A worried pregnancy patient presented to the registration desk of the ED asking to see a doctor because she was not noting fetal movement. The registration clerk reportedly asked a number of questions about the situation and then called the OB unit. A nurse in the OB unit reportedly spoke with the patient, and told the patient that she would not be feeling fetal movement at 21 weeks gestation and that since the patient had just seen her doctor, nothing would be done. When the patient objected and asked to be seen, the registration clerk reportedly told the patient to go to a nearby hospital where she was seen and evaluated.
Upon the CMS visit, the hospital was noted as being unable to provide any medical record of the visit or demonstrate that a medical screening examination was performed, resulting in an EMTALA citation for failure to provide a medical screening examination (Tag A2406).
Comments:
This is a classic violation of a number of EMTALA requirements, but the hospital was fortunate to escape with only the medical screening violation.
Specifically:
- CMS does not allow any screening function by a registration clerk or other RN. The registration clerk is allowed to obtain very minimum “mini-reg” information and then must pass the patient immediately for Triage.
- Phone discussion with a nurse does not meet CMS requirements for triage.
- Phone discussion with a nurse and direct discussion with a registration clerk does not constitute a medical screening examination, as noted and cited by CMS in this case.
- Discharging the patient without a MSE constitutes an improper transfer under EMTALA.
- Telling a patient to go to another hospital constitutes a transfer and requires the original hospital to obtain advanced acceptance, physician certification of the transfer, patient consent to transfer, send medical records, and transport the patient by appropriate medical vehicle, with appropriate equipment, and with appropriate personnel (unless the patient executed a written refusal of ambulance.)
The ultimate mistake that was made by both the registration clerk and the nurse on the phone was the failure to understand that no matter how seemingly minor the presentation, every patient must go through the medical screening process with full supporting documentation.
A3406-WI-2-14-2012