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Based on interviews, the facility failed to maintain a log of all individuals who presented to the emergency room requesting examination or treatment for a medical condition. The facility only logged patients admitted to the emergency room.

A review of the facility's log revealed all individuals presenting to the emergency room requesting examination or treatment for medical condition were not logged.

Review of the document titled Emergency Department Registration and Collections Policy revealed:
VI. Procedure, C. Minimum Guidelines for Compliance; 5. The hospital staff involved may not discourage individuals from remaining for further evaluation.
E. When a patient leaves the ED before receiving a MSE
lf the patient informs the ED registration staff that he/she is leaving the hospital without receiving a MSE, this should be documented (see NOTE below). Registration should advise the patient that he/she will receive a MSE if they stay regardless of his/her ability to pay, lf the patient leaves without receiving the MSE, document the date, time, and disposition in Emergency Department Information: System (EDIS) and reason, if known, on their triage record. You should request the patient to sign the Refusal to Consent to Emergency Department Treatment and/or Evaluation. No request for payment should be made at that time.
If the patient simply leaves the ED without notifying hospital staff, the hospital staff shall document in Emergency Department Information System (EDIS) the fact that the patient presented and the time the staff discovered that the patient had left, and retain triage notes and additional medical records, if any.
If the patient has not provided registration information before he/she leaves, the facility should register that patient as John Doe or Jane Doe:

An interview with patient #14's grandmother revealed she took patient #14, to hospital #1 for care. The grandmother revealed patient #14's speech was very hard to understand and the patient had a hard time standing. The grandmother stated all she could understand is that the patient had been raped, and hit in the back of the head with a wrench. Upon arriving to hospital #1 she repeated to the lady at the desk, the patient had been raped and hit in the back of the head with a wrench. The grandmother of patient #14 was told by the staff, she would need to go to hospital #2 to receive a sexual assault exam. The unidentified staff said hospital #1 did not have a sexual assault nurse. The grandmother stated she followed the direction of the unidentified staff and took the patient to hospital #2.

An interview with staff #10 revealed when asked, explain the process for when a patient presents saying they have been sexually assaulted. Staff # 10 stated I tell them we don't have a SANE (sexual assault nurse examiner) nurse and if they want a SANE exam they need to go to hospital #2. Staff #10 was asked, would the patient be registered in the Emergency Log. Staff #10 responded NO.

Based on document reviews and interview, Hospital #1 failed to provide a medical screening to 1 of 1 patients presenting in the emergency room who was over dosed on heroin, sexually assaulted, physically assaulted and had an infected foot.

Review of the document titled Emergency Department Registration and Collections Policy revealed VI. Procedure, C. Minimum Guidelines for Compliance; 5. The hospital staff involved may not discourage individuals from remaining for further evaluation.

Review of the document titled Procedure Title: Screening/Transfer of Patients, PATIENT EVALUATION, revealed:
When a patient arrives at the hospital (patient defined as an individual seeking medical treatment) who:
1. May or may not be under the immediate supervision of a personal attending physician;
2. Has one or more undiagnosed or diagnosed medical conditions; and
3. Within reasonable medical probability, requires immediate or continuing hospital services and medical care.
The patient must be:
1. Evaluated by a physician who is present in the hospital at the time the patient presents or is presented.

Review of the document titled Emergency Medical Treatment and Patient Transfer revealed:
DEFINITIONS
For the purpose of this emergency medical treatment and transfer policy, the following terms shall have the meaning defined in 42 C.F.R. 489.24(b) and 25 Texas Administrative Code, Chapter 133 Hospital Licensing:
2. "Coming to the Emergency Department" - is defined as follows:
A. Any individual on Hospital property (including the parking lot, campus, and/or off-campus Departments of the Hospital) requesting examination or treatment.
B. An individual in a non-Hospital-owned ambulance on Hospital property.
C. An individual in a Hospital-owned ambulance regardless of the ambulance's location.
4. "Emergency Medical Condition" - means (i) a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:
A. placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
B. serious impairment to bodily functions; or
C. serious dysfunction of any bodily organ or part; or
D. with respect to a pregnant woman who is having contractions
(i) that there is inadequate time to effect a safe transfer to another hospital before delivery, or
(ii) that transfer may pose a threat to the health or safety of the woman or the unborn child.

I. MEDICAL SCREENING EXAMINATION
A. General
1. Medical Screening. When an individual comes to the Emergency Department of the Hospital, or to any location on the Hospital's campus (including Hospital owned satellite facilities that operate under the Hospital's provider number, such as ambulatory care clinics or urgent care centers), and a request is made on the individual's behalf for a medical examination or treatment, an appropriate medical screening examination, within the capabilities of the department (including ancillary services routinely available to the emergency department), shall be provided to determine whether an emergency medical condition exists, or with respect to a pregnant woman having contractions, whether the woman is in labor. It must be remembered that a medical screening examination goes beyond initial triage. Triage is not equivalent to a medical screening examination. Triage merely determines the order in which patients will be seen, not the presence or absence of an emergency medical condition. Also, a medical screening exam is not an isolated event, but is an on-going process. The record must reflect continued monitoring according to the patient's needs and must continue until completion of stabilizing treatment and the patient is discharged, admitted, or appropriately transferred.

A review of the document from Hospital #2, titled History and Physical revealed the patient was admitted to the hospital on 10/14/2015. The History and Physical also revealed:

ASSESSMENT AND PLAN:
1. Acute encephalopathy, likely multifactorial with known heroin abuse, possible physical and sexual abuse, and sepsis Continue with vancomycin and Zosyn Check blood cultures that have already been obtained x2, urinalysis, urine cultures. We were able to obtain drug urine screen. Unable to consent for exam for grandmother's suspicion of rape at this time. Will put the patient on normal saline and IV fluids, Aspiration, fall, and seizure precautions and admit her to MC for close observation.

2. Sepsis, multifactorial, with likely withdrawal, actively occurring, contributing to the tachycardia and drug use contributing to the leukocytosis but also with left lower extremity cellulitis. As above, with IV fluids Check CBC and BMP in the morning. Antibiotics as already stated.

3. Acute kidney injury secondary to dehydration and substance abuse.

4. Substance abuse with known heroin use, tobacco use, alcohol, and possibly other drugs. Will put on NicoDerm patch daily.

5. Prophylaxis, Venodynes"

An interview with patient #14's grandmother revealed she took patient #14, to hospital #1 for care. The grandmother revealed patient #14's speech was very hard to understand and the patient had a hard time standing. The grandmother stated all she could understand is that the patient had been raped, and hit in the back of the head with a wrench. Upon arriving to hospital #1 she repeated to the lady at the desk, the patient had been raped and hit in the back of the head with a wrench. The grandmother of patient #14 was told by the staff, she would need to go to hospital #2 to receive a sexual assault exam. The unidentified staff said hospital #1 did not have a sexual assault nurse. The grandmother stated she followed the direction of the unidentified staff and took the patient to hospital #2.

An interview with staff #10 revealed when asked, explain the process for when a patient presents saying they have been sexually assaulted. Staff # 10 stated "I tell them we don't have a SANE (sexual assault nurse examiner) nurse and if they want a SANE exam they need to go to hospital #2". Staff #10 was asked, would the patient be registered in the Emergency Log. Staff #10 responded NO.