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Based on document review and interview, it was determined that the hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The hospital failed to ensure a medical screening examination was performed. See A-2406.

Based on document review and interview, it was determined that for 1 of 20 patients (Pt. #1) presenting to the emergency department (ED) for evaluation, the Hospital failed to ensure the log was maintained by placing all patients on the central log.

Findings include:

1. The hospital's policy titled, "Emergency Medical Treatment and Active Labor Act" (revised 12/21/22) was reviewed and required, " ... D. "Central Log" is a log the hospital is required to maintain on each individual who comes to a Dedicated Emergency Department seeking care for an emergency medical condition ... documents whether the individual refused treatment ... was admitted, transferred, or discharged ..."

2. The clinical record of Pt. #1 was reviewed on 09/05/23. Pt. #1 arrived at the hospital's ED as a walk-in on 06/30/23 at 22:58 (10:58 PM), with a chief complaint of assault victim/buttocks pain.

3. The Emergency Department Admission, Discharge/Transfer Log" dated 06/30/23 from 12:00 AM to 07/01/23 12:00 AM, was reviewed. The log did not include (Pt.#1).

4. On 09/05/23 at approximately 2:30 PM, an interview was conducted with the Vice President of Patient Safety & Quality/E #6. E #6 confirmed that Pt. #1 presented to the hospital A on 6/30/23 and that Pt. #1 was not listed in the ED central log.

5. On 09/06/23 at approximately 9:50 AM, an additional interview was conducted with the ED Nurse Manager (E#5). E#5 stated that all patients that present to the ED should be included on the ED central log.

Based on document review and interview, it was determined that for 1 of 5 (Pt #1) patients presenting to the emergency department (ED) with sexual assault complaint, the Hospital [Hospital A] failed to ensure that a medical screening examination was completed to determine if a medical emergency existed. Subsequently, Pt #1 left Hospital A without being seen and went to Hospital B, where Pt #1 required to be transferred to Hospital C for a pediatric sexual assault examination.

Findings include:

1. The hospital's policy titled, "Emergency Medical Treatment and Active Labor Act" (revised 12/21/22) was reviewed and required, " ... Patients who come to a Dedicated Emergency Department ... will be Triaged and receive a Medical Screening Examination by a QMP (Qua;lified Medical Provider)."

2. The hospital's policy titled, "Triage of Emergency Department Patients" (revised 3/1017) was reviewed and required, "All patients who present for care to the Emergency Department are screened by a qualified Registered Nurse ... The goals of the triage include initial screening of patients for an emergency condition that requires immediate intervention and the sorting of patients to ensure appropriate placement and flow ..."

3. The hospital's policy titled, "Sexual Assault Survivors Emergency Treatment Act Policy" (revised 3/6/23), was reviewed and included, "H. Pediatric Sexual Assault/Abuse-Pediatric Survivors of sexual assault or abuse are assessed by the QMP. 1. Notify law enforcement ... 3. The QMP and nurse will provide/treat immediate medical needs. 4. Document statements made by the Pediatric Survivor, and parent ..."

4. The clinical record of Pt. #1 from Hospital A was reviewed on 09/05/23. Pt. #1 arrived at Hospital A's Emergency Department (ED) as a walk-in on 06/30/23 at 22:58 (10:58 PM), with a chief complaint of assault victim/buttocks pain. The ED Patient Care Timeline on 06/30/23 included:
-10:58:13 PM: Emergency encounter created (by RN/E#1)
-10:59:00 PM: Arrival Documentation. Stated Reason for Visit: assault victim.
-10:59:50 PM: Patient arrived in ED (emergency department)
-11:00:01 PM: Triage started
-11:06:06 PM: Chief Complaints Assault victim (mother states) updated.

The clinical record indicated that the admission was cancelled, no further documentation after 11:06 PM. The clinical record lacked documentation of an initial triage screening assessment or that a medical screen exam was completed. The clinical record lacked documentation of a reason why the admission was cancelled, or the patient's disposition.