FILE: 11-004
DATE: November 10, 2011
STATE: California
TAG: A2405
TITLE: Emergency Room Log
ALLEGED VIOLATION:
On 11/9/11 review of the EMTALA complaint and interviews with ED staff confirmed Basic Life Support (BLS) EMT personnel brought Patient 8 to the ED by ambulance on 12/17/10. The EMT personnel had been directed to the nearest hospital for confirmation of Patient 8’s death by medical personnel as the EMS personnel are not allowed by law to pronounce a patient’s death. Upon arrival at the hospital the EMS personnel were requested not to unload the patient from the ambulance, as the ED staff stated there were no available beds. There was no documentation to show the patient was entered in the ED log.
TAG: A2406
TITLE: Medical Screening Exam
Based on interview and document review, the hospital failed to ensure a medical screening examination (MSE) was provided to one of 22 sampled patients in order to confirm the death of the patient (Patient 8). Basic Life Support (BLS) EMT personnel brought the patient to the ED by ambulance on 12/17/10. The EMT personnel had notified the hospital the patient, who had a DNR (Do Not Resuscitate) order, had passed away while en route from Hospital 1, located in a neighboring county, to a skilled nursing facility in Orange County. The EMT personnel had been directed to the nearest hospital for confirmation of the death by medical personnel as the EMS personnel are not allowed by law to pronounce a patient’s death.
Upon arrival at the hospital the EMS personnel were requested not to unload the patient from the ambulance, as the ED staff stated there were no available beds. There was no documentation to show the patient was given a medical screening examination. This resulted in the ambulance, after waiting outside of the ED for one hour, returning the patient to Hospital 1, 49 miles away for confirmation of the patient’s death.
TAG: A2404
Title: On Call Physicians
On 11/10/11, review the on-call list of specialty physicians dated 11/10/11, showed “Associated” instead of the name of the physician designated as the urology specialist.
On 11/10/11 at 1440 hours, an interview was conducted with the ED Unit Secretary. The Unit Secretary was asked to state the meaning of “Associated” as found on the on-call list of specialty physicians dated 11/10/11. The Unit Secretary stated “Associated” was a urology physician’s group. The Unit Secretary stated he would call the phone number listed and one of the three physicians in the Associated group
would call back.
COMMENT: CMS requires on-call lists to list the specific individual physician on-call at all times. Group names, answering services, or mid-level providers may not be listed in lieu of the physician name and direct contact information.
TAG: A2402
TITLE: Posting of Signs
1. On 11/9/11, at 1330 hours, the hospital’s ED was toured with the ED Director. The Director stated the ED had three waiting rooms. The initial waiting room, Waiting Room One was the initial entry point for all non-ambulance patients arriving at the ED. Immediately to the left of Waiting Room One a screening nurse was stationed. To the right, a security officer was stationed. Past the screening nurse, also on the left, were the patient registration area and the entrance to triage. To the right there were seats for patients and visitors. No signage specifying the rights of individuals for examination and treatment with respect to emergency medical conditions and women in labor in the ED was visible in Waiting Area One.
On the wall of the hallway leading to Waiting Rooms Two and Three the required emergency treatment signage was observed. The print font of the sign, according to the Director, was sufficient in size. However, it was difficult to read if a person was more than one foot away.
At 1345 hours, an interview was conducted with the parents of Patient 9, an ED pediatric patient waiting to be seen. When questioned about signs they had seen stating their child’s rights to receive emergency treatment, both parents stated they had not noticed the signs.
During a tour of the treatment areas of the ED no conspicuous posting of signage was observed in locations likely to be noted by patients, informing them of their right to a medical screening examination, regardless of the ability to pay and whether the hospital participated in the Medicaid program.
2. The L&D area was toured with the L&D Nurse Manager and the Director of Regulatory on 11/9/11 at 1340 hours. The Nurse Manager stated if a patient who was more than 20 weeks pregnant presented to the ED with problems related to the pregnancy the patient would be brought to the L&D unit for examination and observation.
Observation of the small waiting area outside of the patient registration room as well as the inside of the patient registration room did not show signage specifying the rights of individuals for examination and treatment with respect to emergency medical conditions and women in labor and notice the hospital participated in the Medicaid program.
The required signage was found located inside of a room the Nurse Manager stated was used to triage the pregnant patients waiting for an examination.
NOTE: L&D is considered a designated emergency area, along with the emergency department itself and urgent care areas and clinics that see more than 33.33% walk-in patients under CMS standards.
COMMENT:
CMS sign requirements include – among other requirements—that signage must be posted:
• Conspicuously
• At entrances
• In treatment rooms / bays
• In registration areas serving emergency service areas
• In any area used as a waiting area, including overflow areas
• Be visible from all areas of the waiting room – may require multiple signs
• Be of sufficient size to be clearly read from a distance of 20 feet
• Not be surrounded by distractions or signs that are inconsistent with the EMTALA sign (such as copay notices)
NOTE: Citations issued by CMS for EMTALA violations are allegations that have not been proven in any court and the information is presented here in summary format for educational purposes only to demonstrate the circumstances which in the view of CMS constitute EMTALA violations. Identifying information is removed to focus on the allegation without prejudicing the facility.