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Based on interview and record review, the hospital failed to ensure compliance with 489.24 (a) Medical Screening Exam in that 1 of 1 patient (Patient #1) was brought to the hospital on 10/24/2017 at approximately 7:15 AM and was not provided a medical screening examination, was not listed on the emergency log, and did not have his information documented in a medical record.

Cross reference at A 2405 and A2406

Based on record review and interview, the hospital failed to maintain a central log where each individual who comes to the emergency department, as defined in 489.24 (b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged. This 1 of 1 patient (Patient #1) was not listed on the central log on 10/24/2017.

Findings:

Review of the central log on 12/6/2017 at 2:00 PM did not document an entry for Patient #1 presenting to the facility with the police seeking treatment.

An interview with Personnel #8 on 12/6/17 at 3:55 PM in the Conference Room. Personnel #8 stated that she was on duty that morning and came out to the lobby. She stated that the patient was "crawling around like a snake and barking like a dog" and was out of control and the police officer was having trouble handling him even with Patient #1 in handcuffs. Personnel #8 stated that she told the police officer to take Patient #1 somewhere else, that their assessment area was not safe for a patient. Personnel #8 stated that she left the lobby area.

An interview with Officer #1 on 12/11/2017 at 10:15 AM by telephone. Officer #1 reviewed his record from 10/24/17 and stated that the patient had behavioral problems and Officer #1 stated that he had dealt with Patient #1 on many occasions. This date of 10/24/17, Officer #1 stated he was summoned to the classroom where Patient #1 was a student. Patient #1 was out of control and was very aggressive. Patient #1 was spitting at students and teachers. Patient #1 was trying to bite the students and teachers. Officer #1 attempted to put Patient #1 in handcuffs and had a very difficult time doing so as Patient #1 attempted to bite him. Officer #1 got the handcuffs on Patient #1 and took him by patrol car to Hospital A. Patient #1 had been an inpatient at this facility just a few weeks previously. Officer #1 stated that when he got Patient #1 out of the car he had difficulty getting him to the front door. Patient #1 was very aggressive and was rolling in the floor and barking like a dog. He said Personnel #8 came out to the front desk and stated that Officer #1 needed to take Patient #1 out of the hospital and take him somewhere else. Officer #1 stated he asked Personnel #8 where should he take Patient #1. Personnel #8 stated to Officer #1 "she did not care where Officer #1 took Patient #1 but he could not stay there." Personnel #8 stated Officer #1 could "take Patient #1 to jail." Officer #1 stated that "jail was not an appropriate place for Patient #1." Personnel #8 stated "he cannot stay here" and she left and went back into Hospital A. Officer #1 stated that he called for another police officer to come and assist him as he was not sure he could get Patient #1 back into his car. Officer #1 waited for the other officer to arrive to assist him in getting Patient #1 back into the patrol car. Officer #1 stated that Personnel #8 never returned to the lobby of the hospital.

Based on record review and interview, 1 of 1 patient (Patient #1) did not receive an appropriate medical screening exam when presenting to the hospital in the custody of police.

Findings:

Review of the central log on 12/6/2017 at 2:00 PM in the Conference Room. The central log did not document an entry for Patient #1 on 10/24/2017. Patient #1 did not receive a medical screening exam on 10/24/2017 and was sent away from the facility in handcuffs with Officer #1 to seek assistance elsewhere.

An interview with Personnel #8 on 12/6/17 at 3:55 PM in the Conference Room. Personnel #8 stated that she was on duty that morning and came out to the lobby. She stated that Patient #1 was "crawling around like a snake and barking like a dog" and was out of control and the police officer was having trouble handling him even with Patient #1 in handcuffs. Personnel #8 stated that she told the police officer to take Patient #1 somewhere else, that their assessment area was not safe for a patient. Personnel #8 stated that she left the lobby area.

An interview with Officer #1 on 12/11/2017 at 10:15 AM by telephone. Officer #1 reviewed his record from 10/24/17 and stated that the patient had behavioral problems and Officer #1 stated that he had dealt with Patient #1 on many occasions. This date of 10/24/17, Officer #1 stated he was summoned to the classroom where Patient #1 was a student. Patient #1 was out of control and was very aggressive. Patient #1 was spitting at students and teachers. Patient #1 was trying to bite the students and teachers. Officer #1 attempted to put Patient #1 in handcuffs and had a very difficult time doing so as Patient #1 attempted to bite him. Officer #1 got the handcuffs on Patient #1 and took him by patrol car to Hospital A. Patient #1 had been an inpatient at this facility just a few weeks previously. Officer #1 stated that when he got Patient #1 out of the car he had difficulty getting him to the front door. Patient #1 was very aggressive and was rolling in the floor and barking like a dog. He said Personnel #8 came out to the front desk and stated that Officer #1 needed to take Patient #1 "out of the hospital and take him somewhere else." Officer #1 stated he asked Personnel #8 where should he take Patient #1. Personnel #8 stated to Officer #1 "she did not care where Officer #1 took Patient #1 but he could not stay there." Personnel #8 stated Officer #1 could "take Patient #1 to jail." Officer #1 stated that "jail was not an appropriate place for Patient #1." Personnel #8 stated "he cannot stay here" and she left and went back into the back part of Hospital A. Officer #1 stated that he called for another police officer to come and assist him as he was not sure he could get Patient #1 back into his car. Officer #1 waited for the other officer to arrive to assist him in getting Patient #1 back into the patrol car. Officer #1 stated that Personnel #8 never returned to the lobby of the hospital.