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Based on record review and interview the facility was not in compliance with 42 CFR ?489.24., the facility failed to examine or provide a medical screening exam for one patient (#21) and failed to comply with the regulations for transfer for two (#1 and #21)patients out of 21 patients reviewed. See A2406, A2407 and A2409.

Based on Record Review and Interviews it was determined that the facility did not keep an accurate central log of individuals who come to the Emergency Department seeking emergency medical care for 1 out of 21 records reviewed #21.

Findings Include:

A review of the "run report" for the Hillsborough County Fire Rescue Service reveled that on on 2/23/2014 an Ambulance crew (R 38) responded to a private residence. They found a 2 year old infant in medical distress with a fever of 101.3 and a (Seal like bark) cough. They made arrangements to transport the resident and the mother wanted to go to the nearest Hospital. Patient was transported to Hospital #1. Upon arrival at the hospital the greeting ER nurse scolded the team of R 38, in front of the mother, and told them in a loud voice that Hospital #1 did not have an inpatient pediatric unit and asked why they brought the child to that facility. The crew of R38 were not told what bed to put the patient in only to pick an empty one by this RN. After waiting about 10 minutes in the room the mother became concerned that her child was not going to be seen and doubting the facilities desire to provide care for her child asked R 38 to transport the patient to another Hospital.

During the tour of the emergency department on the morning of March 05, 2014 accompanied by an emergency department (ED) nurse and the VP of Quality Services and Risk management, an interview revealed that the normal practice for an Ambulance bring a patient to the ED was for a radio contact to be made between the two and the ED given the vital information on the patient being transported. If radio contact was not possible then the crews used a cell phone for contact.

A review of the Run Report dated 2/23/2014 revealed that during the initial contact between the crew of R 38 and the RN that evening one of the crew members asked why they were not told not to bring the child to the ED when the Radio Call was made.

A record review of patient #21 from Hospital #2 reveled that the patient did arrive at their facility at 23:55 and that patient #21 was provided a Medical Screening exam and that stabilizing medical care was provided. Pediatric patient was discharge to Home in the care of it's mother.

The central log for the dates in question were reviewed and there was no entry for Resident # 21 on the central log. An Interview with the Interim Risk Manager on March 5, 2014 at approximately 11:30 a.m. revealed that the facility was aware of the incident but did not know the name of the patient and felt that since the crew of R 38 took the patient to another hospital that this patient was never a patient of Hospital # 1.

Based on Record Review and Interviews it was determined that a medical screening examination was not performed on 1 out of 21 (#21) patient records reviewed. A medical record for patient # 21 did not exist at this facility as patient # 21 left the Emergency department before the Medical Screening Examination to seek health care elsewhere.

Findings Include:

Patient #21 arrived by ambulance at 23:17 on 2/23/2014 enroute the Ambulance Crew (R38) made Radio contact with Hospital #1 and let the hospital know the vital information on the pediatric patient they were transporting. The two year old patient had a fever of 101.3 and a (Seal like bark) cough. The Crew of R 38 brought patient #21 into the Emergency Department and were told by the greeting RN to put the patient anywhere so they took patient and mother to a room in the western cubical portion (fast track) of the Emergency Department.

After waiting a period of time without being seen the mother became concerned and told the Ambulance crew she felt uncomfortable after the hostile greeting and wanted them to take patient #21 to another hospital. After contacting the Chief the ambulance crew placed patient # 21 back in the ambulance and transported mother and patient #21 to Hospital #2.

An Interview with the Interim Risk Manager on March 5, 2014 at approximately 11:30 a.m. revealed that the facility was aware of the incident but did not know the name of the patient and felt that since the crew of R38 took the patient to another hospital that this patient was never a patient of Hospital #1. The interview confirmed that patient #21 was not entered on the hospital's log and that no record for patient #21 existed at hospital #1.

Patient #21 was not triaged, nor was a Medical Screening Exam done by Hospital #1 to determine if a medical emergency existed.

Based on Record Review and Interview it was determined that the facility did not provide emergency medial examination and treatment for 1 out of 21 records reviewed #21. Patient #21 arrived at the facility on 2/23/2014 at 22:55 and left the facility on 2/23/2024 at approximately 23:18, without being examined or treated by hospital staff.

Findings Include:

1. Based on review of the ambulance run report, #0013769, signed 2/23/2014, it was determined that
patient #21 was brought to the facility on 2/23/2014 the patient was placed in a room in the fast track area and never examined by hospital personnel. After waiting some time in the room the pediatric patient's mother asked the ambulance crew to take the sick child to another hospital, which they did.

2. In an interview with the Risk Manager on 3/05/2014 at approximately 10:00 it was learned that the facility had done an internal investigation related to Patient #21 and the facility had self reported the incident to the Agency for Health Care Administration on February 27, 2014. It was also discovered based on this interview that the facility did not have any patient documentation on the resident and there was not an entry on the central log or a medical record of this visit available. The interview confirmed that patient #21 was not examined or treated while in the Emergency Department.

3. A review of investigation done by the interim Risk Manager revealed that it consisted of An interview with the nurse who spoke to the Ambulance Crew, an interview of the unit secretary, and interview of 3 other department staff. The investigation did not obtain the Ambulance Run Report or a medical record from the treating facility. The Interim Risk Manager confirmed that they did not even know the name for this patient.

4. Stabilizing medical treatment was not provided by hospital #1. Medical Records obtained from hospital #2 confirmed that hospital #2 did provide a medical screening examination and treatment for patient #21 later that evening.

Based on Record Review and Interview it was determined that the facility did not make appropriate transfer arrangements for two, (#1 and #21) of 21 records reviewed during this investigation.

Findings Include:

Patient #21 was in the Emergency Department of Hospital 1 on February 23, 2014 when the mother asked the ambulance crew, who brought the infant patient to the facility, to take them to another hospital. The Ambulance Crew agreed to do so and left the emergency department with the patient enroute to another facility. The risks benefits of this transfer were never explained to the mother. The facility did not make arrangements with another facility to care for the patient. An interview with the Interim Risk Manager on March 5, 2014 at approximately 11:30 a.m. revealed that the facility was aware of the incident but did not know the name of patient #21 and that no record other than her internal investigation existed of this encounter.

Patient #1's record contained form called "EMTALA/COBRA/Memorandum of Transfer" dated 1/26/2014. This form was used by Hospital 1 to record the Risks and Benefits of a transfer to the patient from their facility to another. The form for Patient #1 was checked that the patient was stable and the reason for the transfer was to a Higher level of Care. Risks were only listed as "MVA". The benefits portion of the form was blank. Patient #1 was transferred to hospital #3 for definitive medical care on .

An interview with the VP of Quality/Risk management on 3/06/2014 at approximately 13:30 revealed that she had reviewed this form and was unsure why the patient was transferred. She agreed that because of this lack of understanding, that she did not know the benefits, to the patient, for the transfer.