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Based on record review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], and perform a medical screening examination. See A2406.

Based on record review and interview, it was determined that the facility failed to perform a medical screening exam by a licensed practitioner to rule out an emergency medical condition for 1 of 22 patients (Patient #22) that presented to the emergency department. Findings include:

On 8/2/12 at approximately 1030 during an interview with physician #1(the physician working the evening of the event on 2/17/2012), it was revealed that he recalled overhearing EDT #1 explaining to PA #1 the reason for the (potential patient) female #1 visit to the ED. Female #1 was brought to the ED by female #2 (family member), who stated that they wanted the facility to " detox the patient and send her to a detox facility. "

PA #1 thought that the two females were asking for information regarding the process and instructed EDT #1 that the patient had to be sober before going to a detox facility. Physician #1 state he too felt that the family was asking about the process, not to be admitted and detoxed at the hospital. Physician #1 and PA#1 instructed EDT #1 to tell female #1 and #2 that once the patient sobered up, they would see the female and then treat her. Female #1 did not register at the ED for treatment and did not return to the ED for treatment.

On 08/03/12 at approximately 1730 during a phone interview with EDT #2, it was determined that EDT #2 was working the night of 02/17/12. EDT #2 made the following statements:
1. " Was asked, how can I help you?"
2. " The sister said she was drunk and addicted to Vicodin and needed to go to a detox center. "
3. "They were never denied treatment, they were asked if they wanted to be registered and seen and their response was they wanted here to go to a detox center."
On 08/02/12 at approximately 1030 during a record review with the Quality Manager, it was determined that during record review the following statements were taken from the facility conducted interview with EDT #1:
1. " The family member appeared to be happy and satisfied with the information I had given her. "
2. " No one ever denied them from being seen in the ER. "
3. " They never said when they walked away that they wanted to be registered."
4. " They said they had a question and I sought out the provider's assistance in answering the question. "
5. "The female never spoke to me, only the family member. "
6. " The female was not stumbling or verbally speaking to anyone. "
7. " The body language appeared to be agitated and somewhat irritated toward the family member. "

On 8/2/2012 during review of the policy titled " EMTALA Emergency Medical Treatment & Labor Act " it was stated that " Definitions: 1. Comes to Emergency Department: Comes to the emergency department means, with respect to an individual who is not an inpatient, the individual has presented a hospital ' s dedicated emergency department and requests examination or treatment for a medical condition, or has such a request made on his or her behalf. In the absence of such a request by or on behalf of the individual, a request on behalf of the individual will be considered to exist if a prudent lay person observer would believe that the individual needs examination or treatment for a medical condition. " It is also stated further down in the same policy that: " Examination and Treatment : 1. Any individual who comes to the Emergency Department requesting examination or treatment will be provided an appropriate medical screening examination by a qualified medical personnel to determine if an emergency medical condition exists, within the Emergency Department ' s capability, utilizing any ancillary services routinely available to the Emergency Department. " In the same policy a "Qualified Medical Personnel" is defined as "An individual qualified by the Board to conduct screening examinations, and stabilizing treatment."

On 8/2/2012 at approximately 1130 it was determined in an interview with the Director of Emergency Services that only physicians are qualified to perform medical screening exams.
During review of the American College of Emergency Physicians ( Vol 12, December 2011, p. 32-36), "The emergency room standard of care relating to the treatment of patients with alcohol and narcotic use, is to admit and monitor the patient until the patient is symptom-free after several hours." Patient #22 was known to have ingested a quarter gallon of alcohol and vicodin (an unknown amount).