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LEGACY SALMON CREEK MEDICAL CENTER 2211 NE 139TH STREET VANCOUVER, WA 98686 June 26, 2019
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
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Based on interview and review of documents, the hospital failed to implement its policies and procedures to provide a medical screening exam for a patient that came to the emergency department (ED) seeking emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) (Patient #1).

Failure to provide a medical screening exam for patients before they leave the ED puts patients at risk for harm from a medical or psychological emergency that is not screened and treated.

Findings included:

1. Document review of the hospital's policy titled, "Administration & Management of Emergency Medical Treatment and Labor Act (EMTALA) Compliance For Legacy Health Emergency, Labor and Delivery, Psychiatric Emergency Services," revised 01/17 showed that all patients presenting to the emergency department were to receive a medical screening exam in the ED.

2. On 06/25/19 at 2:20 PM, the investigator interviewed a contact (Contact #1) that was present on 05/26/19 when the patient was in the hospital ED waiting room and the hospital's main lobby. The contact stated that Patient #1 was in a lot of pain and swearing when they arrived to the ED. The patient asked to see a nurse to be evaluated but the security guard told the patient they needed to leave due to their yelling and swearing.

3. On 06/27/19 at 7:56 AM, the investigator interviewed Patient #1. The patient stated that the security guard told them to leave because they were swearing. The patient asked for a nurse to come examine them but the security guard refused to get a nurse right away and told the patient there was nothing wrong with them. The patient then left and went to another hospital for treatment.

4. Document review of the security department notes for 05/26/19 showed that the patient was "loud, disruptive, vulgar and verbally abusive to all staff and was demanding to be seen now". The patient was advised of the Legacy directive and signage that verbally abusive, agressive, and threatening behavior could result in the patient being asked to leave. The patient "left of their own doing".

5. Document review of Patient #1's medical record showed:

a) The patient arrived at 9:10 AM on 05/26/19 to the ED waiting room.

b) At 9:30 AM, the patient was yelling in the ED waiting room.

c) At 9:40 AM, the patient walked up to the front desk and was yelling and swearing. Security asked the patient to lower their voice. The patient used some profanity and left the ED waiting room lobby.

d) At 09:47 AM, the patient was laying on the floor of the main lobby entrance to the hospital refusing to get up. The security, ED technician and the ED nurse arrived.

e) At 09:47 AM, the patient dismissed.

6. On 06/26/19 at 10:30 AM, the investigator interviewed a licensed nurse (Staff #9). Staff #9 was working on the day the patient came to the ED. Staff #9 stated they were called by hospital security to come to the hospital main lobby to see the patient. Staff #9 stated when they arrived the patient was angry and refused to come with them to the ED triage area. The patient then left with a male gentleman that was with the patient.

7. On 06/26/19 at 11:00 AM, the investigator interviewed a licensed nurse ( Staff #10). Staff #10 was working as the charge nurse on the day the patient came to the ED. Staff #10 stated that they were called to the main lobby at 9:47 AM to come see the patient but the patient had already left the building.

8. On 06/26/19 at 1:30 PM, the investigator reviewed the above findings with the ED manager (Staff #4) and the Interium Chief Nursing Officer (Staff #5). They stated that the expectation was for secuirty to call nursing staff immediately to help assess patients to rule out any emergent medical condition and get the patient in for a medical screening exam.

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