policies, and interviews with facility staff, the facility failed to ensure that one of twenty-one patients (P#1) reviewed for an EMTALA investigation and/or who presented to the Emergency Department (ED) via an ambulance with a chief health complaint of a change of mental status was entered into the ED central log. The finding includes:

Review of the ambulance run sheet dated 8/11/16 at approximately 10:30 AM indicated that Patient #1 was being transported from hemodialysis back to his/her skilled nursing facility (SNF). The ambulance run sheet indicated that the patient had poor color and poor cognition/change of mental status. The run sheet indicated that Hospital #1 was contacted via a land line and the case was reviewed with MD #1. The run sheet indicated that at destination of Hospital #1, MD #1 refused the patient stating that the hospital was on CT (Computed Tomography) scan diversion (makes use of computer-processed combination of many x-ray images). The note indicated that at Hospital #1 MD #1 refused to assess patient and/or take vital signs.
Interview with MD #1 on 8/23/16 at 10:45 AM indicated that on 8/11/16 he was called by the ambulance and was informed that a patient was on the way. MD #1 stated that he informed the Ambulance that the hospital was on diversion secondary to the CT scan being down (not functioning). MD #1 stated that a short time later the ambulance crew arrived at the door and entered the ED with the patient and at that time the physician approached the stretcher and informed the ambulance crew that the Hospital was on diversion and that the patient should be transported to another facility. MD #1 indicated that his medical evaluation consisted of "looking" at the patient.
Interview on 8/245/16 at 11:25 AM with RN #4 (Charge Nurse) indicated that Patient #1 arrived at the ED accompanied by the ambulance crew, MD #1 went to the stretcher and informed the ambulance crew that the hospital was on diversion secondary to the CT scan being down. MD #1 informed them that the patient needed to go to a hospital that could perform a CT scan on the patient. RN #4 indicated that the patient "was not touched" while in the ED.
Review of the ED log for the period of 8/10/16 through 8/12/16 failed to reflect that the patient's information had been entered into the log. Review of the computerized medical record system with RN #1 on 8/23/16 at 10:30 AM failed to reflect that the patient had been registered and/or that a medical record had been initiated for Patient #1
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on a review of the clinical record, facility documentation, facility policies, and interviews with facility personnel, the facility failed to ensure that one of twenty-one patients (P#1) reviewed during an EMTALA investigation and/or who was brought to the Emergency Department (ED) by ambulance, with the chief health complaints of mental status changes was provided a medical screening and stabilized prior to being removed from the ED. Furthermore, the facility failed to ensure that a central log was maintained for each individual who came to the ED, seeking assistance, whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged was maintained.

Please refer to A-2405 and 2406
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on a review of the clinical record, facility documentation, facility policies, and interviews with facility personnel, the facility failed to ensure that one patient (P#1) who was brought to the ED by ambulance with the chief health complaints of mental status changes was provided a medical screening by qualified medical personnel. The finding includes:

Review of the ambulance run sheet dated 8/11/16 at approximately 10:30 AM indicated that Patient #1 was being transported from hemodialysis back to his/her skilled nursing facility (SNF). The ambulance run sheet indicated that the patient had poor color and poor cognition/change of mental status. The run sheet indicated that Hospital #1 was contacted via a land line and case reviewed with MD #1. The run sheet indicated that at destination of Hospital #1 MD #1 refused the patient stating that the hospital was on CT scan diversion. The note indicated that at Hospital #1 MD #1 refused to assess patient and/or take vital signs.
Interview with MD #1 on 8/23/16 at 10:45 AM indicated that on 8/11/16 he was called by the ambulance and was informed that a patient was on the way. MD #1 indicated that the transmission was unclear and he had difficulty understanding what was being said. MD #1 stated that he informed the Ambulance that the hospital was on diversion secondary to the CT scan being down. MD #1 stated that he does not recall the ambulance responding to that information. MD #1 stated that a short time later the ambulance crew arrived at the door and entered the ED with the patient and at that time the physician approached the stretcher and informed that ambulance crew that the Hospital was on diversion and that the patient should be transported to another facility. MD #1 Indicated that his medical evaluation consisted of "looking" at the patient.
Interview with RN # 2 on 8/23/16 at 11:00 AM indicated that she remembered the call and MD #1 stating that the facility was on diversion. Additionally RN #2 stated that the next thing she knew the patient was in the ED hallway.
Interview with the Chairman of the ED on 8/24/16 at 11:00 AM indicated that once Patient #1 arrived to the ED he would have expected the patient to be registered, have a chart initiated, triaged and a medical evaluation completed. The Chairman indicate that once the patient is stabilized the decision to transfer can be made.
Interview on 8/245/16 at 11:25 AM with RN #4 (Charge Nurse) indicated that Patient #1 arrived to the ED accompanied by the ambulance crew, MD #1 went to the stretcher and informed the ambulance crew that the Hospital was on diversion secondary to the CT scan machine being down. MD #1 informed them that the patient needed to go to a hospital that could perform a CT scan on the patient. RN #4 indicated that the patient "was not touched" while in the ED.
Review of the policy "General Information Regarding the Emergency Center" indicated that all patients seeking treatment in the ED must be seen by a physician or private attending. All patients are provided a timely medical screening evaluation appropriate to their presenting complaint and needs. Review of the policy "Authorization for Transfer/EMTALA Form" indicated that all patients being transferred to another facility must have an EMTALA form completed. Review of the computerized medical record system with RN #1 on 8/23/16 at 10:30 AM failed to reflect that the patient had been triaged and/or evaluated. Review of the ED log for 8/11/16 failed to reflect the patient's name.