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Based on record review and interview, the facility did not comply with 42 CFR ?489.24, Special Responsibilities of Medicare Hospitals in emergency cases, in that, the facility did not provide an appropriate medical screening examination within the capability of the hospital's emergency department to 1 of 1 patient (Patient #1) who presented at the ER (emergency room) on 04/16/12. The facility did not abide by their policy.
(Cross Refer to Tag A 2406)

Based on record review and interview, the facility did not provide an appropriate medical screening examination within the capability of the hospitals' emergency department to 1 of 1 patient (Patient #1) who presented at the ER (emergency room) on 04/16/12. Patient #1 experienced convulsions and apnea (suspension of external breathing) and 911 was called. When the ambulance arrived the EMS (emergency medical services) personnel took ownership of Patient #1. The facility did not abide by their policy.

Findings included:

Patient #1 presented in the ER and was triaged at 8:20 PM on 04/16/12. The chief complaint was pain on the right upper side of the chest, low back, and legs. At 8:37 PM, Physician #6 conducted his assessment. Within 60 to 90 seconds of his assessment, the patient began U.E. (upper extremity) tonic-clonic convulsion, had foam at mouth, and an episode of brief apnea. "I bagged her with an Ambu bag, checked her to have positive radial pulse, and she soon regained spontaneous breathing. Our nurse called an aide to call 911 for assistance...EMS (emergency medical services) arrived shortly. I ordered Labetalol and Ativan, but IV (intravenous) access was not available...At 2100, I spoke with Facility B emergency department (ED) Physician #1 to inform him of the developments."

The "Physician Order Sheet" indicated the following were ordered: at 8:40 PM "IV saline lock access; "at 8:45 PM "Labetalol 5 mg IV and Ativan 0.5 mg IV." The physician noted beside the written orders "not done prior to EMS transfer."

The "Additional Progress Notes" written by Physician #6 indicated "...Our nurse called aide to call 911 for assistance...EMS arrived shortly. I ordered Labetalol and Ativan, but IV (intravenous) access was not available...EMS staff deferred my request for IV and meds (medications) ...due to risk of seizure; (EMS) stated would start IV enroute ..."

In an interview on 05/30/12 at 10:25 AM via phone, Physician #6 (the attending ER physician on 04/16/12) stated Personnel #5 asked if she needed to call EMS. "Due to limited manpower, I told her to call. The EMS came in 2-3 minutes after. One of the EMS talked to the patient's family and took over the scene. I reported to one of the EMS that the patient had seizures." The EMS personnel stated the patient will be transferred to Facility B for stroke evaluation. "I did not believe this was a stroke but I did not protest. I would be happy with Facility C, they evaluate stroke also. "

In an interview on 05/29/12 at 1:55 PM via phone, Personnel #5 (the attending ER nurse on 04/16/12) stated she was present when Physician #6 conducted the assessment. Shortly thereafter, the patient began convulsing. The RN stated the physician "bagged the patient" and verbally ordered "to start an IV and give Labetalol, and Ativan." She asked the physician if he wanted her to call 911. The physician told her to do it. The RN instructed the nursing assistant to call 911 and informed the in-patient nurse to help in the ER. The RN stated that she was fixing to gather her supplies to start an IV when the EMS came and took over the patient's care. The RN stated that she did not have time to start an IV and administer the medications as ordered.

Subject/ Policy: "EMTALA guidelines for Emergency Department Services (Emergency Medical Treatment and Active Labor Act)" revised 10/2010 required "All patients shall receive a medical screening exam that includes providing all necessary testing and on-call services within the capability of the hospital..."