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.

MIDDLESEX HOSPITAL 28 CRESCENT ST MIDDLETOWN, CT 06457 March 15, 2018
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on a review of the clinical record, hospital documentation and interviews for one of twenty-one patients (Patient #1) reviewed who either left the hospital against medical advice (AMA) or transferred to another facility, the hospital failed to ensure the patient received a medical screening examination. The findings include:

Patient #1 was transported to Hospital #1's ED (Emergency Department) on 2/14/18 at 8:19 AM via Emergency Medical Service (EMS) #1 for complaints of shortness of breath (SOB) and chest pain. The ambulance run sheet dated 2/14/18 identified that Patient #1 arrived at Hospital #1's ED via EMS #1 at 8:19 AM. ED Medical Doctor (MD) #1 tried to divert EMS, however, the EMS ambulance had already arrived at ED#1's ambulance entrance. During transport via ambulance to Hospital #1's ED, Patient #1 required supportive respiratory interventions and the administration of sublingual nitroglycerine x2 for respiratory difficulty and complaints of chest pain. Upon arrival to Hospital #1's ED, EMS personnel asked MD #1 to evaluate Patient #1 due to acute electrocardiogram (EKG) changes indicative of a STEMI (ST elevation myocardial infarction). Further review of the ambulance run sheet identified that after MD#1 evaluated Patient #1's EKG at 8:19 AM while patient was still in the ambulance. MD#1 instructed EMS to transport Patient #1 to Hospital #2's ED, indicating any delay in transfer would only delay time sensitive patient care/treatment. EMS personnel (Medic #1) requested a second medic to meet them for assistance. Medic #2 met Medic #1 at 8:27 AM and a third sublingual nitroglycerine was administered to Patient #1 at 8:42 AM. Patient #1 arrived at Hospital #2 at 8:52 AM with a total transfer time of 31 minutes from Hospital #1 to Hospital #2. Patient #1's medical record from Hospital #2 identified that the patient was evaluated at Hospital #2's ED on 2/14/18 with a heart rate of 131, blood pressure 150/90, respiratory rate of 24 and oxygen saturation of 94% on bi-pap. Patient #1 was diagnosed with [DIAGNOSES REDACTED]]and coronary artery disease status post stent placements.

Review of the ED record from Hospital #1 dated 2/14/18 failed to identify that an medical screening examination was conducted by the physician. Further review failed to indicate that the ambulance transport documentation for Patient #1's ED visit was not present in a medical record.

Review of the clincal record and interview with the Chairman of Hospital #1's ED, Director of Quality, Manager of Regulatory Compliance and the ED Medical Director of Hospital #1 on 3/15/18 all identified that the hospital policy was not followed. Further interview identified that Patient #1 should have been assessed, stabilized and/or treated prior to transfer to Hospital #2. In addition, Hospital #2 was not notified of and/or accepted the transfer of Patient #1. Further review indicated that the ED record lacked a medical screening evalution and/or medical record documentation.

During a review of the audio call between Secretary #1, EMS and/or MD#1 with Manager of Quality on 3/15/18 at 11:15 AM verified that the hospitals investigation of the chain of events prior to Patient #1's transfer from Hospital #1 to Hospital #2. No discrepancies in the above interviews were identified.

Review of the hospital's EMTALA policy indicated each patient presenting to the ED with an Emergency Medical Condition (EMC) is entitled to a medical evaluation and necessary stabilization.

According to the Chairman of the ED the EMTALA violation occurred 2/14/18. The hospital became aware of the event on 2/23/18. On 2/23/18 the Chairman of the ED reviewed the incident and EMTALA policy with MD#1. On 2/24/18 all physicians received online education about EMTALA. On March 1, 2018 the incident was reviewed at a meeting for all providers. All providers subsequently completed a validation test and signed attestation statement between 3/9/18 and 3/13/18, indicating the EMTALA material was reviewed.

According to the Director and Manager of Quality, subsequent to the EMTALA violation all nursing/support staff were provided with formal education on Emergency Medical Treatment and Labor Act (EMTALA) from March 9 through March 14, 2018. In addition staff completed a validation test and signed attestation statement.
VIOLATION: STABILIZING TREATMENT Tag No: A2407
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on a review of the clinical record, hospital documentation and interviews for one of twenty-one patients (Patient #1) reviewed who was transported to the Emergency Department with a medical condition, the hospital failed to ensure that the patient received a medical exam and treatment needed to stabilize a medical condition prior to transfer to another hospital. The findings include:

Patient #1 was transported to Hospital #1's ED (Emergency Department) on 2/14/18 at 8:19 AM via Emergency Medical Service (EMS) #1 for complaints of shortness of breath (SOB) and chest pain. The ambulance run sheet dated 2/14/18 identified that Patient #1 arrived at Hospital #1's ED via EMS #1 at 8:19 AM. ED Medical Doctor (MD) #1 tried to divert EMS, however, the EMS ambulance had already arrived at ED#1's ambulance entrance. During transport via ambulance to Hospital #1's ED, Patient #1 required supportive respiratory interventions and the administration of sublingual nitroglycerine x2 for respiratory difficulty and complaints of chest pain. Upon arrival to Hospital #1's ED, EMS personnel asked MD #1 to evaluate Patient #1 due to acute electrocardiogram (EKG) changes indicative of a STEMI (ST elevation myocardial infarction). Further review of the ambulance run sheet identified that after MD#1 evaluated Patient #1's EKG at 8:19 AM while patient was still in the ambulance. MD#1 instructed EMS to transport Patient #1 to Hospital #2's ED, indicating any delay in transfer would only delay time sensitive patient care/treatment. EMS personnel (Medic #1) requested a second medic to meet them for assistance. Medic #2 met Medic #1 at 8:27 AM and a third sublingual nitroglycerine was administered to Patient #1 at 8:42 AM. Patient #1 arrived at Hospital #2 at 8:52 AM with a total transfer time of 31 minutes from Hospital #1 to Hospital #2. Patient #1's medical record from Hospital #2 identified that the patient was evaluated at Hospital #2's ED on 2/14/18 with a heart rate of 131, blood pressure 150/90, respiratory rate of 24 and oxygen saturation of 94% on bi-pap. Patient #1 was diagnosed with [DIAGNOSES REDACTED]]and coronary artery disease status post stent placements.

Review of the ED record from Hospital #1 dated 2/14/18 failed to identify that an medical screening examination was conducted by the physician. Further review failed to indicate that the ambulance transport documentation for Patient #1's ED visit was not present in a medical record.

Review of the clincal record and interview with the Chairman of Hospital #1's ED, Director of Quality, Manager of Regulatory Compliance and the ED Medical Director of Hospital #1 on 3/15/18 all identified that the hospital policy was not followed. Further interview identified that Patient #1 should have been assessed, stabilized and/or treated prior to transfer to Hospital #2. In addition, Hospital #2 was not notified of and/or accepted the transfer of Patient #1. Further review indicated that the ED record lacked a medical screening evalution and/or medical record documentation.

During a review of the audio call between Secretary #1, EMS and/or MD#1 with Manager of Quality on 3/15/18 at 11:15 AM verified that the hospitals investigation of the chain of events prior to Patient #1's transfer from Hospital #1 to Hospital #2. No discrepancies in the above interviews were identified.

Review of hospital policy indicated each patient presenting to the ED with an Emergency Medical Condition (EMC) is entitled to a medical evaluation and necessary stabilization.

According to the Chairman of the ED the EMTALA violation occurred 2/14/18. The hospital became aware of the event on 2/23/18. On 2/23/18 the Chairman of the ED reviewed the incident and EMTALA policy with MD#1. On 2/24/18 all physicians received online education about EMTALA. On March 1, 2018 the incident was reviewed at a meeting for all providers. All providers subsequently completed a validation test and signed attestation statement between 3/9/18 and 3/13/18, indicating the EMTALA material was reviewed.

According to the Director and Manager of Quality, subsequent to the EMTALA violation all nursing/support staff were provided with formal education on Emergency Medical Treatment and Labor Act (EMTALA) from March 9 through March 14, 2018. In addition staff completed a validation test and signed attestation statement.