FILE: 11-002
DATE: October 7, 2011
STATE: Alabama
TAG: A 1103
TITLE: Integration of Emergency Services
ALLEGED VIOLATION:
Based on hospital rules and regulations, hospital policy, emergency department (ED) medical record reviews, and interviews, the hospital (Hospital # 1) failed to assure that ED patients receive services integrated with other departments and cardiac specialists (who provide
services to inpatients).On 6/7/2011, Patient Identifier (PI) # 6 presented to Hospital #1’s ED and was found to have an abnormal electrocardiogram (EKG) and a critical Troponin level within 90 minutes of arrival. Tests repeated and again abnormal results reported but ED staff failed to indicate contact with the cardiologist on staff at Hospital # 1, or with a specialist at the receiving hospital (Hospital # 2) prior to, or after, PI # 6 was transferred by ambulance to Hospital # 2 (five hours after presenting to Hospital #1’s ED).
On 6/22/2011, an eight year old patient (PI # 19) presented to the ED and the documented chief complaint was vaginal bleeding. ED staff failed to document an assessment of this patient’s perineal area, and there is no indication that social services, or other agencies, were contacted about PI # 19 before or after discharge.
This deficient practice affected two of twenty eight sampled ED patients (PI # 6 and # 19).
COMMENT: Although these violations were based on actions that were likely allegations of EMTALA violation, CMS chose to cite the facility under a provision of the general conditions of participation rather than the specific sections that trigger “immediate jeopardy”. The rationale for this approach was not addressed in the material available.
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.