Hospital Turns Away Patient Needing Emergency Psych Care

The Centers for Medicare and Medicaid Services (CMS) cited Windmoor Healthcare of Clearwater for noncompliance with several provisions of the Emergency Medical Treatment and Active Labor Act (EMTALA). These include facility failures in accepting transfer patients requiring specialized emergency services and maintaining a central emergency room log tracking individuals seeking treatment at the facility. The cited deficiencies relate to an incident in which a Baker Act patient was referred to Windmoor Healthcare after she intentionally fell out of a slow moving vehicle. The referring facility determined  that she needed inpatient psychiatric stabilizing treatment for acute schizophrenia and paranoid ideation. CMS found that Windmoor Healthcare violated its recipient hospital responsibilities and “failed to comply with the requirement to accept an appropriate transfer of a patient” by initially accepting the patient and then sending her back to the transferring facility upon arrival. Following an initial assessment of the patient in the ambulance, Windmoor Healthcare staff and administrators improperly concluded she could not be admitted due to her “medical complications” and the “extent of her injuries.” However, CMS surveyors found that the nurse only completed a visual assessment of the patient and did not assess the patient’s acuity level or complete a medical (psychiatric) screening exam.  CMS found that this constituted a refusal of necessary treatment that was “within the capability and capacity” of the hospital. CMS also cited the facility for failing to maintain a complete and accurate central emergency log that tracked the individuals who sought treatment, were refused treatment, transferred from, or were admitted to the facility. The Baker Act patient mentioned above was not recorded in the facility’s emergency log. An interview with the Director of Assessment and Referral revealed that “there had been no formal education provided to staff regarding the exclusion of a patient on the log.”