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.

TRI COUNTY HOSPITAL - WILLISTON 125 SW 7TH ST WILLISTON, FL July 1, 2011
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on observations, staff interviews, patient interviews, and record reviews the facility failed to ensure that patients presenting to the emergency room received a medical screening examination and stabilizing treatment prior to leaving the emergency department for 2 of 22 sampled patients (#'s 20 and 21).

Findings:


1. Based on observations, review of medical records, policies and procedures and interviews the facility failed to ensure that medical screening examinations were provided within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed for 2 of 22 (#20, and #21) sampled emergency room medical records. reviewed. REFER TO TAG A-2406.


2. Based on patient and staff interviews, review of medical records and policies and procedures the facility failed to ensure that 2 of 22 (#20, and #21) emergency room patients were provided stabilizing treatment that was within the capability of the staff and facilities available at the hospital for further medical examination and treatment as required to stabilize a medical condition, prior to the patients leaving the facility. REFER TO TAG A-2407.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on observations, review of medical records, policies and procedures and interviews the facility failed to ensure that medical screening examinations were provided within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed for 2 of 22 (#20, and #21) emergency room sampled medical records reviewed.

Findings:

1. Review of the facility's policy titled, EMTALA Compliance" original date June 2010, Last revised May 2011, specified in part, "EMERGENCY MEDICAL CONDITIONS: Emergency medical conditions under EMTALA . . . constitute any condition that is a danger to the patient or unborn fetus, or could result in a risk of loss of function or impairment if the patient is not treated promptly. These conditions include. . . 2. Pregnancy with contractions... STANDARDS: A. All patients presenting to Tri County Hospital -Williston for a non-scheduled visit and seeking care must be accepted and evaluated. . . B. All patients shall receive a medical screening exam that includes providing all necessary testing and services within the capability of the hospital to reach a diagnosis. Federal law requires that all necessary definitive treatment will be given to the patient."
Review of the policy titled, "Medical Screening Examination", Original Date: June 2010, Last Revised May 2010 indicated in part, "Policy: The Emergency Department will provide a Medical Screening Examination (MSE) to determine if the individuals has an emergency medical condition... The MSE shall be provided within the capabilities of the Emergency Department.. . Procedure: 1. Medical Screening Examination: The Emergency Department will provide a Medical Screening Examination (MSE) for every person who comes to the hospital .making a request for examination or treatment. The purpose of the examination is to determine if the individual has an emergency medical condition. A medical screening examination will be conducted as promptly as possible depending on the activity in the ED and the acuity of individuals requesting examination or treatment."

2. Review of the medical record for patient #20 revealed that the patient (MDS) dated [DATE] at 11:30 p.m., with an unknown obstetrics/gynecology (OB/GYN) complaint. Review of the medical record revealed that the record was labeled as LWBS, (left without being seen) 15 minutes after the start of the triage by a paramedic. The 4 page form was blank except for the patient's name, date of triage, time of triage, under the Chief Compliant OB/GYN and marked LWBS. On the last page under DOCUMENTATION completed by the paramedic "LWBS Advised since pregnancy prevented any X-ray would just go to [named hospital] [Labor & Delivery]". Under the DISPOSITION section located on the bottom of the page revealed LWBS, Date of Discharge 05/09/11 Time of Discharge 2325 and on the line Signatures of Nurse and Initials: signed by the paramedic. Review of the medical record did not reveal that the patient had a complete triage or was seen by a physician or PA for a medical screening examination to determine whether or not an emergency medical condition exists for patient # 20 on 5/9/2011. The medical record did not reveal that the patient was informed of the risks and possible complication of transfer in a private care. The medical record did not reveal if the patient was or was not experiencing emergency medical condition and was stable at the time the patient was directed to go to the named hospital. Review of the medical record from the acute care hospital in Gainesville revealed that patient #21 was a [AGE] year old who (MDS) dated [DATE] at 1250 a.m. with a presenting complaint , " Pain in upper rt (right) abd (abdomen) after coughing."Documentation by the obstetrical (OB) triage nurse revealed the patient was not experiencing any uterine contractions or vaginal bleeding. Documentation also indicated that patient #20 was 33 weeks pregnant, and expected date of delivery was 6/22/11. Further review of this form indicated in part, " Pt (Patient) to triage Toco with U/S (ultrasound) transducer to abdomen to monitor . Pt seen by Physician. Evaluation done NST ( Non-Stress Test:A test to monitor and records the baby's heart rate in conjunction with any uterine activity) reactive. Pt. discharged to home."

3. Observation of patient #21 on 06/30/2011 at 3:18 PM sitting in the ER waiting room revealed Patient Access Representative, (not a nurse or a person with a clinical background), approach the patient and asked if he needed to be seen. The patient had another gentleman with him and neither spoke English. The Patient Access Representative continued to ask if the patient needed to be seen. Patient #21 pointed to his hand where he had stitches. His friend stated "knife". The Patient Access Representative asked where he went for stitches. The friend responded Gainesville hospital. The Patient Access Representative told patient #21, "You have to go back to the hospital where they put the stitches in to be seen". The friend again pointed to the wound and appeared not to understand. Patient #21 did not appear to understand. The patient Access Representative repeated that he would need to return to the hospital where he went for the stitches to get the stitches taken out. The facility failed to ensure that a medical screening examination was provided for patient #21 on 6/30/2011 to determine whether or not an emergency medical condition existed. The Patient Access Representative then left the room. The Patient Access Representative returned at about 3:20 PM and told the surveyor that the friend of patient #21 had a girlfriend in the back and she would take him to Gainesville tomorrow. Observation at 3:25 PM revealed the girlfriend of the friend of patient #21 came out to talk with the Patient Access Representative in patient access (registration room). She told the surveyor that she was concerned that the knife wound and stitches might be infected because of itching and had asked for them to be looked at, but they were told to go back to the Gainesville hospital.

The facility failed to ensure that medical screening examinations were provided within the capabilities of the emergency department including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed for patient #'s #20 and #21.
VIOLATION: STABILIZING TREATMENT Tag No: A2407
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on patient and staff interviews, review of medical records and policies and procedures the facility failed to ensure that 2 of 22 (#20, and #21) emergency room patients were provided stabilizing treatment that was within the capability of the staff and facilities available at the hospital for further medical examination and treatment as required to stabilize a medical condition, prior to the patients leaving the facility.

Findings:

1. Review of the policy titled, "Medical Screening Examination", Original Date: June 2010, Last Revised May 2010 indicated in part," 2. Stabilizing Treatment. . . If it is determined that the individual has an emergency medical condition, the ED will provide the individual within the capabilities of the hospital, with such further medical examination and treatment, as required to stabilize the medical condition."

2. Review of the medical record for patient #20 revealed that the patient (MDS) dated [DATE] with an unknown obstetrics/gynecology (OB/GYN) complaint. Review of the medical record revealed that the record was labeled as LWBS, (left without being seen) 15 minutes after the start of the triage by a paramedic. The 4 page form was blank except for the patient's name, date of triage, time of triage, under the Chief Compliant OB/GYN and marked LWBS. On the last page under DOCUMENTATION completed by the paramedic "LWBS Advised since pregnancy prevented any X-ray would just go to [named hospital] [Labor & Delivery]". Under the DISPOSITION section located on the bottom of the page revealed LWBS, Date of Discharge 05/09/11 Time of Discharge 2325 and on the line Signatures of Nurse and Initials: signed by the paramedic. Review of the medical record did not reveal that the patient had a complete triage or was seen by a physician or PA for a medical screening examination with stabilizing treatment. The medical record did not reveal that the patient was informed of the risks and possible complication of transfer in a private care. The medical record did not reveal if the patient was or was not experiencing an emergency medical condition and was stable at the time the patient was directed to go to the named hospital.

3. Observation of patient #21 on 06/30/2011 at 3:18 PM sitting in the ER waiting room revealed Patient Access Representative, (not a nurse or a person with a clinical background), approach the patient and asked if he needed to be seen. The patient had another gentleman with him and neither spoke English. The Patient Access Representative continued to ask if the patient needed to be seen. Patient #21 pointed to his hand where he had stitches. His friend stated "knife". The Patient Access Representative asked where he went for stitches. The friend responded Gainesville hospital. The Patient Access Representative told patient #21, "You have to go back to the hospital where they put the stitches in to be seen". The friend again pointed to the wound and appeared not to understand. Patient #21 did not appear to understand. She repeated that he would need to return to the hospital where he went for the stitches to get the stitches taken out. The Patient Access Representative then left the room.
The Patient Access Representative returned at about 3:20 PM and told the surveyor that the friend of patient #21 had a girlfriend in the back and she would take him to Gainesville tomorrow. At 3:25 PM the girlfriend of the friend of patient #21 came out to talk with the Patient Access Representative in patient access (registration room). She told the surveyor that she was concerned that the knife wound and stitches might be infected because of itching and had asked for them to be looked at, but they were told to go back to the Gainesville hospital.

The facility failed to ensure that stabilizing treatment was provided that was within the capability of the staff and facilities available at the hospital for further medical examination and treatment as required to stabilize a medical condition, prior to patient #'s 20 and 21 leaving the facility.