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Based upon interview and document review, it was determined that the facility failed to have policies and procedures in effect to ensure compliance with 42 CFR 489.24 and the related provisions at 42 CFR 489.20.

Findings include:

Review of medical records revealed the facility did not comply with all of the provisions of maintaining a central log and conducting a medical screening exam. Please reference findings under Tag A2405 and 2406.

Based on document review and interview, the facility failed to ensure that all individuals presenting to the Emergency Department (ED) are entered into the central log for 1 of 45 patients (Patient #1).

Findings include:

Review of facility policy entitled "Obstetrical Patients Presenting to Emergency Department" last revised 3/2011 indicates that all obstetrical patients presenting at less than 20 weeks gestation will be evaluated in the ED unless prior arrangements are made by their physician.

Review of self reported hospital documentation revealed that Patient #1 presented to the ED at approximately midnight on 12/3/13 with complaint of abdominal cramping; the patient was reportedly at 16 weeks gestation. The patient was not entered into the ED central log and instead was sent directly to the the Labor and Delivery unit where she was registered as an outpatient. A medical record was not generated for this patient.

Interview with Staff # 28, nursing supervisor, on 12/19/13 indicated following presentation to the ED the ultrasound technician transported the patient to the Labor & Delivery unit.

These findings were verified with Staff #1 on 12/18/13.

Based upon interview and document review, the hospital did not provide an appropriate medical screening examination for 1 of 45 patients who presented to the Emergency Department (ED) (Patient #1).

Findings include:

Review of facility policy entitled "Obstetrical Patients Presenting to Emergency Department" last revised 3/2011 indicates that all obstetrical patients presenting at less than 20 weeks gestation will be evaluated in the ED unless prior arrangements are made by their physician.

Review of self reported hospital documentation revealed that Patient #1 presented to the ED at approximately midnight on 12/3/13 with complaint of abdominal cramping; the patient was reportedly at 16 weeks gestation. The patient was sent to Labor & Delivery without being triaged or receiving a medical screening examination.

Interview with Staff # 28, nursing supervisor, on 12/19/13 indicated following presentation to the ED the patient was sent to Labor & Delivery for fetal heart rate monitoring without being triaged or receiving a medical screening examination. While in the Labor and Delivery unit, an ultrasound was performed, following which the patient left for home without a medical screening examination being performed.

These findings were verified with Staff #1 on 12/18/13.