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.

MEADVILLE MEDICAL CENTER 751 LIBERTY STREET MEADVILLE, PA 16335 Dec. 21, 2012
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility documents and medical records (MR), and staff interviews (EMP), it was determined the provider failed to abide by its agreement to provide an appropriate medical screening exam to any individual who comes to the emergency department for two of 25 medical records (MR1 and MR24)..

Findings include:


Review of the Meadville Medical Center Emergency Department Rules and Regulations revealed, "Section 2-Patient Care The status of patients seen in the Emergency Department is determined by the physician on duty at that time. Any patient seeking emergency services must be offered an appropriate medical screening examination to determine whether or not an emergency medical condition exists... B. Emergency Cases. If an emergency medical condition is found, the hospital must either: 1. Provide stabilizing treatment within its capabilities or 2. If the patient cannot be stabilized, the hospital must arrange for an appropriate transfer... C. Non-Emergent Cases. 1. Such patients will be evaluated by the emergency physician and treated appropriately..."

Review of Administrative Policy A-123.1 "Emergency Medical Treatment and Labor Act (EMTALA) Policy," published August 30, 2012, revealed, "It is the policy of the Meadville Medical Center that any patient who comes to MMC, is on hospital property and requesting emergency services, is entitled to and will receive a medical screening examination performed by individuals qualified to perform such examination to determine whether an emergency medical condition exists, without regard to a patient's ethnicity, religion, national origin, citizenship, age, gender, pre-existing medical condition(s), physical or mental disability, insurance status, economic status, or ability to pay for medical services... Procedure: All patients who come to the Medical Center requesting emergency medical examination or treatment shall receive an appropriate medical screening examination in the dedicated emergency department or departments that serve as the access point for someone in need of emergency care for a psychiatric or pregnancy-relations condition... Once the medical screening examination is completed and it has been determined that the patient does not have an emergency medical condition or that the emergency medical condition has been stabilized, the patient may be: A. treated for their non-emergency medical condition; or B. discharged with a reasonable plan for appropriate follow up care and discharge instructions; or C. transferred for continued care..."

Review of Administrative Policy A-100, Patients Rights and Responsibilities, published 10/24/2012, revealed, "Patients have the right to: -Receive a medical screening exam to determine treatment..."

1. Review of MR1 on December 19, 2012, revealed the patient presented to the Emergency Department (ED) on November 11, 2012, at 5:29 PM with a chief complaint of "HIV test sent by city police." Review of the medical record failed to reveal any documentation by the triage nurse. The admitted and time and discharge date and time revealed the same time of November 11, 2012, at 5:29 PM. The Emergency Department log revealed MR1 left without being seen or triaged.

Review of facility documentation revealed MR1 contacted the facility on November 12, 2012, initially with concerns unrelated to EMTALA. Additional information revealed, "The mother states that a male nurse came into the waiting area next to the triage window and told them that they wouldn't see [him/her] in the ED because it wasn't an emergency. They were told to follow up with their family physician. [the mother] stated that [son/daughter] was visibly distraught and that the staff did nothing nor offered [him/her] the opportunity to speak with someone. The mother states that the nurse spoke to them about HIV testing, treatment and prognosis in the middle of the waiting room..."

Review of security films from November 11, 2012, revealed a staff person came from the ED to speak with the patient and mother at 5:35 PM, left the waiting area of the ED at 5:40 PM, and the patient and his/her mother left at 5:41 PM.

Interview on December 20, 2012, at 9:37 AM with EMP10 revealed that to the best of his/her recollection, he/she had been working in the back (ED) when EMP8 stated that someone had presented for an HIV test. "[EMP8] came back to see if I would see [MR1]. I said yes but there would be no guarantee of any testing. I would be happy to see [him/her], or [he/she] could follow-up with the PCP." EMP10 added, "I thought [MR1] was here for a lab test. I did not know [he/she] was seeking emergency care."

Interview on December 20, 2012, at 9:55 AM with EMP8 revealed, "I saw it pop up on the screen that the patient [MR1] was requesting an HIV test. I went out to speak with the patient and [his/her] mother... I told them we don't do random testing but they could see the doctor but there was no guarantee of testing... They asked me if there were any options. I said [he/she] could see [his/her] PCP or stay and see our doctor... [He/she] said it was hard to get in to see their PCP, so I said they could follow up with our infectious disease doctor..."

2. Review of MR24 on December 20, 2012, revealed the patient presented on September 5, 2012, at 8:36 PM with the chief complaint of possible sexual assault. The admission time and discharge time were documented as the same time. There was no documentation in the medical record of triage or a medical screening being performed. Review of additional facility documentation revealed MR24 was transferred to another hospital. When questioned on December 20, 2012, at 2:55 PM about where that information (regarding the transfer) was obtained, EMP2 stated that the sexual abuse nurse at Meadville Medical Center is not trained to examine minors under [AGE]. There was documentation in the "T" system [which is not part of the electronic medical record] that the physician transferred the patient to the other hospital. EMP2 confirmed there was no documentation in the medical record of a screening exam or documentation of a transfer, "It was at least an inappropriate transfer."

3. Review of MR26 (the medical record from the receiving hospital to which MR24 was sent) on December 21, 2012, revealed, "... so they went to Meadville Med Ctr and were told there that they would not examine her because she is less than [AGE] years old..."
VIOLATION: ON CALL PHYSICIANS Tag No: A2404
Based on review of facility documents and staff interviews (EMP) and tour of the Emergency Department (ED), it was determined the facility failed to maintain a list of physicians who are on call for duty after the initial examination to provide further evaluation and/or treatment necessary to stabilize an individual with an emergency medical condition.


Findings include:

Review of Administrative Policy A-123.1 "Emergency Medical Treatment and Labor Act (EMTALA) Policy," published August 30, 2012, revealed, "C. On-Call Response -The Medical Center, through its Medical Staff office, shall maintain a list of physicians with active staff privileges who are on-call for duty after the initial examination to help determine if an EMC exists or to provide treatment necessary to stabilize an individual with an EMC. On-call physicians' responsibility to respond, examine, and treat emergency patients are defined int he Medical Staff Bylaws and Department Rules and Regulations. Individual physician names are to be identified on the list. The notification and response of an on-call physician shall be documented.

Review of "HealthStream Regulatory Script, EMTALA, Release Date: May 2012," which was identified by EMP5, as information provided to staff in orientation, revealed, "Under EMTALA, Medicare hospitals must provide MSEs to: All patients who come to a dedicated emergency department (DED) [glossary] and ask for medical services... The on-call list must have names of specific physicians. The list must give each physician's on-call time, specialty, and accurate contact information..."

1. Tour of the ED on December 19, 2012, at 1:40 PM revealed an on-call physician listing for available specialties. Gastroenterology and OWI (Oncology Wellness Institute) had phone numbers only listed. EMP11, present for the tour stated, "They (on-call physicians for Gastroenterology and OWI) don't tell us the name. We have to call the number and they will then let us know (who is the on-call physician for that service)."

2. On December 19, 2012, at 2:11 PM EMP4 confirmed the ED on-call list has no names for the Gastroenterology and OWI services.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility documents and closed medical records (MR), and staff interviews (EMP), it was determined that Meadville Medical Center failed to provide an appropriate medical screening examination for two of 25 Emergency Department medical records reviewed (MR1 and MR24).

Findings include:

Review of the Meadville Medical Center Emergency Department Rules and Regulations revealed, "Section 2-Patient Care The status of patients seen in the Emergency Department is determined by the physician on duty at that time. Any patient seeking emergency services must be offered an appropriate medical screening examination to determine whether or not an emergency medical condition exists... B. Emergency Cases. If an emergency medical condition is found, the hospital must either: 1. Provide stabilizing treatment within its capabilities or 2. If the patient cannot be stabilized, the hospital must arrange for an appropriate transfer... C. Non-Emergent Cases. 1. Such patients will be evaluated by the emergency physician and treated appropriately..."

Review of Administrative Policy A-123.1 "Emergency Medical Treatment and Labor Act (EMTALA) Policy," published August 30, 2012, revealed, "It is the policy of the Meadville Medical Center that any patient who comes to MMC, is on hospital property and requesting emergency services, is entitled to and will receive a medical screening examination performed by individuals qualified to perform such examination to determine whether an emergency medical condition exists, without regard to a patient's ethnicity, religion, national origin, citizenship, age, gender, pre-existing medical condition(s), physical or mental disability, insurance status, economic status, or ability to pay for medical services... Procedure: All patients who come to the Medical Center requesting emergency medical examination or treatment shall receive an appropriate medical screening examination in the dedicated emergency department or departments that serve as the access point for someone in need of emergency care for a psychiatric or pregnancy-relations condition... Once the medical screening examination is completed and it has been determined that the patient does not have an emergency medical condition or that the emergency medical condition has been stabilized, the patient may be: A. treated for their non-emergency medical condition; or B. discharged with a reasonable plan for appropriate follow up care and discharge instructions; or C. transferred for continued care..."

Review of Administrative Policy A-100, Patients Rights and Responsibilities, published 10/24/2012, revealed, "Patients have the right to: -Receive a medical screening exam to determine treatment..."

1. Review of MR1 on December 19, 2012, revealed the patient presented to the Emergency Department (ED) on November 11, 2012, at 5:29 PM with a chief complaint of "HIV test sent by city police." Review of the medical record failed to reveal any documentation by the triage nurse. The admitted and time and discharge date and time revealed the same time of November 11, 2012, at 5:29 PM. The Emergency Department log revealed MR1 left without being seen or triaged.

Review of facility documentation revealed MR1 contacted the facility on November 12, 2012, initially with concerns unrelated to EMTALA. Additional information revealed, "The mother states that a male nurse came into the waiting area next to the triage window and told them that they wouldn't see [him/her] in the ED because it wasn't an emergency. They were told to follow up with their family physician. [the mother] stated that [son/daughter] was visibly distraught and that the staff did nothing nor offered [him/her] the opportunity to speak with someone. The mother states that the nurse spoke to them about HIV testing, treatment and prognosis in the middle of the waiting room..."

Review of security films from November 11, 2012, revealed a staff person came from the ED to speak with the patient and mother at 5:35 PM, left the waiting area of the ED at 5:40 PM, and the patient and his/her mother left at 5:41 PM.

Interview on December 20, 2012, at 9:37 AM with EMP10 revealed that to the best of his/her recollection, he/she had been working in the back (ED) when EMP8 stated that someone had presented for an HIV test. "[EMP8] came back to see if I would see [MR1]. I said yes but there would be no guarantee of any testing. I would be happy to see [him/her], or [he/she] could follow-up with the PCP." EMP10 added, "I thought [MR1] was here for a lab test. I did not know [he/she] was seeking emergency care."

Interview on December 20, 2012, at 9:55 AM with EMP8 revealed, "I saw it pop up on the screen that the patient [MR1] was requesting an HIV test. I went out to speak with the patient and [his/her] mother... I told them we don't do random testing but they could see the doctor but there was no guarantee of testing... They asked me if there were any options. I said [he/she] could see [his/her] PCP or stay and see our doctor... [He/she] said it was hard to get in to see their PCP, so I said they could follow up with our infectious disease doctor..."

2. Review of MR24 on December 20, 2012, revealed the patient presented on September 5, 2012, at 8:36 PM with the chief complaint of possible sexual assault. The admission time and discharge time were documented as the same time. There was no documentation in the medical record of triage or a medical screening being performed. Review of additional facility documentation revealed MR24 was transferred to another hospital. When questioned on December 20, 2012, at 2:55 PM about where that information (regarding the transfer) was obtained, EMP2 stated that the sexual abuse nurse at Meadville Medical Center was not trained to examine minors under [AGE]. There was documentation in the "T" system [which is not part of the electronic medical record] that the physician transferred the patient to the other hospital. EMP2 at that time confirmed there was no documentation in the medical record of a screening exam or documentation of a transfer, "It was at least an inappropriate transfer."

3. Review of MR26 (the medical record from the receiving hospital to which MR24 was sent) on December 21, 2012, revealed, "... so they went to Meadville Med Ctr and were told there that they would not examine her because she is less than [AGE] years old..."

Cross reference with 489.24(e)(1)(2) Appropriate transfer.
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility documents, review of medical records (MR), and staff interviews (EMP), it was determined the facility failed to provide medical treatment within its capacity (a screening exam), and failed to determine that the receiving facility had available space, qualified personnel, and agreed to accept the transfer for one of 25 medical records (MR24)

Findings include:

Review of the Meadville Medical Center Emergency Department Rules and Regulations revealed, "Section 2-Patient Care The status of patients seen in the Emergency Department is determined by the physician on duty at that time. Any patient seeking emergency services must be offered an appropriate medical screening examination to determine whether or not an emergency medical condition exists... B. Emergency Cases. If an emergency medical condition is found, the hospital must either: 1. Provide stabilizing treatment within its capabilities or 2. If the patient cannot be stabilized,t he hospital must arrange for an appropriate transfer... C. Non-Emergent Cases. 1. Such patients will be evaluated by the emergency physician and treated appropriately... 3. Treatment, Discharge or Transfer of Stabilized Patients Once the medical screening examination is completed and it has been determined that the patient does not have an emergency medical condition ... the patient may be: A. treated ... B. discharged ... C. transferred for continue care... EMTALA does not apply to stable patients. A hospital's EMTALA obligations are over when the patient is stable... "

1. Review of MR24 on December 20, 2012, revealed the patient presented on September 5, 2012, at 8:36 PM with the chief complaint of possible sexual assault. The admission time and discharge time were documented as the same time. There was no documentation in the medical record of triage of a medical screening being performed. Review of additional facility documentation revealed MR24 was "transferred" to another hospital. When questioned on December 20, 2012, at 2:55 PM about where that information was obtained, EMP2 stated that the sexual abuse nurse at Meadville Medical Center was not trained to examine children under [AGE]. There was documentation in the "T" system (a computerized system that does not "talk with" the Meditech system that generates the medical record) that the physician transferred the patient to the other hospital. EMP2 at that time confirmed there was no documentation in the medical record of a screening exam being performed or documentation of a transfer. "It was at least an inappropriate transfer."

2. Review of MR26 (the medical record from the other hospital to which MR24 was sent) on December 21, 2012, revealed, "... so they went to Meadville Med Ctr and were told there that they did would not examine her because she is less than [AGE] years old..."


Cross reference with 489.24(r) and 489.24(c) Medical Screening Exam.