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Based on record review and interview, the hospital failed to ensure all patients who presented to the hospital's emergency department (ED) were provided on-going stabilizing treatment for an emergency medical condition. The deficient practice is evidenced by failure of the emergency department to provide stabilizing treatment and appropriate monitoring for one patient (F6) who were evaluated and placed under a Physician's Emergency Certificate (PEC) after an emergency medical condition was confirmed.
Findings:

Review of the hospital policy titled "Emergency Medical Treatment and Active Labor Act (EMTALA)" last reviewed 02/23/2023 revealed in part: DEFINITIONS: Hospital Property: The entire main hospital campus including the parking lot, sidewalk, and driveway or hospital departments, including any building owned by the hospital that is within 250 yards of the hospital. Emergency Medical Condition: A medical condition with sufficient severity (including severe pain, psychiatric disturbances, symptoms of substance abuse, pregnancy/active labor) such that the absence of immediate medical attention could place the individual's health at risk. Upon completion of the MSE: Provide any necessary stabilizing treatment for an emergency medical condition (EMC) or patient in labor within the hospital's capability and capacity. Emergency Medical Conditions include: Psychiatric disturbances, including severe depression, insomnia, suicide ideation or attempt, dissociative state, and inability to comprehend danger or care for self.

Patient #F6

Review of Patient #F6's medical record revealed Patient #F6 was brought to the emergency department (ED) on 10/28/2024 at 7:43 p.m. by family for possible overdose. The patient was unresponsive and the family reported the patient took heroin. The chief complaint listed for Patient #F6 was "unresponsive" and the patient was assigned a triage level 1- RESUSCITATION. Patient #F6 was immediately evaluated by ED MD who documented the patient was unresponsive and apneic. ED Nurse inserted IV heplock and administered Narcan IV push. After Narcan was administered, the patient woke up and was aggressive/combative. Security was called to assist. ED MD completed the Physician Emergency Certificate at 8:20 p.m. due to Patient #F6 being a danger to self and unwilling. At 8:34 p.m. ED nurse administered Benadryl and Haldol IM due to Patient #F6 being uncooperative, threatening, and abusive to ED staff. Patient #F6 then eloped from the ED at 9:05 p.m. Family brought Patient #F6 back to the ED on 10/28/2024 at 9:53 p.m.

Review of the Event log for 10/28/2024 revealed the following documentation, in part, of the event:

Description:
Patient was a very uncooperative PEC patient who arrived unresponsive with apparent overdose. After Narcan admin [administered] patient became very aggressive and threatening so security [named] and Town A PD [police department] called for assistance. Security was at bedside when patient ran out of the hospital eloping from the ED.

Closing Remarks:
. . . . Security at bedside, patient eloped out of ED with security chasing after him with no success to stop him. Patient brought back into ED after some time and treatment was continued, as well as PEC . . .

In an interview on 11/14/2024 at 3:30 p.m. S1DON revealed that the emergency department staff were not trained in de-escalation techniques, and training was not provided after the elopements. S1DON also verified the emergency department does not have a safe room for psychiatric patients, only a curtained ED bay across from the nursing station. S1DON verified the doors to the emergency department are not locked, entry and departure from the area is not restricted, and no changes were made to provide a secure setting for psychiatric patients after the elopements. S1DON also verified staff should have called a code white when Patient #F5 stated he was leaving the ED. S1DON also stated once the patient reaches the outside of the hospital, the hospital staff will not go outside even if the patient is still on hospital property, but will call the police department.