Based on record review and interview, the facility failed to ensure a registered nurse supervise and evaluate the nursing care for each patient, in that, 1 of 8 patients (Patient #1) had a rash and the nurse did not report the rash to the physician.
Patient #1 had a rash on his chest documented on 10/30/2019 and 10/31/2019.
There was no documentation of the nurse reporting the rash to a physician.
During a telephone interview on 1/21/2020 at 3:30 PM, Personnel #4 (Accompanied by Personnel #2) was asked if nursing notified him of the rash that was documented. Personnel #4 stated, No. I was not aware of a rash. Don't think I was notified. I don't remember seeing a rash or the family asking about one. Personnel #2 was asked if the nurse should have notified the physician of the rash. Personnel #2 stated, Yes. Should have.
Violation Name: PATIENT RIGHTS: NOTICE OF GRIEVANCE DECISION(A-0123)
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based on interview and record review, the hospital failed to implement the hospital's policy to ensure patient's rights in that a letter of response to 1 of 3 (Patient #1) who filed a complaint in the 3rd quarter of 2018 did not receive a written notice of it's decision within 21 days of receiving the complaint.
Patient #1 was admitted on [DATE] with abdominal pain, nausea and vomiting. On 09/26/18 Patient #1's family filed a grievance with the hospital. The Hospital sent an initial letter to the complainant on 09/27/18. The hospitals final letter was not mailed until 12/04/18 with no interim letters sent in between.
The Police titled Patient Concerns, Complaints and Grievance Procedure Effective 06/92 and last revised on 02/13 reflected...Page 4, D:3...Following the resolution of the grievance, the patient/family filing a grievance will receive a written notice within 21 days of the hospital's decision...
During an interview with Personnel # 1 on 01/09/18 at 1035 Personnel #1 was informed of the above findings. Personnel #1 verified the above findings.
Based on interviews and record review, the hospital failed to enforce its policy to ensure compliance with 489.24 for 1 of 1 patient (Patient #1) in that (Patient #1) was denied a medical screening on 08/04/14 per Physician #1. Upon arrival to Hospital A2 Patient #1 was not provided a medical screening and told to go to Hospital A1 or Hospital B. Patient #1 left the Emergency Department (ED) of Hospital A2 on 08/04/14. Hospital A2 had both capacity and capability to accept Patient #1 on 08/04/14.
Based on interviews and record review, Hospital A2 failed to provide a medical screening for 1 of 1 patient (Patient #1) in that (Patient #1) was denied a medical screening on 08/04/14 per Physician #1 after presenting to the Emergency Department (ED) with complaints of abdominal pain, nausea, and vomiting. Upon arrival to Hospital A1's off campus ED(Hospital A2) Patient #1 was not provided a medical screening. Patient #1 left the ED. The hospital had both capacity and capability to accept Patient #1 as a patient on 08/04/14.
During a phone interview on 10/14/14 at 08:00 AM with Physician #1 he said on the morning of 08/04/14 the computer system went down and the software to document clinical findings could not be accessed. He said, I thought all systems were locked down. He said he told a female patient she couldn't be taken care of at the ED. He said it was an accident that shouldn't have happened. Physician #1 said he greeted the female patient after she walked in and explained the circumstances to her. He apologized to her and advised her to go across the street to Hospital B or to Hospital A1. Patient #1 complained of abdominal pain, nausea and vomiting. Physician #1 confirmed the female patient didn't receive any medical screening exam. The patient did not sign any consent forms. He didn't know her name. Physician #1 confirmed the ED had the capacity and the capability to screen patients during the time the computer and phone systems were down.
During a phone interview on 10/13/14 at 9:10 PM with Personnel #2 she said she had worked in the hospital's ED for more than 4 years. On 08/04/14 at approximately 2:00 AM the ED's computer system and phones went down except for an emergency landline phone. The tech support was immediately informed and they arrived at the ED at approximately 4:30 AM. Physician #1 was under the impression the the medication station system was locked down and medications couldn't be retrieved. The computer software could not be utilized to enter clinical notes. Personnel #2 told Physician #1 the medication station could be overridden and medications could be retrieved. The ED had printed downtime forms that could be used for clinical notes and physician's orders. She told Physician #1 that patients could be seen. Personnel #2 said the ED had the capacity and the capability to provide a medical screen to any patient during the downtime of the computer and phone systems.
The hospital policy and procedure entitled, EMTALA-Texas Transfer Policy of Patients Between Hospital With and Without Emergency Medical Conditions with a revision date of 07/14 reflected, ...Each individual who comes to the emergency department of the hospital will be evaluated by a physician who is present in the hospital at the time the individual presents ...The individual will be personally examined and evaluated by a physician before an attempt to transfer is made ...