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.

JACKSON MEMORIAL HOSPITAL 1611 NW 12TH AVE MIAMI, FL 33136 Nov. 4, 2011
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
1. Based on review of medical records, Emergency Medical Services run and trip sheets and interviews, the facility failed to complete a medical screening examination for one of twenty sampled patients (#1). Refer to Tag A- 2406.

2. Based on medical record review and interviews, the facility failed to provide stabilizing treatment to an individual as required for a medical condition for one of twenty sampled patients (#1). Refer to Tag A-2407.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on review of medical records, Emergency Medical Services run and trip sheets and interviews, the facility failed to complete a medical screening examination for one of twenty sampled patients (#1).

The findings include:

Patient #1's Baker Act papers titled "Certificate of Professional initialing Involuntary Examination" form dated 10/10/11 at 5: 00 p.m. was reviewed. The Clinical Psychologist documented patient #1' s diagnosis as Depression, Anxiety, and Psychosis and reported with episodes of confusion and paranoid delusions. Further documentation revealed because of Mental Illness, "B. Person is unable to determine for himself/herself whether examination is necessary ... B. There is substantial likelihood that without care or treatment the person will cause serious bodily harm to self and others." The Emergency Medical Services (EMS) Patient care Report dated 10/10/2011 was reviewed. Documentation by the EMS personnel revealed in part, " Pt (patient #1) 50 y/o (year /old) ...AAOx# (Awake alert and oriented) w/o (without distress). Pt. nurse states pt was Baker Acted earlier today due to pt urinating on pt/w (patient/with) open wounds, being aggressive harassing and threatening others, pt was taken to Jackson North, pt is able to ambulate w/out assistance.. . Pt was assisted off of stretcher and onto a bed, pt case was handed ... to nurse for further care ... staff could not accept the pt.. . due to Jackson North not being a Psych facility dispatcher was informed of issue. Pt was assisted off bed and on to stretcher pt was secured to stretcher ...pt was transported to Name of Hospital (another acute care hospital)." Review of the EMS trip sheet dated 10/10/2011 at 8:12 p.m., indicated part, " Crew called 2 (to) advise Gvn-ng(giving) hard time due 2 facility states not a facility 4 (for) this type transport.. 8:19 p.m. ... to be taken 2 Name of hospital (another acute care hospital). " Record review of sample patient #1 revealed that the patient was present in the facility's emergency department on 10/10/11 at 8:15 p.m.. The record only contains a face sheet that the patient was brought to the emergency department. There is no other information in the patient's record. The facility failed to ensure that on 10/10/2011 patient #1 received an appropriate medical screening examination that was within the capability of the hospital ' s emergency department, including ancillary services routinely available to the emergency to department to determine whether or not an emergency medical condition existed. The medical record from the accepting hospital was reviewed. Review of the " Emergency Physician Record indicated the patient #1 ' s chief complaint was " depression and agitated. " Further review indicated that the ED physician performed a medical screening examination, ordered laboratory studies and an Electrocardiogram. The ED physician documented that patient #1 was cleared medically for a psychiatric referral. The ED physician also documented, " Clinical Impression " was depression and psychosis. Patient #1 was admitted as an inpatient to the accepting hospital.
Interview with the Clinical Affairs officer on November 3, 2011 at 11:10 a.m.. revealed that another complaint survey was recently done on sample patient #1. The Clinical Affairs officer stated that the patient was brought to the facility from an assisted living facility. The Clinical Affairs officer stated that once the patient was brought in to the emergency department it was discovered that the patient was supposed to be taken to another facility. According to the Clinical Affairs officer the charge nurse went to speak to the nurse supervisor and when he returned the patient and ambulance staff were gone. She goes on to state that hospital #2 called to inform them the patient was at their facility and the nurse supervisor told them the patient could be brought back but hospital #2 chose to keep the patient.

Interview with the Vice President (VP)of the Ambulance Company (the ambulance company that transported sample patient #1) was done on November 3, 2011 at 11:40 a.m. The Vice President of the ambulance company (VP) stated that his drivers do not look at the paperwork and they transport based on the address dispatch gives to them verbally. The VP stated that Assisted Living Facility (ALF) #1 requested the patient to be transported the hospital #1 when they called in. Furthermore the VP stated that the patient was considered non-emergency so his drivers would have transported anywhere requested. The VP stated that he was called by the ambulance company dispatch and informed that hospital #1 was refusing the patient based on the paperwork reading hospital #3. The VP stated "I called the nurse supervisor at hospital #1 and asked are you aware you just turned away a patient in the ER [emergency room ]?" The VP stated the nurse supervisor replied "he does not belong here" to which the VP replied "this is an EMTALA [Emergency Medical Treatment and Labor Act] situation." The VP stated that the nurse supervisor finally agreed to take the patient back but the patient was at hospital #2 by that time.

Interview with the Emergency Medical Technician (EMT) that transported sample patient #1 was done on 11/3/11 at 12;20 pm. The EMT stated I loaded the patient on the stretcher at ALF #1 and transported the patient to hospital #1, which was the address I was provided. The EMT continues that when he arrived at hospital #1 Emergency Department with sample patient #1 I handed the paperwork from ALF #1 to the lady in the intake area and she informed me the patient should not be at their facility. At this time the EMT stated I removed the patient from the stretcher and allowed him to use the restroom. The EMT stated that a male nurse came and told him again the patient should not be at their facility and said "we are not a psych [psychiatric] receiving facility." The EMT said he then called the ambulance company dispatch and was told to take the patient to hospital #2. The EMT stated that he told the male nurse he was removing the patient to take to another facility. The EMT stated that hospital #2 was hesitant because the paperwork said North Shore but they accepted the patient.

Interview with the Associate Director of the Emergency Department was conducted on 11/4/11 at 10 a.m. The Associate Director of the Emergency Department stated that after speaking with the sample employee #1 he felt that he had no choice but to let the ambulance drivers take sample patient #1. The Associate Director of the Emergency Department stated that all emergency room staff is trained in EMTALA regulations and updated annually. Furthermore she stated this was a rare case. The Director of the Emergency Department stated that she has never had any problems with sample employee #1. She stated that the facility was not a Baker Act receiving facility for a while but began receiving Baker Act patients again in July 2011.

Interview with the Associate Director of the Emergency Department and the Clinical Affairs officer on November 4, 2011 at 3 pm confirmed that sample patient #1 was not medically screened or medically treated and allowed to leave the facility's emergency department. The Director of the Emergency Department stated that she would be in-servicing the emergency department staff to ensure this incident does not happen again.
VIOLATION: STABILIZING TREATMENT Tag No: A2407
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on medical record review and interviews, the facility failed to provide stabilizing treatment to an individual as required for a medical condition for one of twenty sampled patients (#1).

The findings include:

Record review of sample patient #1 revealed that the patient was transferred to the facility's emergency department on 10/10/11. The record only contains a face sheet noting that the patient was brought to the emergency department and was admitted and discharged on [DATE]. There is no evidence of any medical assessment, treatment, or stabilization of the patient's condition prior to discharge. The facility failed to ensure that stabilizing treatment as required was provided for patient #1 on 10/10/11 when he/she presented to the emergency department.

Interview with the Clinical Affairs officer on November 3, 2011 at 11:10am revealed that the patient was brought to the facility from an assisted living facility. The Clinical Affairs officer stated that once the patient was brought in to the emergency department it was discovered that the patient was supposed to be taken to another facility. According to the Clinical Affairs officer, the charge nurse went to speak to the nurse supervisor and when he returned, both the patient and the ambulance staff were gone. She goes on to state that hospital #2 called to inform them that the patient was at their facility and the nursing supervisor then told them that the patient could be brought back, but hospital #2 chose to keep the patient.

Interview with the Vice President of the Ambulance Company (the ambulance company that transported sample patient #1) was done on November 3, 2011 at 11:40 a.m. The Vice President of the ambulance company (VP) stated that his drivers do not look at the paperwork and they transport based on the address dispatch gives to them verbally. The VP stated that Assisted Living Facility (ALF) #1 requested the patient to be transported the hospital #1 when they called in. Furthermore the VP stated that the patient was considered non-emergency so his drivers would have transported anywhere requested. The VP stated that he was called by the ambulance company dispatch and informed that hospital #1 was refusing the patient based on the paperwork reading hospital #3. The VP stated "I called the nurse supervisor at hospital #1 and asked are you aware you just turned away a patient in the ER [emergency room ]?" The VP stated the nurse supervisor replied "he does not belong here" to which the VP replied "this is an EMTALA [Emergency Medical Treatment and Labor Act] situation." The VP stated that the nurse supervisor finally agreed to take the patient back but the patient was at hospital #2 by that time.

Interview with the Emergency Medical Technician (EMT) that transported sample patient #1 was done on 11/3/11 at 12;20 pm. The EMT stated I loaded the patient on the stretcher at ALF #1 and transported the patient to hospital #1, which was the address I was provided. The EMT continues that when he arrived at hospital #1 Emergency Department with sample patient #1, I handed the paperwork from ALF #1 to the lady in the intake area and she informed me the patient should not be at their facility. At this time the EMT stated I removed the patient from the stretcher and allowed him to use the restroom. The EMT stated that a male nurse came and told him again the patient should not be at their facility and said "we are not a psych [psychiatric] receiving facility." The EMT said he then called the ambulance company dispatch and was told to take the patient to hospital #2. The EMT stated that he told the male nurse he was removing the patient to take to another facility. The EMT stated that hospital #2 was hesitant because the paperwork said North Shore but they accepted the patient.

Interview with the Associate Director of the Emergency Department was conducted on 11/4/11 at 10 a.m. The Associate Director of the Emergency Department stated that after speaking with the sample employee #1 he felt that he had no choice but to let the ambulance drivers take sample patient #1. The Associate Director of the Emergency Department stated that all emergency room staff is trained in EMTALA regulations and updated annually. Furthermore she stated this was a rare case. The Director of the Emergency Department stated that she has never had any problems with sample employee #1. She stated that the facility was not a Baker Act receiving facility for a while but began receiving Baker Act patients again in July 2011.

Interview with the Associate Director of the Emergency Department and the Clinical Affairs officer on November 4, 2011 at 3 pm confirmed that sample patient #1 was not medically screened or medically treated and allowed to leave the facility's emergency department. The Director of the Emergency Department stated that she would be in-servicing the emergency department staff to ensure this incident does not happen again.