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.
| BAPTIST HEALTH CORBIN | ONE TRILLIUM WAY CORBIN, KY 40701 | June 20, 2019 |
| VIOLATION: COMPLIANCE WITH 489.24 | Tag No: A2400 | |
| Based on interview, record review, review of the facility's Emergency Medical Treatment and Labor Act (EMTALA) Policy, and review of the Medical Staff Rules, Policies and Procedures, it was determined that the facility failed to ensure a medical screening exam was conducted by a qualified medical person and stabilizing medical treatment was provided for one (1) of twenty (20) patients (Patient #1). According to the facility's Medical Staff Rules, Physicians, Advanced Practice Registered Nurses (APRNs), and Physician Assistants (PAs) could conduct a medical screening exam at the facility. On 02/16/19, Patient #1 presented to the facility's Emergency Department (ED) with a chief complaint of "Addiction Problem" and "Suicidal." An APRN assessed the patient's history of drug use. However, there was no evidence a provider, as defined by the facility's policy, provided a medical screening exam related to the patient's chief complaint of suicidal behavior. Subsequently, stabilizing medical treatment was not provided for Patient #1. The facility discharged the patient home with a diagnosis of Polysubstance Abuse. Patient #1 presented to the ED at Facility #2 three days later and an emergency order for a psychiatric evaluation for the patient was obtained. The findings include: Refer to A2406 and A2407. |
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| VIOLATION: MEDICAL SCREENING EXAM | Tag No: A2406 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, review of the "Emergency Medical Treatment and Labor Act [EMTALA]" policies, and review of the Medical Staff Rules, Policies, and Procedures, it was determined the facility failed to have a qualified medical person provide a thorough medical screening exam to determine whether a medical emergency existed for one (1) of twenty (20) sampled patients, (Patient #1) that presented to the facility's Emergency Department (ED). The findings include: Review of Facility #1's policy titled "Emergency Medical Treatment and Labor Act [EMTALA]," effective 01/19/17, revealed the facility would provide an appropriate medical screening examination, within the capability of the facility's Emergency Department (ED), by a physician or qualified medical person to any individual who comes to a dedicated ED of the facility seeking an examination or treatment for a medical condition or who comes upon hospital property, other than to a ED, seeking examination or treatment for an emergency medical condition (whether or not eligible for insurance benefits and regardless of ability to pay). Further review of the facility's policy revealed the individual's medical record must reflect the performance of a medical screening examination and continued monitoring according to the individual's needs until he/she is stabilized or appropriately admitted or transferred. Further review of the facility's EMTALA policy revealed a medical screening examination must be performed by physicians or other qualified medical personnel who are determined qualified by hospital bylaws, rules, regulations, or other hospital board approved documents. Review of the Medical Staff Rules, Policies, and Procedures-General, amended 05/15/18, revealed Emergency Department practitioners (Physicians, Advanced Practice Registered Nurses [APRNs], and Physician Assistants [PAs]) shall provide care within the guidelines of the Emergency Department. Continued review revealed all patients presenting to the Emergency Department seeking treatment shall be provided a medical screening examination by one of the Emergency Department practitioners to determine whether an emergency medical condition exists. Review of the medical record for Patient #1 revealed on 02/16/19 at 6:54 PM the patient presented to the ED with a Chief Complaint of "Addiction Problem" and "Suicidal." Review of Patient #1's "Flowsheets" dated 02/16/19 at 7:24 PM revealed nursing staff documented: "[Patient #1] reports [he/she] wants detox from meth. [Patient #1] reports [he/she] had been using meth since [he/she] was 14. [Patient #1] reports last use was 1-2 days ago. [Patient #1] stated [he/she] has a history of taking pain pills. [Patient #1] states 'I've done everything'. [Patient #1] states while in triage and being asked questions that [he/she] is now suicidal. [Patient #1] denies specific plan." Review of the "Columbia Suicide Severity Rating Scale (C-SSRS) dated 02/16/19 at 7:27 PM revealed nursing staff documented Patient #1 answered "yes" when asked if he/she wished to be dead, had suicidal thoughts, had suicidal behavior, and had suicidal behavior in the last three months. Review of Patient #1's Medical Screening Exam (MSE) dated 02/16/19 at 8:13 PM revealed the APRN #1 documented that the adolescent patient presented with a complaint of "polysubstance abuse", but did not mention the chief complaint of "suicidal". APRN #1 documented a "review of systems" was conducted that included assessing the patient's respiratory, cardiovascular, and neurological systems, etc. The APRN also documented that Patient #1 had "decreased concentration," was "nervous/anxious," and "hyperactive." Further review revealed the APRN's physical exam revealed Patient #1 had normal speech, behavior, judgement, thought content, cognition, and memory, but appeared anxious. Further review revealed the APRN documented the patient's final diagnosis was Polysubstance Abuse that was "stable". However, there was no documented evidence APRN #1 addressed/assessed Patient #1's complaint of "suicidal." Review of Patient #1's Psychosocial assessment dated [DATE] at 8:44 PM revealed the patient had "pressure speech; response lag," and was "evasive; irritable." However, review of the "Plan" revealed Patient #1 "Does not meet admission criteria per phone contact [with the psychiatrist]." Further review revealed Patient #1 was discharged six minutes later at 8:50 PM on 02/16/19 and staff "discussed rehab places...medical clearance given, along with packet." Interview with APRN #1 on 06/19/19 at 1:00 PM revealed she evaluated Patient #1 in the ED on 02/16/19. APRN #1 stated that she only assessed the patient's medical condition and "medically cleared" Patient #1. The APRN stated "intake" staff from the Behavioral Health Unit were responsible for assessing the patient's behavioral health. APRN #1 stated a "psych" Registered Nurse (RN) in the ED does the "intake" assessment, and then contacts the on-call psychiatrist regarding admission to the facility's behavioral health unit. APRN #1 stated it was up to them whether or not to admit the patient. Interview with RN #1 on 06/19/19 at 3:08 PM revealed she was the RN conducting Behavioral Health assessments on 02/16/19. RN #1 stated that she did not remember Patient #1, but stated that routinely when someone presented to the ED with a behavioral health complaint, the ED requested the RN to conduct an assessment. Once the RN completes the assessment, the RN contacts the on-call psychiatrist and reports their assessment. RN #1 stated the on-call psychiatrist then made the determination whether or not to admit the patient. There was no documented evidence a medical screening exam was completed by a qualified individual in accordance with the facility's policies related to the patient's suicidal ideation. Interview with the ED Director on 06/19/19 at 1:15 PM revealed behavioral health staff completed an evaluation of patients with a behavioral health complaint and determined whether they were admitted . Interview with the Behavioral Health Director on 06/19/19 at 1:41 PM revealed it was common practice for the Behavioral Health RN in the ED to complete a "psychosocial assessment" on any patient that presented to the ED with a behavioral health complaint. The Behavioral Health Director stated that the RN completed the assessment, contacted the on-call psychiatrist, and presented them with the information. The on-call psychiatrist then determined whether the patient met criteria for admission. Continued interview with the Behavioral Health Director revealed on 02/16/19 when Patient #1 presented to the ED, the census on the Behavioral Health Adolescent Unit was six (6) patients, with a bed availability of seven (7). Review of Patient #1's medical record from Facility #2 revealed Patient #1 presented to the ED of Facility #2 on 02/19/19 at 7:12 PM, three days after being discharged from Facility #1's ED. Nursing staff triaged Patient #1 at 7:12 PM and documented the "chief complaint" as "suicidal ideation" and "patient ambulatory to ED from [privately owned vehicle] with [Family Member #1] who reports she received a phone call from patient asking for help." RN #1 documented "Patient reports [he/she] wants to kill [himself/herself] before they get a chance to kill [him/her] first." A review of the physician's assessment dated [DATE] at 8:00 PM revealed the patient was uncooperative and information was provided by a family member. Physician #1 documented "patient refuses to sign consent for evaluation or treatment. Uncooperative when approached for history. History of multiple recent evaluations for similar complaints." |
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| VIOLATION: STABILIZING TREATMENT | Tag No: A2407 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview, medical record review, and review of facility policies, it was determined the facility failed to ensure stabilizing medical treatment was provided for one (1) of twenty (20) sampled patients, (Patient #1) that presented to the facility's Emergency Department (ED) for an Emergency Medical Condition. The findings include: Review of Facility #1's policy titled "Emergency Medical Treatment and Labor Act [EMTALA]," effective 01/19/17, revealed the facility would provide an appropriate medical screening examination, within the capability of the facility's Emergency Department (ED), by a physician or qualified medical person to any individual who comes to a dedicated ED of the facility seeking an examination or treatment for a medical condition and to provide the individual with such further medical examination and treatment as required to stabilize the emergency medical condition, within the capability of the facility, or to arrange for transfer of the individual to another medical facility. Review of the medical record for Patient #1 revealed on 02/16/19 at 6:54 PM the patient presented to the ED with a Chief Complaint of "Addiction Problem" and "Suicidal." Review of Patient #1's "Flowsheets" dated 02/16/19 at 7:24 PM revealed nursing staff documented: "[Patient #1] reports [he/she] wants detox from meth. [Patient #1] reports [he/she] had been using meth since [he/she] was 14. [Patient #1] reports last use was 1-2 days ago. [Patient #1] stated [he/she] has a history of taking pain pills. [Patient #1] states 'I've done everything'. [Patient #1] states while in triage and being asked questions that [he/she] is now suicidal. [Patient #1] denies specific plan." Review of the "Columbia Suicide Severity Rating Scale (C-SSRS) dated 02/16/19 at 7:27 PM revealed nursing staff documented Patient #1 answered "yes" when asked if he/she wished to be dead, had suicidal thoughts, had suicidal behavior, and had suicidal behavior in the last three months. Review of Patient #1's Psychosocial assessment dated [DATE] at 8:44 PM revealed the patient had "pressure speech; response lag," and was "evasive; irritable." Review of Patient #1's Medical Screening Exam (MSE) dated 02/16/19 at 8:13 PM revealed the adolescent patient presented with a complaint of "polysubstance abuse." Advance Practice Registered Nurse (APRN) #1 documented a "review of systems" was conducted that included assessing the patient's respiratory, cardiovascular, and neurological systems, etc. The APRN also documented a "Psychiatric/Behavioral" assessment that stated that Patient #1 had "decreased concentration," was "nervous/anxious," and "hyperactive." Further review revealed the APRN's physical exam revealed Patient #1 had normal speech, behavior, judgement, thought content, cognition, and memory, but appeared anxious. Further review of APRN #1's documentation revealed she documented that Patient #1 was stable and the final diagnosis was Polysubstance Abuse. There was no documented evidence APRN #1 assessed/addressed Patient #1's complaint of "suicidal" or attempted to treat the patient for this behavior. Review of Patient #1's Physician Orders dated 02/16/19 at 7:32 PM revealed the following laboratory tests were ordered: Complete Blood Count with Auto Differential, Comprehensive Metabolic Panel, Ethanol, Urine Drug Screen, Urinalysis with Culture if indicated, and Magnesium. However, at 8:13 PM on 02/16/19, when the MSE was documented, APRN #1 discontinued all laboratory studies. Continued review of the orders revealed that nursing staff ordered "suicide precautions" on 02/16/19 at 8:10 PM based on the facility's suicide protocol. However, APRN #1 canceled the suicide precautions order. Interview with APRN #1 on 06/19/19 at 1:00 PM revealed she evaluated Patient #1 in the ED on 02/16/19. APRN #1 stated that she only assessed the patient's medical condition and "medically cleared" Patient #1. The APRN stated it was the facility's practice for a "psych" Registered Nurse (RN) to assess the patient's behavioral health and to contact the on-call psychiatrist regarding admission/treatment. The APRN stated she canceled the patient's laboratory tests because the RN from the Psychiatric Unit came to assess the patient. Review of the "Plan" for Patient #1 revealed the patient "Does not meet admission criteria per phone contact [with the psychiatrist]. Further review revealed Patient #1 was discharged at 8:50 PM on 02/16/19 and staff "discussed rehab places...medical clearance given, along with packet." Interview with RN #1 on 06/19/19 at 3:08 PM revealed she completed ED Behavioral Health Assessments and notified the on-call psychiatrist of her findings. RN #1 stated the psychiatrist then determined the patient's course of treatment via phone. There was no documented evidence a qualified medical practitioner provided a medical screening exam related to Patient #1's suicidal behavior; subsequently, there was no documented evidence the facility provided stabilizing medical treatment for the patient. Review of Patient #1's medical record from Facility #2 revealed Patient #1 presented to the ED of Facility #2 on 02/19/19 at 7:12 PM, three days after being discharged from Facility #1's ED. Nursing staff triaged Patient #1 at 7:12 PM and documented the "chief complaint" as "suicidal ideation" and "patient ambulatory to ED from [privately owned vehicle] with [Family Member #1] who reports she received a phone call from patient asking for help." RN #1 documented "Patient reports [he/she] wants to kill [himself/herself] before they get a chance to kill [him/her] first." A review of the physician's assessment dated [DATE] at 8:00 PM revealed the patient was uncooperative and information was provided by a family member. Physician #1 documented "patient refuses to sign consent for evaluation or treatment. Uncooperative when approached for history. History of multiple recent evaluations for similar complaints." Further review revealed an emergency order for a psychiatric evaluation for Patient #1 was obtained. |
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