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Based on observation, interview, and review of documents the hospital failed to provide a medical screening exam for a patient (Patient #1) that came to the emergency room.

Failure to provide a medical screening exam for patients before they leave the emergency room puts patients at risk for harm from a medical or psychological emergency.

Findings include:

1. The following is a summarized time line as referenced from paragraphs 2 through 7:
a) Patient #1 presented to the emergency room on 05/08/2016
b) Patient advised by hospital staff to sign in for care or leave ( #2 & #3 below)
c) Patient says they are going to use bathroom (#2 & #3 below)
d) Security guard opens bathroom door after patient locks the bathroom door (#3 below)
e) Patient says they want to check in with reception to be seen. (#3 below)
f) Security guard informs patient hospital can refuse services, advises patient to leave and call law enforcement (#3 below)
g) Local police arrive to escort the patient off hospital property (#3 below)
h) Hospital staff acknowledged the incident (#7 below)
i) Response to patient request not consistent with EMTALA requirements and hospital policy (#4 & #7 below)

2. Review of hospital documents revealed on 05/08/2016 at 04:45 AM the Patient #1was seen "loitering" in the emergency room waiting room. The patient was asked about checking in to be seen with reception. Patient #1 responded they were thinking about checking in. Patient was advised by the security employee to check in or leave. Patient #1 responded they were going to use the bathroom first. The patient locked themself in the bathroom and security opened the door to check on the patient. The patient refused to leave the bathroom. The security staff called the local police. When the police arrived the patient was escorted off the property.

On 05/09/2018 the emergency department manager received information about Patient #1 being escorted off of hospital property the day before. The manager talked to Patient #1 by phone and was told by the patient they were denied the opportunity to check in with reception.

3. On 10/05/2018 at 10:00 AM a compact disc (CD) received by the Department of Health (DOH) was reviewed. The CD showed Patient #1 being questioned by a security guard while using the bathroom facilities. The patient told the security guard they had not registered with the receptionist to be seen by the emergency department (ED) staff. The patient said they wanted to be seen for care. The security guard was heard saying the hospital could refuse to see a patient. The video then showed the local police department officers arriving to escort the patient off of hospital property and ordering the patient to pull up their pants.

4. The hospital policy titled "Emergency Medical Treatment and Active Labor Act (EMTALA) compliance with", revised 10/2017 read in part "V. Medical Screening Exams ("MSE") A. A Medical Screening Examination (MSE) will be offered to: 1. Any individual presenting to a Hospital's emergency department seeking examination or treatment for a medical condition".

"VI. ED EMTALA Central Log: Each Hospital emergency department will maintain a log recording the names of individuals who present to the emergency department or on Hospital property seeking examination or treatment of a medical condition and whether the individual refused treatment, was transferred, admitted, treated, stabilized, or discharged".

The hospital policy titled "Triage", revised 03/2016 read in part "Each patient presenting for emergency services will be evaluated by a registered nurse to determine the nature and urgency of the medical problem".

5. On 10/08/2018 at 12:00 PM Staff #1 was interviewed. Staff #1 stated the patients needed to check in with reception to be seen in the emergency department. Staff #! revealed the followowing information about the incident:

Staff #1 stated they investigated the incident after receiving a telephone call from Patient #1 on 05/09/2016. Staff #1 explained all patients need to check in with reception to be seen in the ED.

On 07/19/2018 the hospital received a greivance regarding Quality of Care about the 05/08/2016 incident.

On 10/01/2018 the hospital patient advocate received email from Patient #1 they would send a copy of the video of the incident that the patient took on 05/08/2016.

6. On 10/08/2018 at 12:30 PM Staff #1 and Staff #2 viewed the video of the 05/18/2016 incident sent by Patient #1 to the hospital's patient advocate with the surveyor present.

7. On 10/08/2018 at 1:00 PM, Staff #3 verified the above information. Staff #3 stated that no patients can be turned away from the ED. They must be assessed to make sure they are stable.