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Based on interviews, observation and policy review, the facility failed to comply with 489.24(A2406) by failing to provide an appropriate medical screening examination for one patient (#21) who presented to the Emergency Department. This deficient practice places all patients seeking emergency medical treatment at risk. The average monthly census of the Emergency Department is 3,685 patients.

Based on staff interviews and medical record and policy review, the facility failed to ensure one (Patient #21) of 20 medical records reviewed, received a medical screening exam. This deficient practice places all patients seeking emergency medical treatment at risk. The average monthly census of the Emergency Department is 3,685 patients.

Findings include:

Staff A was interviewed on 8/20/14 at 3:40 PM. Staff A stated he/she arrived for a scheduled shift on 8/14/14 at 3:00 AM. and Staff G and Staff F reported an incident regarding an emergency squad (Squad A and Squad B) call that Staff F had received. Staff A stated Squad A called Squad B for mutual aide because Squad A needed a medic. Squad B called the emergency department at Facility A (Marietta Memorial Hospital) and reported the family of Patient #21 wanted Patient #21 taken to Facility B (Camden Clark Hospital in W.Va.). Staff A stated the radio reception during the communication was not good and Squad A was hesitant to pass by Facility A. Squad B called asking where they should take Patient #21. The emergency department staff told Squad B to bring Patient #21 to the emergency department at Facility A unless Patient #21 had a return of spontaneous circulation. Staff A stated Squad B called the emergency department again stating "we are here, we don't know where to turn in". Staff A went to the road to tell Squad A how to turn into the facility.

On 8/20/14 at 3:52 PM, Staff F was interviewed. Staff F stated Facility A was notified Patient #21 was coming and reported he/she saw lights from the ambulance in the street on Memorial Way. Staff G told Staff F to go out and find out if Patient #21 had a pulse. Staff F had told the squad to take Patient #21 to Facility B if Patient #21 had a pulse. Staff F went to the street, was told Patient #21's pulse had returned and Patient #21 was being bagged. Squad A was unable to radio to Facility A and Squad B was told over the radio to move on. Staff F reported Squad A was in the street. Staff F reported he/she never told Squad A Patient #21 couldn't be treated. Staff F stated "I said to transfer on" after Squad A stated Patient #21 had a pulse.

On 8/21/14 at 11:00 AM, Staff F was interviewed again. Staff F stated that on 8/13/14, he/she saw lights flashing outside of the emergency department and there were two squads with two paramedics each in the wrong lane on Memorial Way. Squad A rolled down the window and reported Patient #21 had a pulse. Staff F stated he/she instructed Squad A to "transfer on". Staff F also stated Patient #21's family was in the facility's waiting room. The family hugged and thanked Staff F when Staff F told the family of Patient #21 that the patient went to Facility B.

On 8/20/14 at 4:05 PM, Staff G was interviewed. Staff G stated Facility A received a telephone call on 8/13/14 from Squad B informing Facility A they were getting Patient #21 who was in cardiac arrest in Squad A. Staff G reported it "makes sense" to have Patient #21 go to the nearest hospital, Facility B, if Patient #21's spontaneous circulation returned. Staff G stated he/she was told Patient #21 was intubated, spontaneous circulation had returned and Patient #21 was going to Facility B. Staff G reported Squad A stopped on the street, not on Facility A's property. Staff G stated Patient #21 had stabilized and Squad A was never told the patient could not be seen at Facility A. Staff G also stated had Patient #21 decompensated, Staff G would have been happy to stabilize Patient #21. Staff G went on to say Squad A never communicated with Facility A directly due to Squad A was not able to contact Facility A.

On 8/21/14 at 7:14 AM, Staff G was interviewed again. Staff G reported Staff A had all communications with the squads on 8/13/14. Staff G reported Facility A was told Patient #21 was intubated, had lines, and was receiving advanced life support. Staff G reported "it would make the most sense" to have Patient #21 go to the nearest hospital if spontaneous circulation returned. Staff G stated according to Staff G's medical opinion, the best course of action for Patient #21 was to have Patient #21 go to the nearest hospital.

On 8/21/14 at 11:27 AM, Staff B provided a document titled "Emergency Medical Treatment & Active Labor Act (EMTALA)" which Staff B stated is provided to physicians. The document read:
-Presenting Patient: anyone who comes to the emergency department and requests examination or treatment for a medical condition.
-A patient has presented if they request services after coming to any hospital-based entity located on the main hospital campus and includes:
- Parking lot, sidewalk, physician offices and driveway; -Structures within 250 yards of the main building;
-Departments located off the main campus but considered provider-based.

The facility's policy titled "EMTALA - Medical Screening" last reviewed and revised March 2014, was reviewed. The policy included:
-Any patient who comes to the hospital requesting emergency services is entitled to and will receive a Medical Screening Examination performed by individuals qualified to perform such examination to determine whether an emergency medical condition exists.
DEFINITIONS:
-When a Medical Screening Examination is Required.
a) If an individual arrives at the hospital and is not technically in the emergency department, but on Hospital Property or Premises (as defined under this policy) and requests emergency care, he or she must receive a Medical Screening Examination within the capabilities of the facility or, if necessary, execute an appropriate transfer according to the guidelines of EMT ALA and these policies.
3. The Location in Which the Medical Screening Examination Should be Performed.
a)The Medical Screening Examination and other emergency services need not be provided in a location specifically identified as an emergency room or any emergency department. If an individual arrives at a facility and is not technically in the emergency department, but is on the premises of the hospital and requests emergency care, he or she is entitled to a medical screening examination.

This deficiency substantiates Substantial Allegation OH00076079.