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Based on document review and interview, it was determined that 1 of 20 (Patient 20) medical records reviewed of patients who presented to the hospital requesting emergency services, the facility failed to ensure compliance with 489.24 in that the facility failed to provide a complete medical screening exam.

Findings Include:

1. See findings cited at 42 CFR 489.24, A2406.

Based on document review, the facility failed to provide a complete medical screening exam for 1 of 20 patients (patient #20).

Findings include;

1. Facility policy titled Emergency Medical Treatment Medical Screening Exam (MSE) and Transfer Following MSE Policy last reviewed 5/11/23 indicates under purpose statement on page 1 that all persons seeking emergency treatment at the hospital shall receive an appropriate medical screening exam.

2. Review of the closed MR for Patient # 20 indicated the patient arrived at H # 2's (Acute Care Hospital) ED on 01/11/2024 at approximately 10:16 am. The Patient Care Timeline, indicated triage started at 10:19 am. Triage notes dated 01/11/2024 indicated patient stated he/she was getting hooked up to dialysis and staff told him/her that he/she blacked out. Triage plan, vital signs (blood pressure 123/65, pulse 63, respirations 16, temperature 97.5, oxygen saturation 97%), assessment, and triage screening completed by 10:28 am. Patient was seen by MS # 1 (Doctor of Osteopathy-DO/ED) at 10:29 am. Orders (laboratory tests, medications, Electrocardiogram, and chest x-ray) were placed by MS # 1 at 10:30 am. Medication administered to patient at 10:36 am (Zofran-nausea) and 10:38 am (Toradol-pain). Labs completed at 10:42 am. Electrocardiogram resulted normal sinus rhythm at 10:48 am. Chest x-ray performed 10:43 am - completed at 10:58 am resulted normal. ED Provider Notes dated 01/11/2024 at approximately 10:31 am, indicated - physical exam - vital signs and nursing note were reviewed. Patient was not in any acute distress and/or diaphoretic. The patient left before treatment was completed.

3. Review of incident reports indicated S # 3 (Security) completed an incident report related to an altercation between patient #20 and a family member with other family in the emergency department waiting room. Patient # 20 was asked by S # 3 to refrain from profane language. Patient # 20 continued to use profanity at which time S # 3 advised patient # 20 and family member that further disruption would be cause for S # 3 to ask patient # 20/family member to leave the facility (H # 2). Patient # 20 aggressively got close to S # 3's face and clenched his/her fists in a threatening manner which at that time they both (patient # 20/family member) were advised to leave. Patient # 20 refused and indicated that they would have to physically remove him/her. S # 3 requested S # 2 to notify the police department. The family member went to get the car while patient # 20 continued to repeatedly threaten S # 3 with physical violence and then death. Once PD # 1 arrived the patient began to leave.

4. Patient #20 left the facility without a completed medical screening exam and treatment.