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.

EVERGREENHEALTH MONROE 14701 179TH AVE SE MONROE, WA 98272 Feb. 12, 2020
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
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Based on interview and document review, the hospital failed to implement their policies and procedures for evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients who present for emergency treatment receive a comprehensive medical screening examination and stabilizing treatment prior to transfer or discharge risks poor patient care outcomes, injury, and death.

Findings included:

1. The hospital failed to ensure that a patient received a medical screening exam (MSE) in the emergency department (ED) prior to being transported to another hospital's ED.

2. The hospital failed to call the receiving hospital to alert them that the patient was being transported to their ED for a MSE.

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VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
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Based on interview and document review, the hospital failed to implement its policies and procedures to provide a medical screening exam for a patient that was brought to the emergency department (ED) by ambulance in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) for 1 of 26 patient records reviewed (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 "EMTALA: Patient Registration/Patient Transfer," approved 07/19, showed that all patients that presented to the ED were to receive a medical screening exam (MSE).

2. Review of Patient #1's medical record showed that:

a) Patient #1 was brought by ambulance on 01/07/20 from a correctional facility. The ED nurse triaged the patient in the ED. The ED nurse said the orders from the correctional facility stated the patient needed dialysis and the hospital did not have the capability to provide patients with dialysis.

b) The ambulance transported the patient to another ED for care.

c) Documentation showed the ambulance staff left the ED with the patient before the physician could perform a MSE.

3. On 02/12/20 at 9:00 AM, the investigator interviewed the ED manager (Staff #4). Staff #4 stated that all patients that come to the ED are to receive a MSE by the physician and if indicated, transferred to another hospital for a higher level of care. Staff #4 stated that patients should be transferred to another hospital after a MSE was performed by the physician and the physician had contacted the accepting hospital about the patient's condition.

4. On 02/12/20 at 10:00 AM, the investigator interviewed the Compliance Officer (Staff #8). Staff #8 verified the above information.

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VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
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Based on interview and document review, the hospital failed to notify another hospital that a patient was being sent to their emergency department (ED) for treatment (Patient #1).

Failure to notify the accepting hospital of the patient transfer puts patients at risk for delays in receiving treatment and poor patient outcomes.

Findings included:

1. Document review of the hospital's policy titled "EMTALA Transfer Form," approved 10/19, showed that when patients required transfer from the ED to a higher level of care at another hospital, a physician to physician and nurse to nurse report must occur prior to the patient's transfer. Hospital staff also needed to complete the transfer form that has vital information for the care of the patient.

2. Review of Patient #1's medical record showed that:

a) Patient #1 was brought to the emergency department (ED) on 01/07/20 by ambulance from a correctional facility for dialysis treatment.

b) The nurse in the ED did triage on the patient and notified the ambulance service that the hospital did not have dialysis facilities and would need to go to another hospital.

c) There was no docmentation that the hospital contacted the other hospital that the patient was enroute to their ED.

3. On 02/10/20 at 1:25 PM, the investigator interviewed a contact (Contact #1) for Patient #1. Contact #1 stated that Patient #1 arrived at the transferring hospital without a medical screening exam or phone call that the patient was enroute to the hospital. The patient did not have transfer paperwork from the hospital and this caused confusion when the patient arrived at the receiving hospital.

4. On 02/12/20 at 9:00 AM, the investigator interviewed the ED manager (Staff #4). Staff #4 stated that all patients that came to the ED should receive a medical screening exam, and if indicated, transferred to another hospital for a for a higher level of care. Patient should only be transferred after the physician has contacted the accepting physician about the patient's condition. Staff #4 stated that a nurse to nurse report also was required. In addition, the hospital staff need to complete transfer paperwork and send the transfer paperwork with the patient to the accepting hospital.

5. On 02/12/20 at 10:00 AM, the investigator interviewed the Compliance Officer (Staff #8). Staff #8 verified the above information.

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