No MSE of Psych Patients Cited For EMTALA Violations

Patient #26 was brought to the hospital by local police for an involuntary psych process. According to police reports, they were advised by hospital personnel that the hospital no longer had an available psych bed and the patient would have to be transferred to the other hospital in town. The patient was transferred to the other hospital by police after verifying a bed was available. No reason was documented for a failure to provide a Medical Screening Exam prior to transfer. There is no notation of completion of transfer documents or medical records in the CMS report. The hospital was cited for failure to provide a medical screening examination (Tag A2406).

Patient #7 presented to the ED with signs/symptoms noted as “behavior health” at 4:47 pm. At 4:51 pm the Triage nurse documented that the “patient needs his clozaril dose increased, states he feels he is having trouble with thought processes, anxious..Alone…private vehicle.” Patient was noted as being depressed. The patient was triaged as a ESI 2 (emergent) and assumed that he was asked to wait in the waiting area. At 5:34 the patient was noted as expressing intent to leave the ED without care. Documentation for leaving without being seen was printed, but never signed. The patient left. A review of records indicated that the patient was not reassessed at least every 20 minutes per hospital protocol. The hospital was cited for failure to provide a medical screening examination.(Tag A2406)

Two days later the patient returned with a “concern about paranoid schizophrenia” by history and reported having taken his clothes off and run through neighborhood. He was subsequently admitted as a voluntary admission.

Patient #5 presented with a complaint of depression at 12:23. At 12:30 a triage assessment was completed that reported the patient has been depressed for months, crying, doesn’t think he can take it any more, lost home, binge drinks, has been drinking today, has thoughts of harming himself. A review at 12:55 contradicts the triage assessment by stating that he had no thoughts of hurting himself, had no prior attempts, and did not have any current self destructive behaviors.

At 1:14 p.m. a security log noted that an intoxicated male (Patient #5) left AMA and could not be located. Later entries indicated a social worker met with the subject, but when she left to speak with the doctor, the patient eloped. The hospital was cited for failure to provide an MSE. (Tag A2406)

Patient #10 presented seeking care following an accident the prior night, did not sleep well, took some medication and today feels queasy and chilled. An “info” person told him they could not help him, offered to call cab to take him to another hospital. The original hospital has no record of the presentation or reason for why no MSE was provided. The hospital was cited for failure to provide an MSE. (Tag A2406)

A2406-WI-2013-10-3

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