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.

PHYSICIANS REGIONAL MEDICAL CENTER 7565 DANNAHER WAY POWELL POWELL, TN 37849 May 6, 2015
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on facility policy review, review of Emergency Medical Services (EMS) radio communication, review of EMS patient care report, review of Emergency Department logs, and interview, the facility failed to maintain an accurate Emergency Department log, failed to provide a medical screening examination, and failed to provide an appropriate transfer for one patient (#7) of 26 patients reviewed.

The findings included:

Refer to A-2405 for failure to maintain an Emergency Department Log.

Refer to A-2406 for failure to provide a medical screening examination.

Refer to A-2409 for failure to provide an appropriate transfer.
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
Based on facility policy review, review of Emergency Medical Services (EMS) radio communication, review of Emergency Department (ED) logs, and interview, the facility failed to ensure an accurate emergency room log was maintained for one patient (#7) of 26 patients reviewed.

The findings included:

Review of facility policy titled "EMTALA Central Log Policy" last revised on 9/1/13, revealed "...each hospital must maintain a Central Log 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 patients presenting to the Dedicated emergency room regardless of whether they received treatment..."

Review of an audio recording of an EMS radio communication between the Paramedic and the facility revealed the Paramedic called in a report for Patient #7 to the ED on 4/20/15 at 8:36 AM, and they were advised by the ED staff the facility was on Psychiatric Diversion. Continued review revealed there was no further communication on the radio between the Paramedic and the facility.

Review of the ED logs from the facility for 4/18/15, 4/19/15, and 4/20/15, revealed Patient #7 was not listed on the ED logs.

Interview with Registered Nurse (RN) #1 on 5/4/15 at 2:00 PM, in the ED manager's office, revealed "...we do a quick assessment to see if they [patients] are suicidal...if they come in by EMS...go to room 21 or room 20...EMS will give a radio report with symptoms and complaint when they call into the ED...few weeks ago we were on psych [psychiatric] diversion ...someone called us that morning [4/20/15] on the radio [EMS] and told us they were bringing us a psych patient [patient #7]...I told him we were on divert...he came here but left the patient in the truck with his partner...said he wanted to know her [patient] allergies...I told him 'I said we were on divert'...patient never came into the facility..."

Interview with Physician #1 (ED physician on duty 4/20/15) on 5/5/15 at 10:10 AM, in the ED Consultation room, revealed "...I do remember psych diversion...believe there were 12-15 people in the psych room...don't remember anyone being sent away...we would never turn anyone away..."

Telephone interview with Paramedic #1 on 5/5/15 at 11:45 AM revealed "...we had picked the patient up at home because of suicidal ideations...I called a radio report into the ED...I did not hear the nurse say the facility was on diversion..." Further interview revealed "...we were in the facility parking lot when I was notified...I went into the ED and the nurse told me they would not accept the patient due to being on psychiatric diversion..."

Interview with the ED Clinical Leader on 5/6/15 at 11:40 AM, in the conference room, revealed "...if anyone shows up we would've taken them...if they are within 500 feet they are ours...when they are in the parking lot they are ours...when they come up the hill they are ours..." Further interview confirmed Patient #7 was not on the ED log.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on facility policy review, Emergency Medical Services (EMS) radio communication, EMS patient care report, and interview, the facility failed to provide a medical screening examination for one patient (#7) of 26 patients reviewed.

The findings included:

Review of hospital policy titled "EMTALA Medical Screening Stabilization Policy" revised 9/1/13, revealed, "...All individuals presenting on Hospital property requesting emergency medical services, individuals presenting to a Dedicated Emergency Department requesting medical services, and patients arriving/presenting via ambulance requesting medical services shall receive an appropriate Medical Screening Examination and Stabilization services as required by the Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. Section 1395 and all Federal regulations and interpretative guidelines promulgated thereunder...In general, when an individual comes, by himself or herself, with another person, or by EMS to the Dedicated Emergency Department of the Hospital and a request is made on the individual's behalf for a medical examination or treatment, the Hospital must provide an appropriate Medical Screening Examination...A Hospital that is not in diversionary status may not refuse or fail to accept a telephone or radio request for Transfer or admission. Such failure or refusal could represent a violation of the Hospital's obligations under EMTALA. Even when on diversionary status, if a patient arrives on campus, Hospital must provide a Medical Screening Examination within its Capacity and Capability...Once a patient presents to the Dedicated Emergency Department of the hospital, whether by ambulance or otherwise, the hospital has an obligation to see the patient. A hospital's EMTALA obligations begin when the patient presents at the hospital's Dedicated Emergency Department on hospital property...Patients arriving via ambulance meet this requirement when ambulance staff requests treatment from hospital staff..."

Review of an audio recording of an EMS radio communication between the Paramedic and the facility revealed the Paramedic called in a report for Patient #7 to the Emergency Department (ED) on 4/20/15 at 8:36 AM, and they were advised by the ED staff the facility was on Psychiatric Diversion. Continued review revealed there was no further communication on the radio between the Paramedic and the facility.

Review of an EMS Patient Care Report dated 4/20/15, revealed Patient #7 was transported due to complaints of wanting to hurt herself. Further review revealed "...patient wanted to go to [facility #1] they adv [advised] that they were on dervirt [divert]...transported to [facility #2]..."

Interview with Registered Nurse (RN) #1 on 5/4/15 at 2:00 PM, in the ED manager's office, revealed "...we do a quick assessment to see if they [patients] are suicidal...if they come in by EMS...go to room 21 or room 20...EMS will give a radio report with symptoms and complaint when they call into the ED...few weeks ago we were on psych [psychiatric] diversion...someone called us that morning [4/20/15] on the radio [EMS] and told us they were bringing us a psych patient [patient #7]...I told him we were on divert...he came here but left the patient in the truck with his partner...said he wanted to know her [patient] allergies...I told him 'I said we were on divert'...patient never came into the facility..."

Interview with Physician #1 (ED physician on duty 4/20/15) on 5/5/15 at 10:10 AM, in the ED Consultation room, revealed "...I do remember psych diversion...believe there were 12-15 people in the psych room...don't remember anyone being sent away...we would never turn anyone away..."

Telephone interview with Paramedic #1 on 5/5/15 at 11:45 AM revealed "...we had picked the patient up at home because of suicidal ideations...I called a radio report into the ED...I did not hear the nurse say the facility was on diversion..." Further interview revealed "...we were in the facility parking lot when I was notified...I went into the ED and the nurse told me they would not accept the patient due to being on psychiatric diversion..."

Interview with the ED Clinical Leader on 5/6/15 at 11:40 AM, in the conference room, revealed "...if anyone shows up we would've taken them...if they are within 500 feet they are ours...when they are in the parking lot they are ours...when they come up the hill they are ours..." Further interview confirmed Patient #7 was transferred without a medical screening examination.
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
Based on review of facility policy, review of Emergency Medical Services (EMS) transport report, and interview, the facilty failed to arrange for an appropriate transfer to another acute care facility for one patient (#7) of 26 records reviewed.

The findings included:

Review of facility policy titled "EMTALA Emergency Transfers Policy" last revised 9/1/13, revealed "...(2) if a patient comes to the hospital and is determined to have an Emergency Medical Condition following a Medical Screening Examination the hospital must provide further medical examination and treatment..." Further review revealed "...the hospital, through its designated personnel and/or emergency department physicians, must obtain consent of the receiving or recipient Hospital before the transfer of the patient and must make appropriate arrangements for the patient transfer with an authorized representative of the receiving hospital...the physician at the transferring hospital has the responsibility to ensure the Appropriate Transfer meets the heightened standards under EMTALA..."

Review of an EMS Patient Care Report dated 4/20/15, revealed Patient #7 was transported due to complaints of wanting to hurt herself. Further review revealed "...patient wanted to go to [facility #1]...they adv [advised] that they were on dervirt [divert]...transported to [facility #2]..."

Review of an E-Mail dated 4/20/15 at 12:11 PM, from the facility #2 Administrative Supervisor to the other facility #2 Administrative staff revealed the EMS staff was told by a nurse at facility #1 that facility #1 was on Psychiatric Diversion and facility #1 was not accepting Patient #7. Further review revealed "...at 9:20 AM...I spoke with the Paramedic who advised he was in the ER [emergency room ] when he was told the ER would not accept the patient and before leaving he obtained a face sheet and an old medical record from the ER so that he would have the patient's pertinent information..." Further review revealed "...a copy of the paperwork from [facility #1] ER is with the patient's chart as received from EMS..."

Interview with the facility #2 Administrative Supervisor on 5/4/15 at 1:00 PM, in the Nursing Administration office, revealed "...I got a call from the ED around 9:00 AM and told me that [facility #1] had sent a patient to us due to that they were on psychiatric diversion...I called the ED and spoke with the charge nurse who told me they were not on psychiatric diversion and they only had one psychiatric patient in the ED..." Further interview revealed "...I spoke with the EMS dispatch and they were notified at 8:40 AM that [facility #1] was on Psychiatric diversion...I also spoke with the paramedic who told me they were in the ED at [facility #1] and they told them they were not going to accept the patient because they were on divert..." Further interview confirmed the facility had not received any information related to a transfer for Patient #7.

Interview with facility #1 Registered Nurse (RN) #1 on 5/4/15 at 2:00 PM, in the ED manager's office, revealed "...we do a quick assessment to see if they [patients] are suicidal...if they come in by EMS...go to room 21 or room 20...in room 21 there is a room 21A...locked room...do initial eval [evaluation]...have them change clothes and make sure they have nothing on them...EMS will give a radio report with symptoms and complaint when they call into the ED...few weeks ago we were on psych diversion, we had 10-11 psych patients in the ED...we couldn't provide them services...don't know how long we were on diversion...it was still on that Monday...I know because I was the psych nurse when I came in at 9 AM and we were on diversion...we went off it before I left that day...we notified [named EMS and named Crisis facility]...the AOC [administrator on call] made the decision to go on diversion...we would call the AOC and tell them our situation...someone called us that morning [4/20/15] on the radio [EMS] and told us they were bringing us a psych patient [patient #7]...I told him we were on divert...the paramedic came here but left the patient in the truck with his partner...said he wanted to know the patient's allergies...I told him 'I said we were on divert'...patient never came into the facility...after that the EMS supervisor let everyone know we were on diversion so no one else came that I know of..."

Interview with facility #1 Physican #1 (who was on duty on 4/20/15), on 5/5/15 at 10:10 AM, in the ED Consultation room, revealed "...don't remember anyone being sent away...we would never turn anyone away..."

Telephone interview with the EMS Paramedic on 5/5/15 at 11:45 AM revealed "...my supervisor called me and told me [facility #1] was on psychiatric diversion...we picked the patient up at home because of suicidal ideations...I called a radio report into the ED...I did not hear the nurse say the facility was on diversion..." Further interview revealed "...we were in the facility parking lot when I was notified [by the EMS supervisor of the facility #1 diversion status]...I went into the ED and the nurse told me they would not accept the patient due to being on psychiatric diversion..."

Interview with the facility #1 ED Clinical Leader on 5/6/15 at 11:40 AM, in the conference room, revealed "...if anyone shows up we would've taken them...if they are within 500 feet they are ours...when they are in the parking lot they are ours...when they come up the hill they are ours..." Further interview confirmed Patient #7 was transferred without a medical screening and an appropriate transfer was not initiated.