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REGIONAL HOSPITAL OF SCRANTON 746 JEFFERSON AVENUE SCRANTON, PA 18501 July 15, 2014
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
Based on review of facility policy and procedure, facility documents, and interviews with staff, it was determined the facility failed to ensure every individual presenting to the Emergency Department (ED) for treatment was entered into the Emergency Department log (PT1).

Findings include:

Review on July 14, 2014, of the facility's policy "EMTALA Central Log," approval date July 25, 2013, revealed "Purpose To require that each hospital tracks the care provided to each individual who comes to: the hospital seeking care for a medical condition or an emergency medical condition; the hospital's dedicated emergency department seeking care for a medical condition; or [sic] Policy: Each Hospital that provides emergency services must maintain a central log to include information on each individual who comes to the dedicated emergency department seeking examination or treatment for a medical condition or comes on to the hospital property requesting evaluation or treatment for what may be an emergency medical condition. ..."

Review on July 14, 2014, of the CHS [Community Health Systems] Compliance Policy/Procedure G2 "Emergency Medical Treatment and Patient Transfer," revised September 2013, revealed "... Central Log means a log the Hospital maintains of all individuals who present to the Hospital seeking emergency medical assistance and the disposition of such individuals, whether the person refused treatment, was transferred, was admitted and treated, was Stabilized and Transferred, or discharged . The purpose of the Central Lob is to track the care provided to each individual who comes to the Hospital seeking care for an Emergency Medical Condition. The Central Log must include patient logs from other areas of the Hospital, including labor and delivery, where a patient might present for emergency services or receive a Medical Screening Examination instead of in the Dedicated Emergency Department. ... "

Interview with EMP4 on July 14, 2014, at approximately 9:25 AM confirmed PT1 presented on July 7, 2014, at approximately 1:00 PM complaining of cramps. The patient's husband was present and stated his wife was five weeks pregnant. EMP4 asked PT1 if she was experiencing any bleeding, which the patient denied. PT1 was from out of town and was not aware the facility did not provide Obstetrical (OB) services. EMP4 told PT1 the facility did not provide OB services and needed to go to another hospital that provides OB services. The other hospital was approximately two blocks away. PT1 left to obtain further treatment. EMP4 stated they did not know how the patient got to the other facility.

Interview with EMP3 on July 14, 2014, at approximately 9:35 AM confirmed PT1 presented on July 7, 2014, at approximately 1:00 PM complaining of cramps. EMP3 confirmed the patient's husband was assisting his wife out of the car in the ambulance bay and the EMT asked if they needed help. PT1's husband stated that his wife was five weeks pregnant, was bleeding, and needed help. EMP3 confirmed the EMT got a wheelchair for PT1 and brought the patient to the triage area while the husband parked the car. EMP3 confirmed the triage nurse stated the hospital did not provide OB services and told the EMT to take the patient to another facility. PT1 was transferred to the other facility via ambulance without being entered into the ED log.

Review on July 14, 2014 of the Emergency Department log for July 7, 2014 revealed no documentation that PT1 presented to the ED for treatment.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on review of the facility's Medical Staff Rules and Regulations, facility documents, policy and procedure, and staff interview (EMP), it was determined the facility failed to provide a medical screening examination for PT1.

Findings include:

Review on July 14, 2014, of the facility's "Medical Staff Rules and Regulations," last reviewed June 2013, revealed "... Section X: Emergency Medical Services General Statement: To ensure compliance with EMTALA / COBRA screening, stabilization, and transfer requirements, all patient who present to the Emergency Department requesting an examination or treatment, or a request is made on their behalf, will be provided a medical screening examination to determine whether an emergency medical condition exists. The Medical Screening Examination is performed within the capability of the hospital's Emergency Department, including ancillary services routinely available to the Emergency Department. This medical screening examination is provided regardless of the patient's ability to pay for services rendered. ..."

Review on July 14, 2014, of the CHS [Community Health Systems] Compliance Policy/Procedure G2 "Emergency Medical Treatment and Patient Transfer," revised September 2013, revealed "... Medical Screening Examination is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether or not an Emergency Medical Condition exists or a woman is in labor. Such screening must be done within the Hospital's Capacity and Capability and available personnel, including on-call physicians. The Medical Screening Examination is an ongoing process and the medical records must reflect continued monitoring based on the patient's needs and continue until the patient is either Stabilized or Appropriately Transferred. The Hospital must apply, in a non-discriminatory manner and regardless of ability to pay, a screening process that is reasonably calculated to determine whether an emergency Medical Condition exists. ..."

Review on February 14, 2014, of the facility's policy "Medical Screening Examination," review date August 28, 2013, revealed "Any individual who comes to the Emergency Department, Hospital property or Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by individuals qualified to perform such examination to determine whether or not an emergency medical condition exists. Providing the Medical Screening Examination 1. Regional Hospital of Scranton is obligated to perform the Medical Screening Examination to determine if an emergency medical condition exists. 2. In providing a Medical Screening Examination, Regional Hospital of Scranton shall not discriminate against any individual because of diagnosis (e.g., labor, AIDS), financial status (e.g., uninsured, Medicaid), race, color, national origin, or handicap."

Interview with EMP4 on July 14, 2014, at approximately 9:25 AM confirmed PT1 presented on July 7, 2014, at approximately 1:00 PM complaining of cramps. The patient's husband was present and stated his wife was five weeks pregnant. EMP4 asked PT1 if she was experiencing any bleeding, which the patient denied. PT1 was from out of town and was not aware the facility did not provide Obstetrical (OB) services. EMP4 told PT1 the facility did not provide OB services and needed to go to another hospital that provides OB services. The other hospital was approximately two blocks away. PT1 left to obtain further treatment. EMP4 stated they did not know how the patient got to the other facility. EMP4 confirmed a medical screening examination was not performed on PT1 on presentation to the ED on July 7, 2014.

Interview with EMP3 on July 14, 2014, at approximately 9:35 AM confirmed PT1 did not have a medical screening exam performed when presenting to the ED on July 7, 2014.