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Based on reviews of medical records, EMS (Emergency Medical Services) Trip reports, Emergency room schedules, incident reports, policies and procedures and interviews, the facility failed ensure that medical screening examinations were provided for two individuals (#22 and #23)who presented to the emergency department after being involved in a head on motor vehicle accident, but was turned away in the hospital's parking lot. The facility failed to provide medical screening examinations that were within the capability of the hospital's emergency department to determine whether or not an emergency medical condition existed for 2 of twenty-four (#22 and #23) sampled patients.

C/O: #28965

Based on review of Emergency Medical Services (EMS) documentation, review of the facility's Emergency Room Log, and interviews, the facility failed to maintain a central log for two patients (#22 and #23) of twenty-four sampled patients.

The findings included:

Review of an EMS Trip Report dated November 25, 2011, revealed, "...Call Received: 4:04 p.m...(Patient #22)...c/o (complained of) severe right flank pain...Transported to...(Facility #1)...At (Facility #1)-ER (emergency room) staff refused admittance to ER..."

Review of an EMS Trip Report dated November 25, 2011, revealed, "...Call Received: 4:04 p.m...(Patient #23)...c/o right flank pain and mild pain to left knee...(Facility #1) refused to accept patient...transported on to (Facility #2)..."

Review of the facility's Emergency Room Log dated November 25, 2011, revealed no documentation regarding Patients #22, and #23.

Interview with the Director of Nursing on December 5, 2011, at 2:50 p.m., in the Administrator's office, confirmed two patients arrived at the facility by ambulance on November 25, 2011, and the facility failed to maintain a central log for Patients #22 and #23 on November 25, 2011.




C/O: #28965

Based on reviews of medical records, EMS (Emergency Medical Services) Trip reports, Emergency room schedules, incident reports, policies and procedures and interviews, the facility failed ensure that medical screening examinations were provided for two individuals (#22 and #23)who presented to the emergency department after being involved in a head on motor vehicle accident, but was turned away in the hospital's parking lot. The facility failed to provide medical screening examinations that were within the capability of the hospital's emergency department to determine whether or not an emergency medical condition existed for 2 of twenty-four (#22 and #23) sampled patients.
The findings included:
A review of the EMS " Incident Report Form " report dated November 25, 2011, revealed in part, " Dispatched (ambulance) to Clay County to assist the County EMS with a 2 car MVC (Motor Vehicle Accident) ... County EMS ... had (3) pts (patients) and they ask for assistance. Our crew entered the unit to assist. The decision was made to more one of the pts to our unit ....One pt was moved to the unit. We went into our unit and started treatment on this pt ... The two patients were move to ... (an ambulance) at this time. Transport was then started non-emergency to Cumberland River North hospital. County EMS Medic ... was on board with us and he called in to the hospital. He advised what we were coming in with and the hospital advised. To divert to another as there was only one RN (Registered Nurse) on the floor. He advised the hospital that one of our pt had family in the other unit that was already at the hospital and that this pt wanted to come there. After he had spoken to the hospital telling them one of our pts wanted to come there, he then called the EMS director ....She told him to continue to Cumberland River North and that she would contact the EMS Medical Director ...Contact was again made with EMS director and she advised that she had spoken the Medical Director as going to call Cumberland River North himself. On arrival the hospital refused to see the pts. "
Review of the EMS Trip Report dated November 25, 2011 revealed in part, " Call received: 4:04 p.m. (patient #22) ...Situation: Chief complaint: Right Flank pain... Secondary complaint Head on MVC ... Providers Primary Impression: Traumatic Injury ... Assessment: ...Abdomen: Upper Right: Guarding, Tenderness ...Trauma/Injuries: Injuries Present? Yes Injuries sustained: Thorax Pain without Swelling/Bruising. . Cause of injury: Motor Vehicle Traffic accident ..... Vital signs EKG (Electrocardiogram- is a test that checks for problems with the electrical activity of the heart) Sinus tachycardia( Fast heartbeat) Pulse (heart rate) 106; (normal heart rate 60-100). Outcome /Disposition: Patient Disposition: treated and Transported by EMS; Destination Information: ... Location Name: Cumberland River Hospital; Patient ' s Condition upon Arrival Destination: Unchanged; Received by: Refused to Accept pt by RN (Registered Nurse). Further review indicated that patient #22 was taken to another acute care hospital. The facility failed to ensure that a medical screening examination was provided to determine whether or not an emergency medical condition existed for patient #22, when he/she presented to the hospital ' s emergency department on 11/25/2011.
Review of the medical record from the facility where patient #22 was taken on 11/25/2011 was reviewed. The medical record revealed the patient arrived with complaints, " of Rib pain ... Associated injuries: The patient sustained neck injury. Right lateral posterior chest and right lateral anterior chest. Associated sign and symptoms: Pertinent positives: chest pains. Severity of symptoms: severity of symptoms: in the emergency department the symptoms are unchanged ....ROS (Review of Systems) ... Cardiovascular: Positive for chest pain. Respiratory: Positive for shortness of breath. Exam: 19:54 (7:54 p.m.) ENT (Ears, nose & Throat): Neck: External neck: abrasion(s), superficial, of the right side of neck ... tenderness of the right side of neck, C(cervical)-spine collar placed PTA(prior to admission), Vital signs B/P 118/66, Pulse 113, Resp (respirations) 13, Temp (temperature) 97 ... MDM (medical decision making) 19:39 (7:39 p.m.) Patient medically screened. "
Review of the EMS trip report dated 11/25/2011 revealed in part, " Call received: 4:04 p.m. (patient #23).Situation: Chief Complaint: Right Flank Pain, Left Knee pain, and Lac (laceration) under left eye ...Secondary Complaint: 2 Car head on MVC ...Provider Primary Impression: Traumatic Injury ...Abdomen: Upper Right: Guarding: Guarding, Tenderness ... Trauma/Injuries: Injury Present? Yes injuries Sustained: Thorax Pain without/Swelling/Bruising ... Treatment: 1630 Cardiac Monitor ... Spinal Immobilization (Complete spinal immobilization includes the immobilization of the patient using a long board with straps, stiff cervical collar) ... Outcome/Disposition: Patient Disposition: Treated and Transported by EMS ... Destination Type: Hospital ... Location Name: Cumberland River Hospital ... Patient ' s Condition upon arrival at Destination: Unchanged; Received by: Refusal by (name) ... Narrative: During Transport called in to ER (Cumberland River Hospital) for PT report and they advised that they were too full and refused to accept Pt. Pt was moved to Unit (another ambulance) to be transported on to (another acute care hospital). " The facility failed to ensure that a medical screening examination was provided to determine whether or not an emergency medical condition existed for patient #23, when he/she presented to the hospital ' s emergency department on 11/25/2011.
Patient #23 ' s medical record from the facility where he was transported to after being refused at Cumberland River Hospital on 11/25/2011 was reviewed. The medical record indicated that on 11/25/2011 at 6:14 p.m. patient #23 a 79 year old presented to the ED via ambulance with complaint of Rib Pain. Further review revealed in part, " The pt was front seat passenger of a car ... Onset: The symptoms/episode began occurred 1 hours (s) ago. Associated Injuries: The patient sustained injury to the chest, specifically the right lateral anterior chest. Associated signs and symptoms: Pertinent Positives: Chest Pains ... Exam: Neck C-Spine: C -Collar placed PTA, Back Board PTA ... C-Collar removed after CT (Computerized Tomography (CT Scan) is a procedure that assists in diagnosing, tumors, fractures bony structures...) scanning .... Palpation: tenderness, that is moderate, of the right lateral anterior chest ... Musculoskeletal/extremity: Extremities ... Noted to Right knee: Skin: injury laceration (s), the wound is approximately 1 cm (s) , of the left temple .... MDM 19:08 (7:08 p.m.) Patient medically screened. "

Review of facility policy Number ED 6000 dated August, 2011, revealed, " Scope of Care: The emergency department is a three bed unit with focus on emergency care for patients of all ages. It is the responsibility of the ED (emergency department) staff to meet the needs of the patients within our scope of practice ... Description: The department has three beds for examination at present, but can accommodate up to four. There is on closed room, the trauma room...Staffing Pattern Guideline: There will be a RN available 24 hours, 7 days a week along with an in-house practitioner. Adjustments to staffing are if census ... in which there is an additional RN in the Emergency Department from noon until midnight. If planned staffing is not available, staffing will be arranged by using overtime shifts ... Procedure: An ED Practitioner call schedule is maintained in the ED at all times. There is an in-house Practitioner available 24 hours per day, seven days a week ... The ED RN may call for back-up from the Med-surg (Medical -Surgical) department if needed....Organization...D. Medical Staff coverage: 1. A practitioner is responsible for the degree of evaluation and treatment provided to any patient that presents to the ED."
The CRH (Cumberland River Hospital) November 2011 ER emergency room schedule was reviewed. The schedule revealed that on 11/25/2011 that the "([Nurse Practitioner/MD])" were scheduled. An interview was conducted with the Director of Nursing on December 5, 2011 at 2:50 p.m. The Director of Nursing stated " Dr. (ED Physician) supervises NP ...not in facility on 11/25/11 at time of inc.(incident). The hospital's emergency department was not staffed on 11/25/2011 according to the facility's policy and procedure.
Interview with the Chief Executive Officer on December 5, 2011, at 10:30 a.m., revealed the facility had completed an investigation regarding these patients (#22 and 23) presenting to the Emergency Department on November 25, 2011, and the facility had not accepted care of the patients.

Interview with the Director of Nursing on December 5, 2011, at 2:50 p.m., in the Chief Executive Officer's office, confirmed three patients arrived at the facility by ambulance on November 25, 2011. The facility failed to provide a medical screening examination for Patients #22 and #23.

The facility failed to ensure that their policy and procedure was followed to ensure that patient #'s 22 and 23 were provided a medical screening examinations, instead they were turned away in the hospital's parking lot on November 25, 2011.