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Based on document review and staff interviews, it was determined that the hospital failed to provide an appropriate Medical Screening Examination (MSE) to four (4) out of twenty-one (20) patients (Patients #1, 2, 9, and 10) who presented to the ED for examination and treatment.

Findings include:

Hospital policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," revealed: " ...Except where otherwise permitted by law, Emergency Medical Screening and stabilizing treatment will provided to all individuals presenting at Dignity Health Dedicated Emergency Departments (DED) requesting examination or treatment of a medical condition, and to individuals presenting on hospital property (including parking lots, sidewalks and driveways on all Dignity Health campuses) within 250 yards of the hospital requesting examination or treatment of an Emergency Medical Condition, and if one exists, either to stabilize the emergency condition or to Transfer the individual appropriately and in conformity with the legal and regulatory requirement, without regard to their age, race, color, creed, national origin, immigration status, insurance, disability, handicap, diagnosis, sexual orientation or ability to pay...All individuals who come to a DED of the hospital (whether on campus or off-campus) for examination or treatment of an Emergency Medical Condition shall receive an appropriate Medical Screening Examination. The hospital shall not delay in providing a Medical Screening Examination or necessary stabilizing treatment in order to inquire about an individual's ability to pay or to inquire about eligibility for financial assistance under the hospital's Financial Assistance Policy ...."

A review of Patient #1's medical record contained a note titled "Triage Note," which revealed: " ....Performed on: 06/28/2024 14:32...Pt arrived via pov with boyfriend. Cc abdominal pain 8/10. Took Advil and Zofran at 0600am. Denies fevers and diarrhea. Furthermore, fatigue x2days. Hx: IBS...Tracking Acuity: 3 ...."

Patient #1's medical record revealed a note titled "Clinical Discharge Summary," which revealed: "...Arrival 06/28/2024 14:27...Check Out Time 06/28/2024 15:30...."

Patient #1's medical record revealed a note titled "ED Abnormal Results Call to Pt," dated 07/01/2024, which revealed: "...Called to speak to pt about positive urine culture. Pt had left AMA so adviced {sic} pt to f/u with [her] PCP for treatment of [her] UTI. Pt was angry and states that [she] waited hours in the waiting room...."

Nineteen additional ED medical records were randomly selected for review, which included patients who were transferred, admitted, as well as six who left before Medical Screening Examinations. The review revealed the following patients who left before an MSE was completed:
- Patient #1- arrived 06/28/2024 at 14:27, triaged 14:32, ESI 3, chief complaint 8 out of 10 abdominal pain, left before MSE at 15:30; called 07/01/2024 for a positive urine culture from ED visit (63 minutes elapsed time between registration and leaving)
- Patient #2 (5 years old)- arrived 07/07/2024 at 15:28, triaged 15:35, ESI 4, chief complaint foot pain, left before MSE at 19:30. X-ray image of foot taken at 16:23 and read at 18:47 revealed: "...there is a comminuted fracture through the right metatarsal extending from the proximal growth plate through to the distal head. Fracture fragments are mildly displaced...." The ED provider spoke with mom via telephone at 19:34 regarding results of the xray and urged follow up care the following day. (4 hours, 2 minutes elapsed time between registration and leaving)
- Patient #9- arrived 06/17/24 at 11:22, triaged 11:27, ESI 2, chief complaint shortness of breath and light headed, left before MSE at 14:55; Chest X-ray at 12:25 revealed a right-sided transvenous defibrillator device, and no acute cardiopulmonary findings. Refusal of MSE for signed at 14:55 with no further documentation by ED staff after 11:29. (3 hours 28 minutes elapsed time between registration and leaving)
- Patient #10- arrived 08/01/2024, at 15:58, triaged at 16:04, ESI 3, chief complaint relapsed on meth and feeling very anxious. Provider note at 18:46 revealed: "...The patient eloped after triage but prior to evaluation...." (2 hours, 48 minutes time elapsed between registration and leaving)

Employee #1 and #3 confirmed in an intervew on 09/09/2024, that Patients #1, 2, 9, and 10 left before receiving a medical screening exam.

Based on record reviews and staff interviews, it was determined the Hospital delayed examination and treatment for four (4) out of twenty (20) patients (Patients #1, 2, 9, and 10) who presented to the ED seeking medical treatment. Failure to provide timely medical examination and treatment poses a potential risk that a patient is denied necessary medical treatment.

Findings include:

Hospital policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," revealed: "...Except where otherwise permitted by law, Emergency Medical Screening and stabilizing treatment will be provided to all individuals presenting at Dignity Health Dedicated Emergency Departments (DED) requesting examination or treatment of a medical condition, and to individuals presenting on hospital property (including parking lots, sidewalks and driveways on all Dignity Health campuses) within 250 yards of the hospital requesting examination or treatment of an Emergency Medical Condition, and if one exists, either to stabilize the emergency condition or to Transfer the individual appropriately and in conformity with the legal and regulatory requirement, without regard to their age, race, color, creed, national origin, immigration status, insurance, disability, handicap, diagnosis, sexual orientation or ability to pay...All individuals who come to a DED of the hospital (whether on campus or off-campus) for examination or treatment of an Emergency Medical Condition shall receive an appropriate Medical Screening Examination. The hospital shall not delay in providing a Medical Screening Examination or necessary stabilizing treatment in order to inquire about an individual's ability to pay or to inquire about eligibility for financial assistance under the hospital ' s Financial Assistance Policy...Once the Medical Screening Examination is completed and there is a determination that the individual does not have an Emergency Medical Condition or the Emergency Medical Condition has been stabilized, the individual may be (i) treated; (ii) discharged as clinically appropriate and the individual is given a reasonable plan for appropriate follow-up care and/or discharge instructions; or (iii) transferred for continued care in accordance with appropriate Transfer procedures...."

A review of 20 ED records randomly selected for review included patients who were transferred, admitted, or left before Medical Screening Examinations. Four patients were found to have a delay in treatment due to failure to receive an MSE:

· Patient #1- arrived 06/28/2024 at 14:27, triaged 14:32, ESI 3, chief complaint 8 out of 10 abdominal pain, left before MSE at 15:30; called 07/01/2024 for a positive urine culture from ED visit (63 minutes elapsed time between registration and leaving)
· Patient #2 (5 years old)- arrived 07/07/2024 at 15:28, triaged 15:35, ESI 4, chief complaint foot pain, left before MSE at 19:30. X-ray image of foot taken at 16:23 and read at 18:47 revealed: "...there is a comminuted fracture through the right metatarsal extending from the proximal growth plate through to the distal head. Fracture fragments are mildly displaced...." The ED provider spoke with mom via telephone at 19:34 regarding results of the xray and urged follow up care the following day. (4 hours, 2 minutes elapsed time between registration and leaving)
· Patient #9- arrived 06/17/24 at 11:22, triaged 11:27, ESI 2, chief complaint shortness of breath and light headed, left before MSE at 14:55; Chest X-ray at 12:25 revealed a right-sided transvenous defibrillator device, and no acute cardiopulmonary findings. Refusal of MSE for signed at 14:55 with no further documentation by ED staff after 11:29. (3 hours 28 minutes elapsed time between registration and leaving)
· Patient #10- arrived 08/01/2024, at 15:58, triaged at 16:04, ESI 3, chief complaint relapsed on meth and feeling very anxious. Provider note at 18:46 revealed: "...The patient eloped after triage but prior to evaluation...." (2 hours, 48 minutes time elapsed between registration and leaving)

Employees #1 and #3 confirmed in an interview on 09/09/2024, the Patients #1, 2, 9, and 10, did not get treatment for the symptoms that brought them to the ED because they did not receive an MSE.