HospitalInspections.org

Based on Emergency Medical Treatment and Transfer Policy (EMTALA) policy review the facility failed to follow their policy for 1 (Patient 5) of 20 sampled Emergency Department (ED) patients. This failed practice has the potential to cause negative outcomes for all patients who present to the ED seeking emergent care and treatment. According to facility provided data the ED saw an average of 2,852 patients per month.

See citation A2406, that also resulted in A2400 to not be met.

Based on policy and procedure review, medical record review, staff and medical staff interviews the facility failed to ensure a discharged patient was provided a medical screening exam (MSE) to rule out an emergency medical condition (EMC) who attempted to return to the facility emergency department (ED) for 1 (Patient 5) of 20 sampled emergency department (ED) patients. This failed practice has the potential to cause harm or death to all patients who present to the ED with an EMC. According to facility provided data the ED saw an average of 2,852 patients per month.

See citation A2400, that also resulted in A2406 to not be met.

Findings Include:

A. Review of facility policy titled Examination, Treatment, and Transfer of Individuals who come to the Emergency Department (EMTALA) approved 2/2023 revealed:

-Hospital Property means the entire main hospital campus, including parking lots, sidewalks and driveways.
-MSE: the process required to determine within reasonable clinical confidence whether an EMC does or does not exist conducted by a physician or Qualified Medical Personnel (QMP). An appropriate MSE can include a wide spectrum of actions ranging from a simple process only involving a brief history and physical examination to a complex process that also involves ancillary studies and procedures. The act of patient triage is not considered an MSE.
-QMP: individuals who have demonstrated current competence in the performance of an MSE.
-The hospital will provide to any individual who comes to the ED an appropriate MSE within the capabilities of the hospitals ED, to determine whether or not an EMC exists, regardless of the individual's ability to pay.

B. Review of P5's medical record revealed, P5 presented to the acute care hospital on 01/15/2025 at 8:19 PM via car, with a chief complaint of leg swelling. P5 had discharged from two facility ED's prior to presentation. P5 received lab blood tests, and chest Xray. No medications given. Discharged 1/16/2025 at 2:42 AM with a disposition of no clinical indication for hospitalization at this time.

-P5's medical record revealed a documented temperature of 100.2 Fahrenheit. P5's medical record lacked evidence of a temperature recheck prior to 1/16/2025 2:42 AM discharge, confirmed by Registered Nurse (RN)-A and Physician-A.

-P5's medical record lacked documentation of calls to shelters as instructed by Physician-A prior to discharge, confirmed by RN-A.

C. During an interview on 4/1/2025 at 9:39AM, Security-A revealed if someone seeks medical treatment, they are allowed to enter the ED regardless of a ban and bar (trespass notice, can be issued for 90 days, 6 months or 1 year by security and local law enforcement signatures). Security perimeter checks are expected once per hour. If security sees anyone on the hospital property, the process is to call into dispatch. If someone approached the ED not seeking medical treatment it would be considered trespassing. The security guards have a computer log for ban and bar to refer to if a call is received regarding disruptive behavior.

During an interview on 4/1/2025 at 11:55AM, Physician-A revealed, P5 did not return to the acute care facility to be seen that Physician-A was aware of. Physician-A worked 1/15/2025 from 5:00 PM to 1/16/2025 at 2:00AM.

During an interview on 4/1/2025 at 11:50AM, RN-A confirmed P5 had no documented calls to shelters or repeat vitals prior to discharge 1/16/2025 at 2:42 AM.

During an interview on 4/1/2025 at 1:40 PM, RN-C revealed, P5 shelter called the facility ED and said P5 not allowed due to medical needs. RN-C revealed P5 became aggressive and demanding to go to a different facility. RN-C recalled P5 was discharged in a wheelchair because P5 was unable to walk due to legs. "If P5 did walk, it wasn't far." RN-C recalled P5 leaving in a police car.

During an interview on 4/1/2025 at 2:05PM, Security-B revealed was dispatched to the facility ED on 1/15/2025 at 11:35PM for P5 disruptive behavior. P5 was given 1 hour to call for a ride after being discharged. P5 was demanding an ambulance to take to a different hospital and became more verbally aggressive with staff. Security-B called law enforcement to have P5 banned and barred. Security-B recalled, "as far as I know P5 did come back, police were called again and went into back of the police car approximately 1 hour later."

During an interview on 4/1/2025 at 3:07PM, the Registrar revealed did not recall P5 name specifically. The registrar revealed two scenarios in the past few months where two patients attempted to return to the facility ED and were turned away, could not recall name of the patients.

During an interview on 4/2/2025 at 11:53AM, RN-D revealed RN-C called to inform of disruptive patient in the ED who was banned and barred. RN-D revealed no further calls regarding P5, and was not aware of P5 attempting to return. RN-D revealed if anyone returns to the ED seeking medical care the triage process starts over.