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Based on clinical record review, policy review and staff interview it was determined the facility failed to comply with the requirement to provide an appropriate medical screening examination for 1 ( #1) of 20 sampled patients. See A 2406; 489.24(i) Medical Screening Examination.

Based on reviews of clinical records, policy and procedure and interview it was determined the facility's emergency department (ED) physician failed to complete an appropriate medical screening examination (MSE) to include ancillary services routinely available in the emergency department to determine whether or not an emergency medical condition existed for 1 (#1) of 20 sampled patients.

Findings include:

A review of Patient #1's clinical record dated 1/20/13 revealed the patient presented to the emergency department at 5:05 am, via ambulance, with a stated complaint of "headache", A review of the emergency department (ED) nursing notes revealed the patient arrived by ambulance. The nurse documents according to the ED clerk and the ED physician involved, the physician advised the patient "we weren't going to do anything further for her and she should just leave." The patient intravenous line was removed by the paramedics and the patient left without being visualized by the hospital nursing staff.

Further review of the clinical record revealed the patient never received a MSE on 1/20/13 by a physician.

A review of the facility's policy, EMTALA: Florida Medical Screening Examination and Stabilization, policy # B. 17, reviewed 7/12, page 3 of 15, paragraph 2,when a Medical Screening Examination (MSE) is required, revealed the following:

"A hospital must provide an appropriate MSE within the capability of the hospital's emergency department, including ancillary services routinely available to the dedicated emergency department (DED), to determine whether or not an emergency medical condition (EMC) exists; (i) to any individual who has such a request an examination".

A review of the Medical Staff Rules and Regulations approved 11/24/12, page #29, Part D, paragraph 1, states members of the medical staff shall accept responsibility for care in accordance with Emergency Department policies and procedures.

An interview was conducted with the Director of Risk Management on 1/29/13 at approximately 3:00 pm. Upon review of the credential file of the physician involved revealed the physician was relieved of her privileges with the hospital by the Governing Body on 1/28/13 and is no longer employed with the emergency department partnership group. The removal of the physician was based on Peer review of the incident conducted on 1/22/13.

The Emergency Department Physician's completed a refresher course on EMTALA on 1/30/13. The Emergency Department staff is scheduled for a refresher course following the Physicians course.

The Director of Risk Management confirmed the above.