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Based on interview and record review, it was determined the hospital failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, citing 1 of 1 pediatric patient (Patient #1). No description of the examination, treatment, and/or refusal of such was documented in the medical record prior to transfer.

Findings included:

Hospital A's medical record for (Patient #1) reflected the following:

The Emergency Services Encounter Summary Report reflected, "Arrival date/time "none" and the admit date/time "04/27/12." Admission type "Emergent." Admission source "Patient coming from home or workplace." Discharge date/time 04/27/12 at 05:16 PM, awol, home, discharge provider "none." ED disposition "arrived in error." 04/27/12 timed at 17:16 PM
"Patient departed from ED signed by Personnel #5."

No further medical record documentation was found for this event. No documentation was found which indicated a medical screening was completed, refused and/or refused treatment. Additionally no documentation was found which indicated the patient was transferred to Hospital B.

Hospital B's medical record for (Patient #1) reflected the following:

The hospital face sheet dated 04/27/12 at 17:33 PM noted (Patient #1) arrived to the ED..."

The ED note dated 04/27/12 timed at 18:04 PM reflected, "Pt (Patient) to room 16. Pt with RLQ (right lower quadrant pain) times 2 days, denies fever or vomiting/diarrhea...positive nausea this AM...pt abd (abdomen) soft and tender, positive for guarding..."

The physician ED provider note dated 04/27/12 timed at 18:20 PM reflected, "Abdominal pain...patient is a 14 year old with no significant past medical history, here for RLQ (Right Lower Quadrant) pain...patient states yesterday evening, she suddenly experienced periumbilical pain that was not present in the RLQ. Patient describes the pain as 7/10, non-radiating, no alleviating factors (has not tried pain meds); aggravating factors include movement or palpation. Denies fevers, nausea, vomiting, dysuria, diarrhea, or constipation, hematuria or blood in her stool..."

The Pediatric Emergency Attending Admit Sign off note dated 04/27/12 timed at 22:53 PM reflected, "Right lower quadrant abdominal pain found to have acute appendicitis. Antibiotics infused, surgery consulted who would like to admit to their service until definitive repair can be performed. Patient has remained stable throughout her emergency course..."

The discharge summary dated 04/29/12 timed at 12:34 PM reflected, "The parents consented for surgery which was performed by Dr...on 04/28/12. The procedure proceeded without complications and postoperatively the patient was admitted to the floor for continuing care. IV (Intravenous) antibiotic course started...discharged 04/29/12.

On 05/04/12 at 04:15 PM Personnel #3 (Hospital A) was interviewed. Personnel #3 stated he could not provide documented evidence (Patient #1's) legal guardian refused a medical screening nor was there any documentation regarding the incident and/or transfer. Personnel #3 stated the tech took the patient in the wheelchair to Hospital B. Personnel #3 stated Hospital B's nurse was upset with the tech and requested transfer documentation which was not provided.

On 05/08/12 at 02:05 PM Personnel #7 (Hospital A) was interviewed. Personnel #7 stated there was not a MOT (Memorandum of Transfer) for (Patient #1) and/or any documentation which indicated a medical screening was completed, refusal of care and/or transfer documentation.

On 05/10/12 at 01:45 PM Personal #6, Technician was interviewed. Personnel #6 stated she was working in triage on 04/27/12 and was notified by Personnel #5 via radio to go out to parking garage and take a wheelchair. Personnel #6 stated Patient #1 was kneeling down holding her stomach with several adults with her. Personal #6 stated she placed the patient in the wheelchair and was going up the hill to the hospital when the patient's father said no not Hospital A we need to go to Hospital B. Personnel #6 stated she did not think anything of it and took the child to Hospital B going through Hospital A. She stated when she arrived at Hospital B the nurse asked her for the MOT (Memorandum of Transfer). She stated she told the nurse the patient was in the wrong parking garage and the family wanted the patient to come to Hospital B not Hospital A. Personnel #6 was asked by the surveyor if she communicated with Personnel #5 regarding the patient. Personnel #6 stated she did not tell the nurse. She stated she really felt it was no big deal. Personnel #6 stated this type of situation had never happened to her before.

On 05/10/12 at 04:23 PM Personnel #5 (Hospital A) was interviewed. Personnel #5 stated she did not remember seeing the patient or checking her in. Personnel #5 was asked why she entered the patient's name in the computer. Personnel #5 stated she did not know and could not offer any further details other than she received a call from the information desk that a person in the parking garage needed a wheelchair. Personnel #5 stated she was unaware Personnel #6 took (Patient #1) to Hospital B. Personnel #5 said she did not find out this happened until the technician returned from Hospital B.

On 05/10/12 at 03:30 PM an interview was conducted with Family #15. Family #15 stated (Patient #1) was not in the wrong parking garage. Family #15 said (Patient #1) was coming to Hospital A's ED (Emergency Department) due to abdominal pain. Family #15 said upon arrival to the ED the receptionist said Hospital A did not treat children. Family #15 said he left with (Patient #1) and was going back to the parking garage. Family #15 stated (Patient #1) was in pain and could not walk and someone passing by told him to call for a wheelchair. Family #15 said a lady came with a wheelchair from Hospital A and took (Patient #1) to Hospital B.

The policy entitled, "Patient Transfer and Emergency Medical Treatment & Active Labor Act (EMTALA) Compliance" with a revision date of 08/11 reflected, "If an individual waiting for a MSE (medical screening examination) decides to leave without examination the following steps should be taken...explain to the individual that it is important to have a MSE to rule out whether or not the individual has a medical condition that requires treatment...use an interpreter if the individual has limited English proficiency...inform the individual of the risks of not having the MSE...ask the individual to sign AMA form acknowledging the individual understands the risks of leaving without the MSE...document in the medical record the above information and if the individual refuses to sign the AMA, document that in the medical record...transfers from hospital...a transfer for the purpose of completing formal transfer forms is defined as patient movement from campus of one acute care facility to the campus of another acute care facility...all transfers from...to another acute care facility require completion of the transfer packet...memorandum of transfer...transfer certification and consent...transfer checklist..."