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NORTHBAY MEDICAL CENTER 1200 B GALE WILSON BLVD FAIRFIELD, CA 94533 Jan. 11, 2017
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on observations, staff interviews, medical record, document and policy and procedure review, the hospital was in noncompliance with the requirements under EMTALA (Emergency Medical Treatment and Labor Act) when the facility failed to:

1) Ensure one out of 37 patients reviewed at the Fairfield campus (Patient 1), received a medical screening exam by a physician after seeking medical care in a an emergency room (ER). (Refer to A 2406)

2.) Maintain an ER electronic log to ensure treatment was provided to one out of 37 patients reviewed at the Fairfield campus (Patient 1), when documentation was missing from the electronic log to show the patient was seen by a physician or staff resulting in the inability to determine if the patient had an emergent medical condition and potential further harm to the patient. (Refer to A 2405)
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, the facility failed to ensure one of 37 patients reviewed at the Fairfield campus (Patient 1) received a medical screening exam by a physician after seeking medical care in the emergency room (ER). This had the potential for the patient to have been released from the hospital without receiving medical evaluation for a health condition which could have worsened and caused the patient harm.

Findings:

Review of "Self reporting Of EMTALA [Emergency Medical Treatment and Labor Act]Violation" letter received from the facility, dated 12/16/16, indicated Patient 1 (MDS) dated [DATE] at approximately 5:05 a.m. Patient 1 was registered for care at 5:15 a.m. and her chief complaint was leg pain and weakness. Patient 1 was triaged and stated she could not walk. Patient 1 was very anxious and tried to kick the RN. Patient 1 was uncooperative with the triage process. Patient 1 was escorted out of the building without being seen by a physician. The letter indicated the patient visit did not meet the EMTALA guideline for receiving a medical screening exam to rule out an emergency medical condition. The patient was discharged and escorted out of the building at 5:35 a.m., without receiving a medical screening exam by a physician.


During an interview on 1/9/17 at 2:40 p.m., The Patient Safety Director stated Patient 1 came into the hospital on [DATE] and registered at 5:15 a.m. The patient complained of leg pain and weakness in both legs. The Patient Safety Director stated a Registered Nurse (Licensed Staff A) took her into the triage room where Patient 1 became agitated, uncooperative and tried to kick Licensed Staff A. Licensed Staff A went to get Security Staff B. Security Staff B asked if Licensed Staff A was done with the patient and Licensed Staff A told him he did all he could do with Patient 1. Security staff then escorted Patient 1, who was verbally combative out of the building. The Patient Safety Director stated facility administrative staff did not find out about the incident until the Patient 1 called that morning and stated Licensed Staff A was rude to her. The facility determined the patient left without a medical screening. The Patient Safety Director stated it would have been appropriate for the physician to see Patient 1 and also stated the nurse should have later questioned why Patient 1 was no longer in the lobby of the ER. The Patient Safety Director stated there was miscommunication between Licensed Staff A and Security Staff B about what to do with Patient 1.

During an interview on 1/9/17 at 4:25 p.m., Licensed Staff A stated Patient 1 was "hysterical" when she (MDS) dated [DATE] and when he went out to see her in the lobby. Licensed Staff A stated Patient 1 stated she could not walk but Licensed Staff stated he saw her walk to the triage room. Licensed Staff A stated Patient 1 kept getting up, not letting him take her vital signs and Patient 1 kept complaining about her legs, kicking at him with her left leg. Licensed Staff A stated he had security called to deal with the situation with this "hysterical" patient as he could not do anything with her. Licensed Staff A stated he was aware that all patients should be screened by the physician and stated security staff asked her to leave. Licensed Staff A stated security staff did not want staff threatened by patients. Licensed Staff A stated he did not report the event to any one and he did not finish the triage paperwork or make a note about the patient leaving. Licensed Staff A stated he did not think this incident was an EMTALA violation because the patient was very aggressive and he thought security should deal with this.

During an interview on 1/10/17 at 7:30 a.m., Licensed Staff C stated a patient must have a medical screening exam once on the hospital property. Licensed Staff C stated if the patient became aggressive we call security to escort the patient in the hospital and get the physician involved to look at the patient. Licensed Staff C stated it was "not OK" for the security officer to escort the patient out before he was seen by the physician. Licensed Staff C stated the nurse must document and report what happened as it was an EMTALA violation.

During an interview on 1/10/17 at 2:12 p.m., Security Staff D stated he was with Security Staff B on 12/9/16, when Licensed Staff A requested security because of an altercation with Patient 1. Security Staff D stated Security Staff B received a phone call that the ER Nurse needed a patient escorted out of the hospital. Security Staff D stated he and Security Staff B asked the patient to leave and walked her off the hospital property. Security Staff D stated he had "no idea" if Patient 1 saw the physician. Security Staff D stated he thought Patient 1 was assessed by staff and had assaulted a staff member. Security Staff D stated he did not remember EMTALA training or know much about it.

During an interview on 1/10/17 at 2:40 p.m., ER Technician E stated when a patient came into the ED, the patient was registered and triaged. When the patient was triaged, the nurse determined the severity of the illness and the physician performs a medical screening exam. The physician must see the patient and the patient must be discharged by the physician. ER Technician E stated if the resident was fighting, staff tried to defuse the situation and if the behavior escalated, staff called security and had the physician see the resident.

During an interview on 1/10/17 at 2:55 p.m., Licensed Staff F stated EMTALA means that an ER is required to treat people "by law" and there must be a proper medical screening by the physician. Licensed Staff F stated the EMTALA law means we don't turn away anyone. Licensed Staff F stated security was there for staff and the patient's security and it was not the right thing to do to let security escort patients out before they were seen by the physician.

During an telephone interview on 1/10/17 at 3:45 p.m., The ER Medical Director stated he knew about the incident with Patient 1. He stated there was no physician involved and no medical screening exam was performed. The ER Medical Director stated there was a "lapse of judgement" when the patient was escorted out without a medical screening, because staff dealt with violent patients all the time and there are methods to diffuse the situation. The ER Medical Director stated he did not know if security staff received any EMTALA training.

During an interview on 1/11/17 at 7:50 a.m., Security Staff B stated (on 12/9/16) he received a call from Licensed Staff A in the ED, that a female patient (Patient 1) was not cooperating with the triage process and tried to kick Licensed Staff A. Security Staff B stated when he asked Licensed Staff A if they were done with the patient, Licensed Staff A stated he was "done with her and the patient needed to go". Security Staff B stated Patient 1 did not want to go. Security Staff B stated he usually did what the nurse required him to do. Security Staff B stated he did not remember EMTALA training and he did not "know what the EMTALA rules are" and also stated "We don't get involved with that."

During an interview on 1/11/17 at 8:35 a.m., the Security Supervisor stated she did not know what EMTALA was and did not know about the situation that happened with the patient leaving the ER. The Security Supervisor stated she started five years ago in 2012 and did not remember her EMTALA Training.

Review of the policy and procedure, last reviewed 9/14, titled Cobra/EMTALA-Medical Screening indicated when an individual came to the hospital property and there was a request made on an individual's behalf for a medical examination or treatment, the hospital or department must provide an appropriate medical screening examination to determine whether or not an emergency medical condition exists. Individuals coming to the emergency department must be provided a medical screening exam beyond initial triage. Triage is not equivalent to a medical screening exam. Triage merely determines the order in which patients will be seen.