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ST JOSEPH'S HOSPITAL 2661 COUNTY HWY I CHIPPEWA FALLS, WI 54729 April 22, 2014
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on record review, interview with staff, and review of policy and procedures, the facility failed to ensure compliance with EMTALA Regulations 489.20 and 489.24 in that the facility failed to provide a medical screening exam for 2 of 20 patients (Pt. #1, Pt #2). Failure to provide an emergency medical screening exam has the potential to affect all patients presenting in an emergency.


See findings:

The hospital failed to provide a medical screening exam. See A2406.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record review, facility staff interviews and review of EMTALA policies and procedures, the hospital failed to ensure that 2 of 20 sampled patients (Patient #1 and #2), who came into the Emergency Department requesting emergency medical treatment, had an appropriate medical screening exam to rule out emergency medical conditions. This has the potential to affect all patients presenting in an emergency.

Findings include:

The hospital policy on EMTALA reviewed on 04/22/2014 at 2:00 PM entitled;"Transfer of the Patient to Other Institution" dated 09/2013 states;

- "Emergency service area patients will be examined by a qualified physician or midlevel provider and treatment undertaken, as necessary, within our scope of service to stabilize the patient for transfer."

-"The patient is not transferred until the receiving physician and the receiving facility accepts the patient and the patient is considered sufficiently stable, or the benefits of the transfer outweigh the risks."

- "A copy of all pertinent medical information will be sent with the patient."

- "The Hospital will comply with all EMTALA regulations regarding patient transfers."



Findings on patient #1:

Ambulance run documentation reviewed on 04/22/2014 at 1:30 PM which was dated 04/09/2014 reveals Patient #1, a ventilator dependent nursing home resident was picked up from the nursing home at 5:11 AM on 04/09/14 and arrived at this hospital at 5:42 AM. The ambulance report states, : "We arrived on scene and the staff was doing CPR (Cardio-pulmonary resuscitation). Staff stated that they were advised by the AED (automated external defibrillator) to shock once and did. Patients airway was being bagged through his tracheostomy. When the machine was analyzing it advised not to shock. We placed our pads on the patient and it showed a sinus tach. We checked for a pulse and patient had a carotid and radial pulse. Patient had a measurable blood pressure at 98/78. Patients airway was clear ....

We arrived (the hospital) and took the patient into the ER. Staff stated, and was wondering if we should be there because the patient was brought back and would probably need to be seen at (another hospital for cardiac). We took the patient back out to the ambulance and requested the staff send the ER physician out to the ambulance. We started an IO (intraosseous line) and Dr.(A) came out. We explained the situation and he check(ed) the patient(s) vitals. Patient was alert at this time. Patient was able to open his eyes on command and track my finger. Patient was also able to lip words. Dr. (A) felt confident that the patient should go to (other hospital). We continued transport to (other hospital)."

In review of the ED log kept by the hospital on [DATE] at 1:00 PM, revealed no documentation of the arrival Patient #1. In interview with Patient Services Manager F on 04/21/2014 at 1:00 PM it was confirmed no medical record was established for Patient #1, there is no documentation of a medical screening examination done for Patient #1.

Per interview by phone with ED physician A on 04/23/14 at 4:00 PM, he was called to the ambulance bay to see a patient in the ambulance. According to A, ambulance staff were asking if the patient (#1) was stable for a trip to another hospital less than 20 minutes away. Per a cursory exam, A determined pt. #1 was stable and would be better served at (another hospital) A stated he did not document his observations or communicate with the receiving hospital, he said he believed the nurses would contact the other hospital.

Per interview by phone with RN B on 04/22/14 at 2:30 PM, B stated that EMT's called before arrival with report on pt. #1. Pt. #1 was taken to trauma room #2. Per B, the patient had a normal rhythm, slightly tachycardic, oxygen saturation of 100%, was being bagged with good color and stable vitals. According to B, Pt. #1 was taken back to the ambulance for transfer to (another hospital). B stated that Dr. A was paged to come to the ED and saw Pt. #1 in the ambulance bay.


Findings on Patient #2:

On 04/13/14, per ambulance report dated 04/13/14 .... " (Patient #2), a 38 y/o M pt who had fallen in his home and is unresponsive. Upon arrival, EMT 651 was on scene and stated that the pt. was on the floor but still breathing. Pt. was found lying on a wood floor in the doorway of the house. Pt. was face down and still unresponsive but breathing. Pt. had a 2" laceration above the right eye and slight swelling in the right ankle. Pt. was placed on a long board, secured, and the wound was bandaged. Placed pt. on the stretcher and loaded into the ambulance. A 5 lead EKG was attached to the pt. and vitals were taken. GCS (Glasgow Coma Score) score of 3. Pt was transported to (the hospital) in Chippewa Falls. About 5 minutes from the facility, the pt. became concious but not alert. GCS score of 13. Pt. also began to complain about pain in his back and lower right leg. Arriving at (the hospital) ER (emergency room ) staff came into our rig and assessed the pt. "

In review of the ED log kept by the hospital on [DATE] at 1:00 PM revealed no documentation of the arrival Patient #2. In interview with Patient Services Manager F on 04/21/2014 at 1:00 PM it was confirmed no medical record was established for Patient #2, there is no documentation of a medical screening examination done for Patient #2.

Per interview with RN D on 04/23/14 at 11:55 AM , when the call came on the afternoon of 04/13/14 about Pt. #2's imminent arrival, attempts were made to divert the ambulance but this did not occur in time. According to D, physician C did a quick assessment and sent the patient to another hospital. The patient was not registered.

Per interview with ED Physician C on 04/22/14 at 11:20 AM, the ED was notified by EMS of the impending arrival of Pt. #2 who had sustained a head injury with loss of consciousness and altered mental status. According to C, another physician was contacted at another hospital to request transfer to their facility. Per C, EMS arrived in the meantime. C stated that a medical screening exam was done but not documented. According to C, Pt. #2 was stable but confused at the time of arrival. The ambulance was directed to proceed to another hospital and was ultimately diverted to a third hospital.