The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.
|KINGS COUNTY HOSPITAL CENTER||451 CLARKSON AVENUE BROOKLYN, NY 11203||Sept. 17, 2012|
|VIOLATION: MEDICAL SCREENING EXAM||Tag No: A2406|
|Based on review of patient medical records, hospital documents, ambulance call reports (ACR), staff interviews and facility investigative reports, it was evident that the hospital refused to perform an appropriate medical screening examination for a patient who came to the emergency department.
Review of MR #1 on 9/17/12 found that the patient who had a psychiatric history was combative and handcuffed throughout the incident. This patient was transported by FDNY ambulance and officers of the New York City Police Department to the CPEP (Comprehensive Psychiatric Emergency Program) on 8/11/12. Further review of facility computer records and ED logs found evidence that the patient was mini-registered by clerical staff at 1949 hours and that the visit was "cancelled " by an unknown staff at 2024 or 2027 hours. Review of the ACR found that an unknown staff member signed as the hospital receiving agent and that " on arrival to ED, the psychiatric MD refused patient and as per C383 patient was redirected to another hospital (H41) for evaluation. "
Review of the hospital's "summary of EMTALA concern " on 9/17/12 found that the facility stated that the physician named in the complaint intentionally refused to accept the patient based upon concerns that the patient represented a threat to the safety of another patient who was in the CPEP at the time. Further review of that report found reference to the ADN (Assistant Director of Nursing) being involved in the incident and warning the physician that this refusal represented an EMTALA violation. The patient remained in the "sallyport "which is an anteroom with the capacity to have locked doors that are on opposite sides of the room. This room will prevent patient escapes. The patient remained there for approximately 25 minutes without treatment and left the ED with EMS staff and NYC Police Officers at 2016 hours (8:16 PM).
Review of the ACR on 9/17/12 found that the EMT did not document any vital signs. No vital signs were taken by any hospital staff.
At interview with two (2) Behavioral Health Technicians (BHT ) on 9/ 17 /12 it was stated that they witnessed the patient in MR# 1 in the sallyport and one of them spoke to the patient. The patient never entered the CPEP Unit.
At interview with the Medical Director of the CPEP on 9/ 17 /12 it was stated that the physician in this case violated EMTALA regulations and should have performed an assessment of the patient and kept him on a 1:1observation.
At interview with the Director of Regulatory Affairs on 9/17/12 it was stated "the ADN is under the MD and therefore would be expected to defer to the clinical judgment of the attending in this matter".