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Based on observation, review of documentation and interviews with facility staff, the facility failed to provide an appropriate and thorough medical screening examination (MSE) within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether an emergency medical condition (EMC) existed for 2 of 22 patients reviewed that presented to the emergency department (ED).

The findings were:

The facility self-report stated, "A mother presented to the emergency department with her 2 minor daughters (Ages 13 & 15) with a chief complaint 'smoking weed with a man'. One of the ED RNs (Staff #5) went to the waiting room where the mother was with her daughters. According to interview with the RN, the mother requested for her daughter to be 'checked', the RN suggested that although they could be seen, that going to another ER (Cook Children's) may be a better option. According to the RN's Nurse Notes-the mother had verbalized concerns that her daughters had been with an adult male, '...have been doing drugs and wants them tested. She also states that she is worried that he has been sexually abusing them...' The mother left with the 2 females from the waiting room and they were not evaluated by the physician."

The facility policy titled, "EMTALA - Medical Screening Examination and Stabilization Policy," states, "When an individual comes to a dedicated emergency department ("DED") and a request is made on his or her behalf for an examination or treatment for a medical condition, or a prudent layperson observer would believe that the individual presented with an EMC, an appropriate medical screening examination ("MSE"), within the capabilities of the hospital's DED (including ancillary services routinely available and the availability of on-call physicians), shall be performed by an individual qualified to perform such examination to determine whether an EMC exists, or with respect to a pregnant woman having contractions, whether the woman is in labor and whether the treatment requested is explicitly for an EMC. If an EMC is determined to exist, the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility, or an appropriate transfer as required by EMTALA and State laws and regulations. Such stabilization treatment shall be applied in a non-discriminatory manner (e.g., no different level of care because of diagnosis, financial status, race, color, national origin, or handicap)."

Review of the medical records of Patient #1 and Patient #2 on 6/6/23 revealed that a medical screening exam by a physician was not performed when the patients presented to the ER. Both records are identical, the nurse note stated, "Pt's mother states that pt and sister have been spending time at a man's trailer. She is worried that they have been doing drugs and wants them tested. She also states that she is worried that he has been sexually abusing them. Mother did not have any complaint or need for treatment of either of the patients. Mother agreed that going to Cook's medical center was a better option." The medical records indicated that they "Left Without Being Seen."

Interviews with the Hospital Compliance Officer (Staff #2) and the Hospital Administrator (Staff #4) on 6/5/23 acknowledge that Patients #1 and #2 did not receive a medical screening exam because Staff #5 directed the patients' mother to another hospital.