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Based on document review and staff interview, it was determined the Hospital failed to ensure all patients are logged in the Emergency Department central log and failed to provide a Medical Screening Exam to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24.

Findings include:

1. The hospital failed to document all patients on the ED central log. See deficiency at A-2405

2. The hospital failed to ensure patients who did come to the Emergency Department were provided an appropriate medical screening examination within the capability of the hospital's emergency department. See deficiency at A-2406

Based on a request for documents and staff interview, it was determined for 1 of 20 patients, (Pt #1) presenting to the emergency department (ED) for treatment, the hospital failed to ensure the patient was documented in the ED central log. This has the potential to affect all patients receiving care in an ED that treats approximately 25 patients a day.

Finding include:

1. On 11/03/2022 at approximately 10:00 AM, a request was made to the Emergency Department Director (E #3) for documentation indicating Pt #1 presented to the ED on 9/10/2022. E #3 was unable to provide any evidence that the patient was ever registered or placed on the ED tracking log, even though there was communication between ED Nurse (E #6) and the patient's son-in-law.

2. On 11/03/2022 at approximately 10:20 AM, a review of the "Emergency Department Log" was reviewed. There was no evidence that Pt #1 was logged into the log by ED staff.

3. On 11/03/2022 at 11:40 AM, an interview with ED Nurse (E #6) was conducted. E #6 confirmed that a conversation took place between the Emergency Department Director (E #3) and the patient's son-in-law. E #6 indicated the patient was brought to the ED by the patient's son-in-law for treatment and then left after the being told there would be a wait time before the patient would be brought into a room for treatment.

4. On 11/03/2022 at 11:15 AM, an interview with ED Director (E #3) was conducted. E #3 confirmed that Pt #1 was not logged into ED Log and stated "All patients who present to the ED should be logged in."

Based on document review and staff interview, it was determined for 1 of 20 (Pt #1) patients who presented to the Emergency Department (ED) seeking treatment, the hospital failed to provide an appropriate medical screening to determine within reasonable clinical confidence whether an emergency medical condition existed. This has the potential to affect all patients receiving care in an ED that treats approximately 25 patients a day.

Finding include:

1. A request for documentation of a medical screening for Pt #1 was made on 11/03/2022 during the entrance conference. No documentation was provided indicating a medical screening was completed for Pt #1.

2. On 11/03/2022 at 12:30 PM, an interview with Emergency Department Nurse (E #6) was conducted. E #6 confirmed that Pt #1 arrived in the ED for treatment and was not provided a medical screening. E #6 recalled working in the ED the night that Pt #1 presented to the ED for treatment. The patient's son in law came into the ED seeking treatment for his father-in-law (Pt #1). Someone knocked or rang the doorbell to the ED, and I answered the door. It was a man who stated Pt #1 was sick and needed to be seen. He never asked me to help get the patient out of the vehicle. E #6 grabbed a piece of paper and pen, because the ED was full at that time. If the ED would have had a room available, the patient would have been immediately placed in an ED room. E #6 couldn't bring the patient back, so E #6 grabbed a pen and paper to get his name and birthday. E #6 stated I could take his name and birthdate and the patient's reason for coming. E #6 replied we were full, but we would make a room and get the patient back as soon as possible. He said, "is there anywhere else in town that I can take the patient? E #6 said, "not that I'm aware of." He said, "I'm not from here, how far is Mt. Vernon?" E #6 replied, "well, I'm not telling you to go somewhere else, you're welcome to wait". He asked, how far is Mt. Vernon from here and E #6 replied, "it's about 22 miles down the interstate". E #6 repeated that Pt #1 was welcome to wait, it may be a while. E #6 asked for the patients name and the son-in-law wouldn't give it. "It wasn't like he refused; it was more like he didn't acknowledge that I asked him for that information". He asked again, how to get to the hospital in Mt. Vernon. E #6 replied, "if you take the second exit in Mt. Vernon, you can see the hospital from there." He turned around and left. Did you ever see the patient? "No." As far as I know, the patient never came into the hospital. Were you ever told that the patient was unconscious? "No." "I was told that the patient was throwing up. I never refused care, I told the patient that the ED was full and that the patient would have to wait.

3. On 11/03/2022 at 2:10 PM, a telephone interview with Emergency Room Physician (E #8) was conducted. E #8 confirmed that he was working in the ED when Pt #1 presented for treamtment. E #8 was not aware of Pt #1 or any other patient arriving in the ED then leaving without being seen on 09/10/2022.