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.
| PENN HIGHLANDS HUNTINGDON | 1225 WARM SPRINGS AVE HUNTINGDON, PA 16652 | Feb. 14, 2019 |
| VIOLATION: EMERGENCY ROOM LOG | Tag No: A2405 | |
| Based on a review of facility documents, video footage, and staff interviews (EMP), it was determined that J.C. Blair Memorial Hospital failed to ensure that an individual who came to their Emergency Department seeking assistance, was entered onto the Log, for one of one patients identified (PT1) Findings include: "J.C. Blair Memorial Hospital Title: Emergency Medical Care and EMTALA Requirements Revisions: ... 11/13/2018 Policy Number: ADM-120 ... Originator: Administration II. Purpose: I. Scope: Emergency Department/Obstetric Unit/Registration II. Purpose: To meet the hospital's obligation under the Emergency Medical Treatment and Active Labor Act (EMTALA) by ensuring that when an individual comes to the hospital for emergency care, the hospital will: 1. Provide an appropriate medical screening examination; 2. If the individual has an emergency medical condition, either: a. provide any necessary stabilizing treatment; b. transfer the individual in compliance with the requirements of Section IV below; or c. admit the individual. 1. Appropriate Medical Screening Examination (MSE) A. MSE Procedure - General. 1. When an individual comes to the hospital for emergency care, the hospital must provide the individual with an appropriate medical screening examination (MSE). Within the capability of the ED (including ancillary services routinely available) to determine whether an emergency medical condition exists. 2. For this policy, comes to the hospital for emergency care means the individual - (a) has presented at the ED or the obstetric unit, or at any other hospital-operated location on the hospital's campus, and either: * requests examination or treatment for a medical condition. * has such a request made on his or her behalf, or * a prudent layperson observer would believe, based on the individual's appearance or behavior, that the individual needs examination or treatment for a medical condition; or (b) Is in an ambulance on hospital property for presentation for examination and treatment for a medical condition at a hospital's emergency department. 3. For the purpose of this policy, emergency medical condition means - (a) A medical condition manifesting itself by acute symptoms of sufficient severity ( including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably by expected to result in - (i) Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (ii) Serious impairment to bodily functions; or (III) Serious dysfunction of any bodily organ or part; or (b) With respect to a pregnant woman who is having contractions --- (i) That there is inadequate time to effect a safe transfer to another hospital before delivery; or (ii) That transfer may pose a threat to the health or safety of the woman or the unborn child. 4. The MSE must be performed by Qualified Medical Personnel, which means and emergency medicine physician or a resident in an approved training program supervised by an emergency medicine physician or mid-level providers (Physician Assistants or Certified Registered Nurse Practitioners) working in the Emergency Department under the supervision of an Emergency Department Physician. A Qualified evaluator to perform a medical screening exam is: (a) A licensed Practitioner with medical staff privileges at this hospital that include obstetric care of emergency medicine. 5. As part of the MSE, the physician will perform and document the history and physical assessment. 6. The MSE must be the same MSE that the hospital would perform on any individual coming to the hospital with the same signs and symptoms, regardless of diagnosis (e.g., labor, AIDS), financial status (e.g., uninsured, Medicaid), race, color, national origin or disability. 7. The MSE may not be delayed in order to inquire about an individual's ability to pay or to perform insurance verification, See Part III. 8. If, prior to completion of the MSE, the patient expresses the intent to leave the hospital, either a Qualified Medical Personnel, R. N. or L.P.N. in ED shall encourage the patient to remain and explain to the patient the risks of leaving and the benefits of the MSE. If patient still chooses to leave, they will be asked to sign an AMA form. ... 11. Hospital staff may not take any action to suggest that the patient leave the hospital prior to an MSE. B. MSE Procedure - Emergency Department When an individual present at the ED: 1. The ED/OB Nurse will immediately assess patient's chief complaint. 2. Upon completion of the initial assessment, assignment of care will be based on the identified acuity. 3. A qualified medical personnel will provide an MSE as soon as possible. ... II. Stabilizing Treatment. Stabilizing Treatment means: (a) such medical examination and treatment of the condition as is necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility; or (b) with respect to pregnant woman who is having contractions, that the woman who may or mat not have delivered the child and the placenta. 2. If the MSE indicated that the individual has an emergency medical condition, then appropriate hospital staff should provide stabilizing treatment tot the individual, unless the individual is admitted , or a transfer is warranted in accordance with Section IV below. 3. If the hospital staff seeks to provide stabilizing treatment to an individual, but the individual refuses to consent to such treatment, hospital staff must: (a) Encourage the individual (or that of the person acting on his or her behalf) to consent to stabilizing treatment, and explain the risk and benefits of such examination or treatment; (b) Take all reasonable steps to secure the individual's written informed refusal (or that of the person acting on his or her behalf). Written documentation shall indicate that the person has been informed of the risks and benefits of the examination or treatment, or both. (c) Document on the medical record the above information and if they refuse to sign the AMA form, document that on the record as well. III. Prohibition on Delaying Screening or Stabilizing Treatment. 1. The hospital may not delay providing a medical screening examination or stabilizing treatment in order to inquire about the individual's method of payment or insurance. 2. Hospital registration personnel may obtain information relating to a patient's insurance status and demographic information prior to the MSE or further stabilizing treatment, as long as that inquiry does not delay the MSE or stabilizing treatment or unduly discourages individuals from remaining for such services. ... C. The following requirements apply to the transfer of any patient from the ED, whether or not the patient has been stabilized: 1. The transferring hospital (i.e., J.C. Blair) provides medical treatment within its capacity that minimizes the risks to the individual's health and, in the case of woman in labor, the health of the unborn child. Such treatment shall include stabilizing treatment, as indicated, to address airway, oxygenation ... and all immediate threats to life, limb of function, 2. The transferring hospital has confirmed in advance that the receiving facility - (a) has available space and qualified personnel for the treatment of the individual; and (b) has agreed to accept transfer of the individual and to provide appropriate medical treatment ... VI. Emergency Medical Care Log 1. The emergency medical care logs will include an entry for EVERY patient that comes to the ED seeking treatment. This will also include those patients transferred from other facilities to the ED, and also include those who left without being seen (LWBS). 2. Data entry to the log shall not delay the medical screening exam, necessary treatment or stabilization. If the patient is to be transferred, the entry will be finalized following the move. 3. The log must contain: a. the name; b. date and time of arrival; c. complaint and disposition; d. whether the individual: i. refused treatment; ii. was refused treatment; iii. Left without being seen (LWBS); iv. stabilized and transferred (include facility name and time of transfer); v. transfer to another facility (include facility name and time of transfer); vi. admitted and treated; vii. discharged including date and time. ... VIII. Reporting Violations 1. Any employee who is aware of a violation of this policy shall report it to the Medical Director of the ED or the Risk Manager as soon as the violation is identified. ... ." "Triage", dated September 2018, which stated "... The Registration Clerk will immediately place patient on tracker board each time a patient presents to the Emergency Department for treatment ... ." "Scope of Emergency Services", dated September 2018, which stated "... The Emergency Department meets the emergent needs of the community by providing adequate assessment and initial treatment to any ill or injured person presenting to the Emergency Department ... Control Record: The Emergency Department will keep a control log containing the following information for each patient treated in the Emergency Department: 1. Date 2. Time. 3. Patient's name & Medical Record #. 4. Age. 5. Sex. 6. Admitting Physician. 7. Diagnosis or complaint. 8. Disposition. 9. Time of disposition ... ." 1. An interview with EMP1 on February 13, 2019, revealed the facility has no documentation of PT1 being at the hospital, and stated that PT1 was not registered as a patient. 2. A review of the video monitoring footage recorded at the entrance to the Emergency Department Registration/Greeting window was completed on February 14, 2019. It was observed on camera footage (CH03 - Channel 3) on February 6, 2019, at 23:36, a male and female (PT1) present to the Registration window and stand at the window for 5 minutes and at 23:41, leaves the Registration area and exits the facility. A review of the Video monitoring footage recorded within the Registration/Greeter office located at the entrance to the Emergency Department. It was observed on camera footage (CH05 - Channel 5) on February 6, 2019, at 23:36, one Registration Clerk was stationed in front of a computer, and another Registration Clerk enters the office and goes to the Registration/Greeting window where a female (PT1) is standing. It is observed at 23:36 that a conversation occurs between the female presenting to the Registration/Greeting window and the Registration Clerk. At 23:36 the Registration Clerk picks up the phone and is talking on the phone. At 23:40 the Registration Clerk hangs up the phone and has a conversation with the female at the Registration/Greeting window. At 23:41 the conversation ends, and the female could no longer be seen at the Registration window. 3. A review of the ED Log, dated February 6, 2019, was completed and revealed PT1 was not entered on the Log. |
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| VIOLATION: MEDICAL SCREENING EXAM | Tag No: A2406 | |
| Based on review of facility documents, video footage, medical record (MR1), and staff interviews (EMP1), it was determined the facility to follow adopted policies by failing to ensure that an appropriate medical screening was provided for one of one patients who presented to the Emergency Department. (PT1) Findings include: "J.C. Blair Memorial Hospital Title: Emergency Medical Care and EMTALA Requirements Revisions: ... 11/13/2018 Policy Number: ADM-120 ... Originator: Administration II. Purpose: I. Scope: Emergency Department/Obstetric Unit/Registration II. Purpose: To meet the hospital's obligation under the Emergency Medical Treatment and Active Labor Act (EMTALA) by ensuring that when an individual comes to the hospital for emergency care, the hospital will: 1. Provide an appropriate medical screening examination; 2. If the individual has an emergency medical condition, either: a. provide any necessary stabilizing treatment; b. transfer the individual in compliance with the requirements of Section IV below; or c. admit the individual. 1. Appropriate Medical Screening Examination (MSE) A. MSE Procedure - General. 1. When an individual comes to the hospital for emergency care, the hospital must provide the individual with an appropriate medical screening examination (MSE). Within the capability of the ED (including ancillary services routinely available) to determine whether an emergency medical condition exists. 2. For this policy, comes to the hospital for emergency care means the individual - (a) has presented at the ED or the obstetric unit, or at any other hospital-operated location on the hospital's campus, and either: * requests examination or treatment for a medical condition. * has such a request made on his or her behalf, or * a prudent layperson observer would believe, based on the individual's appearance or behavior, that the individual needs examination or treatment for a medical condition; or (b) Is in an ambulance on hospital property for presentation for examination and treatment for a medical condition at a hospital's emergency department. 3. For the purpose of this policy, emergency medical condition means - (a) A medical condition manifesting itself by acute symptoms of sufficient severity ( including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably by expected to result in - (i) Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; (ii) Serious impairment to bodily functions; or (III) Serious dysfunction of any bodily organ or part; or (b) With respect to a pregnant woman who is having contractions --- (i) That there is inadequate time to effect a safe transfer to another hospital before delivery; or (ii) That transfer may pose a threat to the health or safety of the woman or the unborn child. 4. The MSE must be performed by Qualified Medical Personnel, which means and emergency medicine physician or a resident in an approved training program supervised by an emergency medicine physician or mid-level providers (Physician Assistants or Certified Registered Nurse Practitioners) working in the Emergency Department under the supervision of an Emergency Department Physician. A Qualified evaluator to perform a medical screening exam is: (a) A licensed Practitioner with medical staff privileges at this hospital that include obstetric care of emergency medicine. 5. As part of the MSE, the physician will perform and document the history and physical assessment. 6. The MSE must be the same MSE that the hospital would perform on any individual coming to the hospital with the same signs and symptoms, regardless of diagnosis (e.g., labor, AIDS), financial status (e.g., uninsured, Medicaid), race, color, national origin or disability. 7. The MSE may not be delayed in order to inquire about an individual's ability to pay or to perform insurance verification, See Part III. 8. If, prior to completion of the MSE, the patient expresses the intent to leave the hospital, either a Qualified Medical Personnel, R.N. or L.P.N. in ED shall encourage the patient to remain and explain to the patient the risks of leaving and the benefits of the MSE. If patient still chooses to leave, they will be asked to sign an AMA form. ... 11. Hospital staff may not take any action to suggest that the patient leave the hospital prior to an MSE. B. MSE Procedure - Emergency Department When an individual present at the ED: 1. The ED/OB Nurse will immediately assess patient's chief complaint. 2. Upon completion of the initial assessment, assignment of care will be based on the identified acuity. 3. A qualified medical personnel will provide an MSE as soon as possible. ... II. Stabilizing Treatment. Stabilizing Treatment means: (a) such medical examination and treatment of the condition as is necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of the individual from a facility; or (b) with respect to pregnant woman who is having contractions, that the woman who may or mat not have delivered the child and the placenta. 2. If the MSE indicated that the individual has an emergency medical condition, then appropriate hospital staff should provide stabilizing treatment tot the individual, unless the individual is admitted , or a transfer is warranted in accordance with Section IV below. 3. If the hospital staff seeks to provide stabilizing treatment to an individual, but the individual refuses to consent to such treatment, hospital staff must: (a) Encourage the individual (or that of the person acting on his or her behalf) to consent to stabilizing treatment, and explain the risk and benefits of such examination or treatment; (b) Take all reasonable steps to secure the individual's written informed refusal (or that of the person acting on his or her behalf). Written documentation shall indicate that the person has been informed of the risks and benefits of the examination or treatment, or both. (c) Document on the medical record the above information and if they refuse to sign the AMA form, document that on the record as well. III. Prohibition on Delaying Screening or Stabilizing Treatment. 1. The hospital may not delay providing a medical screening examination or stabilizing treatment in order to inquire about the individual's method of payment or insurance. 2. Hospital registration personnel may obtain information relating to a patient's insurance status and demographic information prior to the MSE or further stabilizing treatment, as long as that inquiry does not delay the MSE or stabilizing treatment or unduly discourages individuals from remaining for such services. ... C. The following requirements apply to the transfer of any patient from the ED, whether or not the patient has been stabilized: 1. The transferring hospital (i.e., J.C. Blair) provides medical treatment within its capacity that minimizes the risks to the individual's health and, in the case of woman in labor, the health of the unborn child. Such treatment shall include stabilizing treatment, as indicated, to address airway, oxygenation ... and all immediate threats to life, limb of function, 2. The transferring hospital has confirmed in advance that the receiving facility - (a) has available space and qualified personnel for the treatment of the individual; and (b) has agreed to accept transfer of the individual and to provide appropriate medical treatment ... VI. Emergency Medical Care Log 1. The emergency medical care logs will include an entry for EVERY patient that comes to the ED seeking treatment. This will also include those patients transferred from other facilities to the ED, and also include those who left without being seen (LWBS). 2. Data entry to the log shall not delay the medical screening exam, necessary treatment or stabilization. If the patient is to be transferred, the entry will be finalized following the move. 3. The log must contain: a. the name; b. date and time of arrival; c. complaint and disposition; d. whether the individual: i. refused treatment; ii. was refused treatment; iii. Left without being seen (LWBS); iv. stabilized and transferred (include facility name and time of transfer); v. transfer to another facility (include facility name and time of transfer); vi. admitted and treated; vii. discharged including date and time. ... VIII. Reporting Violations 1. Any employee who is aware of a violation of this policy shall report it to the Medical Director of the ED or the Risk Manager as soon as the violation is identified. ... ." "Triage", dated September 2018, which stated "... The Registration Clerk will immediately place patient on tracker board each time a patient presents to the Emergency Department for treatment ... ." "Scope of Emergency Services", dated September 2018, which stated "... The Emergency Department meets the emergent needs of the community by providing adequate assessment and initial treatment to any ill or injured person presenting to the Emergency Department ... ." 1. An interview with EMP1 on February 13, 2019, at approximately 9:45AM, revealed the facility has no documentation of PT1 being at the hospital, and stated that PT1 was not registered as a patient. 2. A review of the Video monitoring footage recorded at the entrance to the Emergency Department Registration/Greeting window was completed on February 14, 2019. It was observed on camera footage (CH03 - Channel 3) on February 6, 2019, at 23:36, a male and female patient (PT1) presents to the registration window and stands at the window for 5 minutes and at 23:41, leaves the registration area and exits the facility. A review of the Video monitoring footage recorded within the registration/greeter office located at the entrance to the Emergency Department was completed on February 14, 2019. It was observed on camera footage (CH05 - Channel 5) on February 6, 2019, at 23:36, one registration clerk was stationed in front of a computer, and another registration clerk enters the office and goes to the registration/greeting window where a female patient (PT1) is standing. It is observed at 23:36 that a conversation occurs between the female presenting to the registration/greeting window and the registration clerk. At 23:36 the registration clerk picks up the phone and is talking on the phone. At 23:40 the registration clerk hangs up the phone and has a conversation with the female at the registration/greeting window. At 23:41 the conversation ends, and the female could no longer be seen at the registration window. 3. A telephone interview with EMP5 on February 13, 2019, at 1:25PM, revealed "I think (the patient) was 30 weeks pregnant. I was sitting at the nurse's station. Registration called to alert staff about what was going on. EMP4 stated (they) wanted to do this by the book. EMP4 specifically said (they) would be glad to see (the patient), but more than likely we would have to transfer (the patient), because of no OB. I think (the patient) ended up going home and calling EMS." 4. An interview with EMP6 on February 13, 2019, at 1:35PM, with EMP8 revealed "I was here, but I didn't know. I heard about it later. Someone told the patient we don't have OB." 5. A telephone interview with EMP10 on February 14, 2019, at 10:40AM, revealed "... I was on the computer finishing registering with a gentleman. I called for EMP13 to help me and to get the patient's information. I do remember the patient was 30 weeks pregnant. (The patient) called their OB/GYN in Johnstown and (they) told (them) to go to the closest ED to be assessed, and (they) felt JC Blair could get (them) there (Johnstown) faster." (EMP10) stated that EMP13 advised (the patient) that (they) couldn't give the patient a time frame on how fast they could get (them) out the ED, but told the patient they could get (them) assessed, but that it was (their) choice to wait at JC Blair and then get her transferred as quickly as possible. 6. A telephone interview with EMP13 on February 14, 2019, at 12:45PM, with EMP1 revealed "I was in the back and EMP10 asked me to come. The patient was 30 weeks pregnant and (their) water broke. (They) wanted to get to Johnstown as soon as possible. I talked to the doctor and (the patient) asked how long it would take. I did tell (the patient) we don't have maternity. The patient already knew that. (They) wanted to know how long for transport. (They) wanted to know how long to get to Johnstown. I told (them) I couldn't guarantee a time, and told (them) it was (their) decision. (They) didn't put (themselves) on the board." 7. Review of MR1 revealed "... Patient seen on 2/7/2019 ... Time of exam ... 1:00:00 AM ... (Patient) presented to the ER at JC Blair for evaluation however they could not get ambulance transport so the patient went home and called an ambulance which brought (them) ... to (OTH1) ... Patient discussed with Dr. ... at (OTH2) ... will accept patient in transfer ... BLS ambulance transport ... Diagnosis: Preterm premature rupture of members ... with unknown onset of labor ... Gestational diabetes mellitus ... affecting sixth pregnancy ... History of cesarean delivery, currently pregnant ... ." |
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