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.

Based upon interview, medical record review and document review, it was determined that the facility failed to have policies and procedures in effect to ensure compliance with 42 CFR 489.24 and the related provisions at 42 CFR 489.20.

Findings include:

Review of the Emergency Department log and medical records revealed the facility did not comply with the provisions of maintaining a central log and providing a medical screening examination for all patients presenting to the ED. Please reference findings under Tag A2405 and A2406.
Based upon document review a central log was not maintained for Patient #1 who presented to the Emergency Department (ED) on 8/13/11after eloping from the ICU.

Findings include:

Review of the Emergency Department Visit Log dated 8/13/11 revealed no evidence the patient was entered into the log after being brought by the police to the ED for evaluation.

This finding was verified with Staff #1 on 10/20/11.
Based on medical record review, document review and interview, there is no evidence to indicate Patient #1 was screened to determine if an emergency medical condition existed following his presentation to the ED on 8/13/11 after eloping from the ICU.

Findings include:

Review of Emergency Nursing Record dated 8/12/11 revealed the patient was brought to the ED at 10:25pm following a motor vehicle accident (MVA). The patient was noted to be belligerant, spitting and moving his extremities excessively.

Review of Emergency Provider Record dated 8/12/11 revealed a clinical impression of substance abuse, aggressive behavior, renal insufficiency and altered mental status.

Review of History and Physical dated 8/13/11 at 1:57am revealed the patient admitted to using both heroin and bath salts prior to the MVA. Following the administration of Ativan, the patient was noted to be less agitated, but continued to be significantly paranoid, delusional and with acute hallucinations. The plan was to admit the patient to the ICU due to his acute psychosis for monitoring, intravenous fluids and Ativan as needed.

Review of urine toxicology collected on 8/13/11 at 2:00am revealed a positive result for cannabinoid, cocaine, opiates, amphetamines, benzodiazepine and oxycodone.

Review of the hospitalist's note dated 8/13/11 at 8:00am revealed the patient was restless and confused.

Review of Physician Directions dated 8/13/11 at 8:15am revealed an order for a psych consult.

Review of the Critical Care 24 hour flow sheet dated 8/13/11 at 9:00am revealed the patient was observed walking in the hall and returning to his room. When staff went into another patient's room, the patient left the unit and a "Dr. Green" was called. At 9:45am the police department called to report that the patient had been picked up on the Parkway.

Review of the facility's internal investigation revealed the police brought the patient back to the hospital after a passerby reported a person in hospital garb at the side of the road talking to the trees and bushes.

Interview with Staff #3 on 10/21/11 revealed the police brought the patient to the ED and were initially directed to take the patient to the ICU, following which the patient was returned to the ED for evaluation. The triage nurse reported to him that the patient did not want to be seen and was questioning their authority to treat a patient who was refusing care and who was not under Mental Hygiene arrest.

Intervew with Staff #7 on 10/25/11 revealed she was informed of the situation and contacted the administrator on call who concurred that the patient needed to be evaluated in the ED. This information was relayed to the triage nurse who responded in anger. The nursing supervisor was enroute to the ED; however, the patient had been allowed to leave prior to her arrival.

There is no evidence a medical screening examination was obtained on Patient #1 following his presentation in the ED on 8/13/11after eloping from the ICU.