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.

EMERSON HOSPITAL - 133 OLD ROAD TO 9 ACRE CORNER W CONCORD, MA 01742 Sept. 8, 2014
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
Based on record review and staff interview, the Hospital failed to ensure one patient (Patient #1) in a total sample of 30 patients, was appropriately transferred.

Findings include:

1.) The Emergency Medical Service (EMS) ambulance trip record, dated 8/27/14, indicated Patient #1 was brought to Hospital #1 with an emergency medical condition.

2.) The Surveyor interviewed the Attending ED Physician at 8:30 A.M., on 9/8/14. The ED Attending said he looked at Patient #1's EKG and said that Patient #1 would need a cardiac catheterization and it was in his/her best interest to immediately transfer Patient #1 to Hospital #2.

3.) Patient #1 had an emergency medical condition that was not assessed. The required documentation for an appropriate transfer of a patient with an emergency medical condition (under the Emergency Medical Treatment and Labor Act) was not completed.
VIOLATION: STABILIZING TREATMENT Tag No: A2407
Based on record review and staff interview, for one Patient, (Patient #1), in a total sample of 30 patients, the Hospital #1 failed to ensure that stabilizing treatment for an emergency medical condition was provided and the care was documented prior to sending Patient #1 to Hospital #2.

Findings include:

1.) The Emergency Medical Service (EMS) ambulance trip record, dated 8/24/14, indicated Patient #1 was successfully resuscitated after a cardiac arrest and was brought to Hospital #1.

2.) The Surveyor interviewed the Attending ED Physician at 8:30 A.M., on 9/8/14. The ED Attending said he saw that Patient #1 was lying in the ambulance, intubated (a tube place in the throat to keep the patient's airway open), his/her eyes were open, was waking up and moving his/her extremities.

3.) Hospital #1 did not create a medical record for Patient #1 and therefore there was no documentation that stabilization care was provided by Hospital #1, for Patient #1 who had an emergency medical condition. No medical screening examination was performed, no assessment of Patient #1's emergency medical condition and no documentation that transfer arrangements were made.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on record review, review of policies and procedures, review of Medical Staff Bylaws, Rules and Regulations and staff interviews, it was determined the Hospital failed to ensure that 1 patient (Patient #1) in a total sample of 30 patients, was provided with an appropriate medical screening examination after presenting to the Emergency Department (ED) seeking treatment and that a medical record was created for Patient #1

Findings include:

1.) The Hospital's Medical Staff Bylaws Rules and Regulations indicated that any patient who presents to the ED requesting a medical evaluation shall have a medical screening evaluation performed and have necessary stabilization treatment. The Rules and Regulations also indicate a medical record will be generated.


2.) The ED log, dated 8/27/14, indicated the Hospital did not generate a medical record on 8/27/14, for Patient #1.


3.) The Emergency Medical Service (EMS) ambulance trip record, dated 8/27/14, indicated Patient #1 had a cardiac arrest and was successfully resuscitated. The EMS record indicated Patient #1 was brought to Hospital #1 and was met by the ED Attending Physician in the ambulance bay area. The ED Attending Physician requested the ambulance crew bring Patient #1 to Hospital #2, despite no electrocardiogram (EKG) changes. The EMS record indicated the ED Attending Physician felt that Hospital #2, a cardiac catheterization capable facility, would be most appropriate for Patient #1.


5.) The Surveyor interviewed the ED Charge Nurse at 11:00 A.M., on 9/4/14. The ED Charge Nurse said an ambulance crew, waiting in the ED, reported to her that an 80 + year old patient who had a cardiac arrest was coming to the Hospital with another ambulance crew. The ED Charge Nurse said they received a telephone call from the EMS crew that was bringing Patient #1 to the ED. The ED Charge Nurse said that the EMS crew reported they were sending Patient #1's EKG electronically to the Hospital. The ED Charge Nurse said she received the EKG and handed it to the ED Attending Physician. The ED Charge Nurse said the ED Attending said Patient #1 needed an urgent cardiac catheterization and would need to go to Hospital #2. The ED Charge Nurse said she saw the ambulance in the Hospital's driveway and saw the ED Attending walk out to the ambulance. The ED Charge Nurse said she was not aware of the "250 yard rule" (a patient presenting to a hospital in any area located within 250 yards of the facility main building are requirement to provide a medical screening examination), when the ambulance transporting Patient #1 was in the ambulance bay area.


6.) The Surveyor interviewed the Attending ED Physician at 8:30 A.M., on 9/8/14. The ED Attending said he looked at Patient #1's post cardiac arrest EKG and saw ischemia (a lack of oxygen) and a heart rhythm disturbance. The ED Attending Physician said the advanced cardiac life support (ACLS) algorithm (standards of care) indicated that an urgent cardiac cath was needed. The ED Attending said it was in Patient #1's best interest to take him/her as quickly as possible to hospital with a cardiac catheterization laboratory. The ED Attending said he telephoned Hospital #2 and Hospital #2 accepted Patient #1 and they were able to take Patient #1 to the cardiac catheterization laboratory. The ED Attending said he did not document his assessment of Patient #1's EKG nor did he complete the required transfer forms and he did not complete a medical screening evaluation.