HospitalInspections.org

Based on interview and record review, the facility failed to provide a medical screening examination to 1 of 30 sampled patients who presented to the Emergency Department for treatment (Patient ID # 8).

Findings include:

Record review of complaint narrative (TX # 00193901) revealed Patient ID # 8 (32 weeks pregnant) had a syncopal episode and fallen in the hallway of her OB physician's office, following an appointment. Patient did not want to go to an Emergency Room (ER); her OB physician wanted the patient evaluated. The OB physician did not want her to go to Hospital B's ER because she believed it was a medical problem and not related to her fetus or pregnancy. Patient ID # 8 agreed to be evaluated at University General Hospital, as she did not want to go to the medical center ERs. Once the EMS crew arrived, before they gave any report, the staff at the hospital saw the patient was pregnant and stated "why didn't you take her across the street?" They did not take any vital signs or assess the patient. An administrator, doctor, and a nurse, convinced the patient's husband to take her in a private auto across the street..."

Record review on 04-07-14 of facility policy titled "Scope of Services: Emergency Department" dated 07-26-06, stated: "All patients that present to University General Hospital premises for a non-scheduled visit and are seeking care shall receive a medical screening exam by an Emergency Department physician that includes providing all necessary testing and on-call services with the capability of (the hospital) to reach a diagnosis..."

Interview: Patient ID # 8:

Interview (telephone) on 04-07-14 at 11:40 a.m., with Patient ID # 8 she stated she fainted at her OB's office on 03-26-14; she fell on her side, abdomen and also hit her head. She said her OB doctor checked the baby's heart and then wanted her to go to an ER and be checked. When we got there, the ER doctor (ID # 7) said to the ambulance people: "What happened?" When she saw I was pregnant, she said "You need to take her somewhere else, we don't do OB here." I heard the ER doctor (ID # 7) say "What kind of a doctor sends a 30 week pregnant girl here?"

Patient ID # 8 went on to say they left her on the stretcher and put her in the hallway. "I felt very uncomfortable the whole time I was there. No hospital staff attempted to take my vital signs or check me out." Patient ID # 8 denied refusing treatment. She said she was very upset because the ER doctor called her OB doctor and said she refused treatment. "This wasn't true. They did not want me there; I never refused treatment." Some person came and spoke with us and said "You can stay here if you want, but they have everything at (Hospital B), they can take care of you and your baby. This was a horrible experience. They were trying to make me feel uncomfortable so I wouldn't stay there. My OB doctor wanted me to be checked out there and I didn't know what to do. By this time, I had started having some contractions. Finally, my husband said: Let's just go to (Hospital B). As soon as he said that, they got a wheelchair fast and got me out quick." The hospital (University) did not ask her to sign anything before she left and did not explain the risks of her leaving without them checking her out.

Interview: Paramedic ID # 15:

Interview (telephone) on 04-05-14 at 10:45 a.m. with Houston Fire Department (HFD) Paramedic ID # 15, he stated that he and his partner responded to a 911 call on 03-26-14 from an Obstetrician (OB) physician's office. He went on to say they transported Patient ID # 8 into the ER on the stretcher. Immediately upon arrival, the ER Physician/ ID # 7 said: "No, No, No, we don't do OB here. Why didn't you take her across the street?" The ER physician would not listen to the explanation of why the patient was brought to the ER and that it was not an L & D issue. The ER physician began making several telephone calls. He went on the say that no one in the ER took a set of vital signs or even touched the patient. He said they took her ID but that was all. He did not witness the patient sign anything. Paramedic ID # 15 said "in my opinion, the hospital convinced the patient to leave their facility and go across the street ..."

Interview: Paramedic ID # 16:

Interview (telephone) on 04-15-14 at 11:45 a.m. with HFD Paramedic ID # 16, he stated Patient ID # 8 was taken to the facility ER. The ER physician ID # 7 immediately said: "No, No, No this is OB, we don't do OB." We couldn't get our story out. We wanted to explain that all the patient needed was to be cleared. The doctor wouldn't listen.

No one took any vital signs or examined the patient in any way, including the doctor the entire time the patient was there.

At some point someone from Administration came and told the patient "We can do a CT and we' ll treat you like any other patient and check you out. If you don't want to, it is up to you ...." The hospital seemed to be encouraging her not to stay there.

Interview: Husband of Patient ID # 8

Interview by telephone with Patient ID # 8's husband on 04-07-14 at 12:00 p.m., he stated when he arrived at the ER from the OB doctor's office, his wife was still on the EMS stretcher in a hallway. She told him "they don't want to see me because I am pregnant."

"There was a lot of tension between me and my wife by this time. My wife had to be convinced to come to this ER in the first place and now she was very uncomfortable being there. I wanted her to get checked out but it needed to be her decision. The entire time my wife was there, the hospital was pushing her out of there; implying she should not be there."

Some woman, I think from administration (did not remember name) said "Hospital B can do everything we can do and they have an OB doctor to take care of your baby."

He went on to say that no one took his wife's vital signs or assessed her. He said his wife never refused care, although the ER doctor told her OB doctor she had. This was very stressful to his wife. The hospital ER staff did not ask his wife to sign anything nor did anyone explain the risks of them traveling by private car to Hospital B.

Interview Registered Nurse (RN)/ ID # 6

Interview on 04-08-14 at 10:30 a.m. with RN ID # 6 he stated he was on duty in the ED the day Patient ID # 8 was brought in. He said they got a call from the patient's OB doctor saying she was sending the patient to the ER because she'd had a syncopal episode. He did not remember anyone saying the patient had hit her head during the fall.

The ER Physician ID # 7 was not comfortable handling an OB patient. RN ID # 6 stated he said he was not in the position to make this decision and followed the chain of command. He called the ER Manager, House Supervisor, and Chief Nursing Officer; all of the people he telephoned came down to the ER at some point while the patient was still there.

RN ID # 6 went on to say "we didn't put her (Patient ID # 8) in our system; we didn't want to have a record until we figured out what we were going to do. We did not do vital signs on her or triage her. I asked the EMS for their vital signs. They told me she was alert, oriented, and stable. I trusted their assessment."

RN ID # 6 stated the patient did not refuse to have her vital signs taken or to be examined.

RN ID # 6 said he witnessed ER doctor ID # 7's conversation with Patient ID # 8 and her husband. According to RN # 6, the ER doctor told them: "If you stay here, I am going to do the complete neuro work-up which would include blood work and a CT scan, which would expose your baby to radiation." The patient said "I don't want that and I already had blood tests done."

"We did not refuse to take the patient we just wanted to get her the best care possible." RN ID # 6 said at some point the patient started having contractions. They asked the husband if he felt comfortable taking his wife to (Hospital B) in their car; he said he was. The EMS people helped her from the stretcher to the wheelchair and assisted them to their car.

Interview: ER Physician ID # 7

Interview with ER physician ID #7 on 04-08-14 at 3:10 p.m. she stated, when Patient ID #8 was brought in to the ER on the stretcher, the patient said "This is the wrong hospital, I'm supposed to be across the street." The patient went on to say she had a lot of complications in her pregnancy and that she was usually treated at (Hospital B).

ER physician ID # 7 said "I spoke with the husband and explained we can treat her and stabilize her. I told the patient and the husband we would do basic lab work, an EKG, chest x-ray, and a head CT. I asked the husband to please talk with his wife and explain that we can treat her. He was unable to convince her and said she "made up her mind."

ER physician ID # 7 said she told the ER nurse ID # 6 that we can't treat her because she is refusing medical care. She further stated she was unsure if anyone took any vital signs. She went on to say she did not know the patient had hit her head during the fall; the patient told her "I hit my belly."

ER physician ID # 7 said the EMS people were unable to transport Patient ID # 8 by ambulance over to (Hospital B). The husband drove her in their car. She estimated the patient was in the ER for 30 to 45 minutes.

She went on to say the patient was not asked to sign anything regarding refusing treatment or leaving "Against Medical Advice." ER Physician ID # 7 said she did not specifically explain the risks of leaving by private car. "I did document in the progress note that the patient declined medical advice to be further evaluated."

Record review on 04-07-14 of the clinical record of Patient ID # 8 revealed a face sheet with demographic information. The date on the face sheet was 03-26-14 time 16:26; listed diagnosis was Syncope. Triage assessment: 16:41: "patient presented to the ER from Dr. Tran's office ....after discussion with patient and spouse decided to go (Hospital B) by personal vehicle ... Director of Nursing, Department Manager, House Supervisor, Director of Patient Care Services were called to ER to speak with patient and spouse. General consensus was to have patient go to (Hospital B) for higher and appropriate care. Patient was not seen by ER physician and left ER without being seen....." There was no documentation of vital signs, neuro checks, or signed documentation of "refusal of care" or leaving Against Medical Advice (AMA).

Record review of ER physician ID # 7's Progress note, dated 03-26-14 (4:50 p.m.) read: " ..Immediately upon arrival, patient stated she did not want to be seen or evaluated at UGH ...that she wanted to go to (Hospital B) ...I explained to the husband that we were here and available to evaluate and treat his wife, he verbalized understanding of this but stated he wanted to follow her wishes of not being seen ...The patient left with her husband for further evaluation at (Hospital B), again declining our advice to stay and be further evaluated ... "