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Based on interview and record review, the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to provide a medical screening exam (MSE) for 1 (P-1) patient of 20 patients reviewed for medical screening exams, resulting in the potential for less than optimal outcomes for all patients seeking emergency care. Findings include:

See tag 2406: Failure to provide a medical screening exam.

Based on record review and interview, the facility failed to provide a medical screening exam for one (P-1) of twenty patients reviewed for a medical screening exam resulting in the potential for less than optimal patient outcomes for all patients seeking emergent care. Findings include:

On 2/3/2025 during record review of P-1's medical record it was revealed that on 1/10/2025 P-1 was brought to the facility Emergency Department (ED) via ambulance at 1141. P-1 was seen by staff J, ED physician. According to the medical record staff J documented, "Patient well known to this emergency department with multiple visits for intoxication. Presents today belligerent and intoxicated. I was asked to come to triage to evaluate him. At that time, he was belligerent, shouting obscenities, but able to ambulate and in fact attempted to attack a patient in the waiting room. I asked security to escort him out. Diagnosis: Intoxication, Disposition: Discharge, I saw and evaluated this patient. Patient's prior records were reviewed." P-1 was discharged from the facility ED at 1153.

On 2/4/2025 during continuation of record review of P-1's medical record it was revealed that on 1/10/2025 at 1313, P-1 was brought back to the facility ED via police escort. P-1 was discharged from the facility on 1/10/2025 at 1349. A medical screening exam was not found for the second presentation to the facility ED.

An interview was conducted with staff J on 2/6/2025 at 1000. Staff J was queried if a medical screening exam was done on P-1 on the second presentation of P-1 on 1/10/2025 at 1313. Staff J stated he had been informed that P-1 had returned to the ED facility by the triage nurse and was requested to go to the lobby to assess P-1. Staff J stated that security was asked to have additional staff present related to P-1's previous behavior that day (1/10/2025 at 1141). Staff J stated that when he went to the lobby P-1 was sitting quietly and sleeping in a chair by the "glass house" (an area where security is located). Staff J stated he had trepidation of waking P-1 because P-1 was unpredictable and sometimes would play "possum." Staff J stated with 2 security guards present he woke P-1. Staff J stated he asked P-1 several questions and asked P-1 to ambulate. Staff J stated P-1 was alert and oriented times three (person, place, and time) and could ambulate without difficulty. Staff J was again queried if a medical screening exam had been performed on P-1. Staff J stated, "Yes...I did not document it as I thought the note from earlier covered that visit as well."

On 2/4/2025 a review occurred of the policy titled, "Emergency Medical Treatment and Labor Act," policy number 17038111, effective on 1/22/2025. According to the policy, "IV. Policy Standards, #A. Any (1) individual who comes to a (facility) ED and requests examination or treatment for any medical condition or (2) any individual on (facility) Property in need of or requesting emergency medical treatment is entitled to and will receive, regardless of diagnosis, race, religion, gender, ethnicity, national origin, age, disability, marital status, sexual orientation or source of payment for care, an appropriate MSE (Medical Screening Exam) by a QMP (Qualified Medical Professional) to determine if the individual has an EMC (see Addendum A: Medical Screening Examination). Triage is not equivalent to the MSE (see Addendum B: Triaging and Registering Patients)."