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.

NORTH METRO MEDICAL CENTER 1400 BRADEN STREET JACKSONVILLE, AR 72076 May 24, 2017
VIOLATION: EMERGENCY ROOM LOG Tag No: A2405
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of the emergency room (ER) Daily Log, Medical Staff Rules and Regulations review, policy and procedure review, and interview, it was determined the facility failed to accurately and completely record Patient #1's ER presentation into the ER Log. Failure to enter Patient #1's name into the ER Log did not allow the facility to track Patient #1's presentation and treatment. The failed practice affected Patient #1 on 04/26/17. Findings follow.

A. Review of policy titled "Admission of Patient to Emergency Department, EMTALA Regulations" stated, "All patients must be logged in and a permanent record produced."
B. Review of Medical Staff Rules and Regulations stated under "General Rules Regarding Emergency Services: An appropriate medical record shall be kept for every patient receiving emergency service and be incorporated into the patient's hospital record, if such exists. The record shall include: Adequate patient identification; Information concerning the time of the patient's arrival, means of arrival and by who transported ...".
C. Review of the ER Log revealed Patient #1 (MDS) dated [DATE] at 1729. Review of the clinical record of Patient #1 revealed he left, and returned to the ER at 1915. The ER Log revealed no evidence of Patient #1's second presentation to the ER.
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on clinical record review, policy review, ER log review, and interview, it was determined the facility failed to ensure Patient #1 received an appropriate and timely medical screening exam (MSE) for one of two visits to the Emergency Department (ED) on 04/26/17. Failure to provide a timely MSE did not ensure the facility was aware of whether or not Patient #1 had an emergency medical condition, which caused a delay in treatment. The failed practice affected Patient #1 on 04/26/17. Findings follow.

Patient #1 first (MDS) dated [DATE] at 1732, with complaints of nausea and vomiting. The patient was triaged and had an extended wait in the waiting room. The patient's spouse went up to admissions several times, to see when the patient was going to be seen. Licensed Practical Nurse #1 was interviewed on 05/24/17 from 0926-0936 and confirmed the patient had been triaged on the prior shift and stated "the physician was not notified the patient was in the ED, because he had not been brought back and put into a room. The medical screening exam is done when the Patient is taken back to a room."

The patient's spouse called 911 from the waiting room because she was trying to get her husband into the ED to be seen faster. Since 911 refused to come to the waiting room, the patient and spouse then left the ED and called 911 from outside the facility. The patient and spouse walked down the street so he could be picked up by EMS. The patient was returned to the same ED by EMS. Per the patient's medical record, documentation of the patient's second visit started at 1918.

For the first visit, there is no medical record for review except for triage notes. There is no documentation to support the patient was evaluated or re-evaluated while in the ED waiting to be seen if there was a long wait. The patient did not receive an appropriate and timely medical screening exam during the first presentation.

During the second visit, the patient was being treated, but went into a cardiac arrest. CPR was unsuccessful and the wife discontinued their efforts at 2251, and the patient expired.

Review of policy titled "Admission of Patient to Emergency Department, EMTALA Regulations" stated, "C. A physician, nurse practitioner or physician assistant must do a medical screening on each patient to determine if an emergency exists. If no emergency exists, EMTALA is not involved. D. The medical screening must use all resources of the hospital, as deemed necessary, from laboratory, radiology, and even consultation to decide if an emergency exists. E. Treatment and management must then follow. F. EMTALA involves all of the above and also the stabilization and transfer, if necessary, of the patient."