HospitalInspections.org

Based on observations, review of the hospital self-disclosure report, hospital policies and procedures and staff interviews, the hospital failed to comply with all requirements of 489.24.

Refer to citations and examples at:

A 2402 (489.20(q)) Required Signage - Hospital failed to ensure that signs specifying the rights of individuals to receive examination and treatment for emergency medical conditions and women in labor was conspicuously posted in areas likely to be noticed by individuals entering or receiving treatment in the emergency department.

A 2405 (489.20 (r) (3)) Emergency Room Log - The hospital failed to ensure that all individuals who arrived at the emergency department for care were registered in the Emergency Room Log with pertinent information and documentation of their disposition, including refusal of treatment.

A 2406 (489.24(a)) Medical Screening Exam - Hospital staff failed to provide a medical screening exam for a patient who arrived at their Emergency Department on January 1, 2018. The hospital was not on diversion status at the time.

In addition, the hospital failed to have language in hospital regulations or by-laws, approved by the Governing Body, that specified which medically qualified personnel had been approved to conduct emergency medical screening exams (MSEs) for their hospital.

Based on observations and staff interview, the hospital failed to ensure that signs specifying the rights of individuals to receive examination and treatment for emergency medical conditions and women in labor was conspicuously posted in areas likely to be noticed by individuals entering or receiving treatment in the emergency department.

Failure to post required signage risked violation of patient rights.

Findings were:

During a tour of the emergency department with administrative staff on 01/23/18 at approximately 2 P.M., it was observed there were no posted signs in the entrance or waiting areas of the emergency department which specified patient rights to examination and treatment for emergency medical conditions and women in labor. Required signage was observed in the treatment rooms.

Administrative staff agreed the signs were absent in the entrance and waiting areas.

Based on review of the hospital's self-disclosure report, observation of the hospital's emergency department log, and staff interview, the hospital failed to document the arrival and disposition of a patient who came to the emergency department for 1 of 1 patients identified as not registered in the Emergency Room Log (Patient #1).

Failure to document arrival, treatment/refusal of treatment, and disposition of a patient was a violation of EMTALA regulations which require that staff register and track all patients coming into the emergency department and document the patient's final disposition.

Findings include:

Patient #1: Per review of the hospital's self-disclosure report, internal documents, and staff interview, Patient #1 arrived by police escort at the Emergency Department on 1/01/18 at approximately 4:30 A.M. Hospital internal review documented she had been assaulted and
was pregnant.

Review of the hospital's Emergency Department Log for the date and time in question revealed there was no entry documenting Patient #1's arrival, presenting symptoms, or final outcome. There was no record that she refused care and treatment, or that she decided to go with her mother to another area hospital by private vehicle to be examined.

Record review of hospital policy titled, "Triage and Medical Screening Examination" last dated 12/11/15, directed that any patient who presents to the emergency department will be provided with a timely and appropriate triage and medical screening examination.

The hospital failed to document the arrival and outcome of the patient's visit in the Emergency Department Log as required.

Based on review of the hospital's self-disclosure report, review of hospital policy and procedure, and patient and staff interview, the hospital staff failed to provide a medical screening exam to rule out an emergency medical condition for a pregnant patient who arrived with police officers following an incident of assault for 1 of 25 patient records reviewed (Patient #1); and failed to have signed Governing Body authorization in hospital by-laws or regulations of which qualified medical professionals were approved to provide medical screening exams.

Failure to provide a medical screening exam risked patient health and safety, and is a violation of the federal "anti-dumping" regulations.

Item #1--Failed to Provide a Medical Screening Exam

Findings include:

Record review of hospital policy titled, "Triage and Medical Screening Examination" last dated 12/11/15, directed that any patient who presents to the emergency department will be provided with a timely and appropriate triage and medical screening examination.

Patient #1: Per review of the hospital's report, internal documents, and staff interview, the Patient arrived by police escort at the Emergency Department on 1/01/18 at approximately 4:30 A.M. Hospital internal review documented she was pregnant and had been assaulted. When asked if she wanted to be examined, she replied, "I'm not even sure I want to be seen." Per the report, the Registered Nurse told the patient she could be examined by a physician on site, and also told she could be seen at Samaritan Hospital if she preferred. [Samaritan Hospital, located 19 miles away in Moses Lake, WA, has an obstetrical department and specialists available to provide care.] Per the hospital's internal review, the patient didn't complain of pain or ask to be seen or treated. She decided to wait for her mother to arrive, and together they decided to go by personal car to Samaritan Hospital for an exam and any treatment. Staff did not provide triage, and the physician did not see or examine the patient in order to rule out an emergency medical condition for the patient or her unborn baby.

Patient #1 was interviewed by telephone on 1/29/18 at 10:30 a.m. Per interview, she stated that she asked the staff to "put a stethescope on my belly and see if my baby was alright." She stated she didn't mind being registered or transferred, but the staff did not provide an assessment or care.

The hospital failed to provide an appropriate medical screening exam to rule out an emergency medical condition for the patient and her unborn baby as required by hospital policy and federal regulation.

Item #2--Governing Body designation to perform Medical Screening Exams

Based on review of the hospital documents and staff interview, the hospital failed to have language in hospital regulations or by-laws, approved by the Governing Body, that specified which medically qualified personnel had been approved to conduct emergency medical screening exams (MSEs) for their hospital.

Findings:

Interview with administrative staff on January 23, 2018 at 1:30 P.M. showed that only Emergency Department physicians performed medical screening exams for the hospital's emergency department patients.

Review of the hospital's regulations and by-laws failed to evidence that the Governing Body had identified and approved which qualified medical personnel were approved to conduct Medical Screening Exams. Staff interview on January 24, 2018 at 10:30 A.M. verified that comparable language did not exist in current hospital regulations or bylaws.