HospitalInspections.org

Based on interview and record review the facility failed to provide a medical screening exam citing 1 out of 1 patient who presented to the emergency department.

Findings:

1. A written complaint was received at the Department of State Health Services on 01/04/2010. The complainant was from a hospital that was located approximately 20 miles from the facility reporting that patient #1 had presented to the emergency department (ED) of East Texas Medical Center in Trinity in a pick-up truck on 12/13/09. Upon arrival at the emergency department, the friend that took the patient to the ED, summoned for some help. An ED nurse came out and asked what the problem was, then went back inside to call 911. An ambulance arrived at the ED and took the patient to the reporting facility where the patient was later diagnosed with a spiral fracture.

2. A review of the facility's emergency room log on 01/06/10 for the date of service 12/12/09 through12/14/09 found no evidence that patient #1 had been registered or seen at this hospital.

3. An interview on 01/06/10 with staff #3, the ED nurse on duty the night of 12/12/09 through 12/13/09 revealed that he was called at approximately 11:00 p.m the night of 12/12/09 or a little after by the front clerk that someone was in front of the hospital in a truck that needed help. Staff #3 reported that he went outside and found a young man in the back seat of the pick-up truck with a leg that was obviously injured and swollen. The patient had fallen off a four wheeler and another four wheeler had run over the patient's leg. Staff #3 stated "I knew I couldn't get the patient out of the back of the truck by myself so I told the clerk to call 911." Staff #3 reported that "someone said" there was no "orthopedics here" while the patient was being transferred out of the truck and onto the stretcher. After staff #3 assisted the emergency medical service (EMS) in getting the patient out of the truck and onto the stretcher, EMS personnel said to staff #3 that the family wants the patient to go to the hospital in Huntsville. Staff#3 reported that "I didn't argue with the EMS cause the closet Orthopedics was Huntsville."

4. A review of the facility policy titled "Transfer of Patients from ETMC Trinity to Another Facility," #910-02-064, revised date 07/1997, found that "any individual (whether or not eligible for benefits) that comes to the emergency department and a request is made on the individual's behalf for examination or treatment for a medical condition, ETMC Trinity will provide for an appropriate medical screening examination with the capability of our emergency department , including the use of ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists." The facility failed to follow their policy and provide a medical screening examination to determine if a medical emergency existed for patient #1 who came to the ED for treatment.

Based on record review and interview the hospital failed to determine that the patient had an emergency medical condition and failed to stabilize the medical condition of the patient citing one out of one patient.

Findings:

1. An interview with staff #3, emergency department nurse, on 01/06/10 found that he was called from the emergency department (ED) to the front of the hospital where there was patient #1 in the back seat of a truck. He looked at the patient and reported that he could not get the patient out of the back seat of the truck by himself so 911 was called. The emergency medical personnel and staff #3 transferred patient onto stretcher and then the ambulance took the patient to another hospital instead of inside the facility's ED for determination and stabilization of the patient's medical condition.

2. A review of the facility policy titled "Transfer of Patients from ETMC Trinity to Another Facility," #910-02-064, revised date 07/1997, found that "when a patient arrives at the hospital the patient must be 1. Evaluated by a physician who is present in the hospital at the time the patient presents" ( a review of the physician staffing schedules for 12/13/09 found physician # 7 was present in the ED) and the "transferring physician shall determine and order life support measures which are medically appropriate to stabilize the patient prior to transfer and to sustain the patient during transfer." The hospital failed to follow their policy and evaluate patient #1 who presented to the hospital for treatment and failed to stabilize the patient prior to transfer.

3. Refer to tag 2406 for further detail