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May 19, 2017
Hospital cited for violating patient anti-dumping law
By James T. Mulder
AUBURN, N.Y. — After a woman jumped two stories off its parking garage last month, Auburn Community Hospital called 911 and had an ambulance take the injured woman to a Syracuse hospital 30 miles away instead of caring for her in its own emergency room, an inspection report shows.
The hospital has been cited for violating a federal patient anti-dumping law that prohibits hospitals from transferring patients to other hospitals without doing a medical screening exam to make sure they are stable for transfer.
The federal Centers for Medicare & Medicaid Services has not said if it will penalize Auburn. Small hospitals that violate the Emergency Medical Treatment and Labor Act can face fines up to $25,000 and be barred from participating in the Medicare program.
A state Health Department inspection done on behalf of the Centers for Medicare & Medicaid Services found Auburn's response to the emergency situation also violated the hospital's policies.
Here's what happened, according to the inspection report:
A 24-year-old woman and her father came to the ER early on the morning of April 14. While the man was registering his daughter, she ran out of the waiting room and jumped from the second level of the parking garage.
An ER staff member ran outside and found the patient lying on her back on the parking garage driveway with a security guard and her father by her side. The driveway is about 100 yards from the ER entrance.
The patient was alert and complaining of pain in her chest, wrist, hip, jaw and when taking deep breaths. She had a cut on her chin.
After telling the security guard to call 911, the ER staffer performed a neurological exam, but did not document it, and put a neck brace on the patient.
An Auburn Fire Department emergency medical services crew arrived at 2:12 a.m., loaded the patient into an ambulance and transported her to Upstate University Hospital, the nearest trauma center.
The inspection report faulted the hospital for:
Not providing a medical screening exam in the ER even though the patient was on hospital grounds and needed emergency care.
Not effectively training staff how to comply with Emergency Medical Treatment and Labor Act rules.
Failing to enter information about the patient into the ER log.
Failing to document the risks associated with transferring the patient.
Scott Berlucchi, Auburn's president and CEO, said hospital staff responded immediately to the incident and provided "potentially lifesaving emergency care" to the patient. But he acknowledged that care did not meet federal requirements and said hospital staff will be educated about Emergency Medical Treatment and Labor Act guidelines.
Tom Dennison, a Syracuse University professor and health care expert, said the Auburn ER is not equipped to handle a traumatic spinal injury. Bringing the patient into the ER to conduct a medical screening exam could have delayed critical treatment, he said.
"I would rather have the clinicians make that judgment than to blindly follow a policy," said Dennison, a former hospital administrator.
He said it seems like the government is " ... interpreting the regulations to the letter without considering the reality of the situation."
The ER medical director told inspectors ER doctors typically don't leave the ER to respond to emergencies. The ER director said paramedics are authorized to decide when to transfer a patient and they did so appropriately in this situation.
But the inspection report noted federal regulations and the hospital's own policies require the patient to get a medical screening exam.
The ER nurse manager told inspectors the hospital should have called a "code blue" instead of 911. A code blue is an announcement alerting hospital staff that a patient requires immediate medical attention. The hospital's policy says ER nurses can respond to code blue calls on hospital property.
The inspection report did not identify the patient or provide any details on her condition.
"Our major concern is for the patient and their family," Berlucchi said. "Our thoughts and prayers are with them."
The Emergency Medical Treatment and Labor Act was signed into law in 1986 by President Ronald Reagan in response to national outrage over a surge in community hospitals transferring unstable emergency patients, including women in labor, to public hospitals and academic medical centers for financial reasons.