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Based on observation and interview, the facility failed to post in the emergency department the required signage regarding patient rights with respect to examination and treatment for emergency medical conditions and women in labor.

Findings include:

TX # 00164074

On 08-06-12 at 10:30 a.m. during a tour of the facility's Emergency Department and patient entrances , observation failed to reveal required Emergency Medical Treatment and Labor Act (EMTALA) signage informing patients of their rights with respect to examination and treatment for emergency conditions and women in labor.

Interview on 08-06-12 at 3:00 p.m with Director of Nurses (DON) ID # 52, she stated the facility did have the required EMTALA signs posted but they must have been removed when the walls were painted. She went on to say she was aware of the requirement, as the Emergency Room had a Level IV trauma designation.

Based on record review and interview, the facility failed to maintain a medical record for 1 of 4 sampled patients (Patient ID # 4) who had been transferred to other facilities from the hospital ' s ER.

Findings include:

TX # 00164074

On 08-06-12 review of the facility ' s Emergency (ER) Log for 2011-2012 revealed four (4) patients were transferred to other facilities (Patient ID # 4, 7, 10, 12).

Further review of the ER Log revealed Patient ID # 4 was seen in the ER on 05-02-12. The documentation read: " codes blue ...OD/ opiate ...transferred to ( ) Hospital at 11:40 a.m. ... "

Interview on 08-07-12 at 2:30 p.m. with the Director of Nurses (DON) ID # 52, she stated she was unable to locate the medical record for Patient ID # 4. She went on to say there was a record for this patient and a staff nurse had been working on it. " The DON reported the nurse was out on sick leave.

Based on record review and interview the hospital failed to ensure 2 of 24 emergency room records reviewed contained a Medical Screening examination. (Patient ID# ' s 9 and 14)

Findings include:

The following emergency room records failed to document an appropriate medical screen:

Patient ID# 9 presented to the emergency room on 2/27/12 at 4:29 p.m. with a laceration to the forearm status post fight. The Director of Nursing (ID# 52) triaged the patient, cleaned the wound and applied a dressing. The nurse also obtained verbal orders from a physician to administer the patient an antibiotic injection and a Tetanus shot. An appropriate medical screen was not documented in the patient ' s record.

Record review of a policy titled " The Federal Emergency Medical Treatment and Active Labor Act " (EMTALA) stated " General: the hospital must provide for an appropriate medical screening examination within the capability of the hospital ' s emergency department ... "

The Director of Nursing (ID# 52) acknowledged 8/6/12 at
3 p.m. that not all patients receive a medical screening examination. The Director of Nursing stated only a physician is qualified to perform a medical screening examination.

Patient ID# 14 presented to the emergency room on 9/20/11 at 3:20 p.m. with complaints that she stepped on a nail. The Registered Nurse triaged the patient and obtained verbal orders from a physician to administer the patient a Tetanus shot. An appropriate medical screen was not documented in the patient ' s record.

Based on interview and record review , the facility failed to ensure an appropriate transfer for 4 of 4 sampled patients (Patient ID # 4, 7, 10, 12) transferred to other facilities from the hospital ' s ER.

1.There was no documentation of physician certification of medical risks/benefit discussion of transfer (4 of 4 records).

2. No documentation of acceptance by receiving hospital or indication of medical information sent to receiving hospital (4 of 4 records).

Findings include:

TX # 00164074

On 08-06-12 review of the facility ' s Emergency (ER) Log for 2011-2012 revealed four (4) patients were transferred to other facilities (Patient ID # 4, 7, 10, and 12) during this time period.

On 08-06-12, review of Patient ID#s 7, 10, 12 medical records failed to reveal a memorandum of Transfer (MOT); physician certification of medical risks/benefits of transfer; documentation of acceptance by receiving hospital, and indication of medical information sent to receiving hospital.


Patient ID # 10: seen in the facility ER on 02-27-12 with a diagnosis of diagnosis of Paranoid Schizophrenia. Patient ID # 10 was transferred to another hospital the same day at 6:15 p.m.

Patient ID # 7: seen in the ER on 04-12-12: diagnosis Overdose /Seroquel; was transferred to ( ) Hospital at 5:40 p.m. the same day.

Patient ID # 12: seen in the ER on 11-14-11: diagnsis of Head Injury: transferred to a local children ' s hospital at 10:50 a.m. on the same day.

Per facility ER Log: Patient ID # 4: 05-02-12 (code blue), diagnosis Overdose; was transferred to ( ) Hospital at 11:40 a.m. Surveyor was unable to review Patient # 4 ' s medical record, as facility could not locate it (see TAG A-2403).

Interview on 08-07-12 at 1:00 p.m. with the Medical Records Manager (ID # 55) she stated the MOTs were kept in the patient ' s medical record.

Interview on 08-07-12 at 2:30 p.m. with the Director of Nurses (DON) ID # 52, she stated an MOT was required for each patient transferred from the facility to a different hospital. She went on to say it the MOT was located in the medical record and it contained documentation regarding physician certification of risk/benefit of transfer; acceptance by receiving hospital, and list of medical information sent to receiving hospital. The DON was unable to locate an MOT for Patients ID# 4, 7, 10, 12).

Review of facility policy titled " Transferring /Receiving Patient To/From Outside Facility, " undated, read: " ...5. The transferring physician shall secure a receiving physician and a receiving hospital that are appropriate to the medical needs of the patient ...Nursing: 2. Initiate and assist the physician in the completion of the " memorandum of transfer " ensuring that all area are completed ...8 make sure all components of the medical record have been xeroxed, including lab data, x-ray, electrocardiogram, and all documentation, requested by receiving facility or as requested by the physician ...10. The original copy of the MOT should be attached to the patient ' s transferring record and a copy forwarded to medical record and Nursing Administration ... "

Review of the facility form titled " Memorandum of Transfer " revealed spaces provided to document acceptance of receiving physician and hospital (name, date and time); patient diagnoses, medical record attachments; and signature line for physician transfer risk/benefit certification.