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Based on document review and interview, it was determined that for 1 of 20 patients the hospital failed to ensure compliance with 489.24 (r) and 489.24 (c) in that the hospital failed to provide a medical screening and failed to ensure compliance with 489.24 (e) (1)-(2) in that the hospital failed to provide an appropriate transfer (patient #N1) .

Findings include:

1. See findings cited at 489.24 (r) and 489.24 (c), and 489.24 (e) (1)-(2).

Based on medical record review, document review and staff interview, the facility failed to provide an appropriate medical screening exam for 1 of 20 patients presenting to the emergency department (patient #N1).

Findings include:

1. Review of patient #N1 medical record from facility #1 indicated the following:
(A) He/she presented to the facility #1 ED at 2125 on 8/9/12 with complaint of a possible sexual assault. Triage category was listed as a "3". Triage notes were documented by RN #1.
(B) Further nursing documentation states the patient was discharged at 2200 on 8/9/12 with disposition listed as "left without being seen" and condition listed as "stable".
(C) The medical record lacked evidence of a medical screening exam by the physician as required in facility policy.

2. Review of patient #N1 medical record from facility #2 indicated the following:
(A) He/she presented to the ED at 0040 on 8/10/12.
(B) Nursing notes at 0115 state "Pt here with c/o alleged sexual assault approx 12+ hours ago......" and "Pt reports going to (facility #1) first and was told that the hospital was not equipped to handle any sexual assault exam and that she needed to come to (facility #2). Pt states she was not examined by an ER MD at (facility #1)....."
(C) Dictated physician note dictated by M.D. #3 states "She went to (facility #1) and was advised by the doctor there to leave and go to (facility #2). She states she was not examined at that hospital."

3. Facility policy titled "PHYSICIAN RESPONSIBILITIES" last reviewed/revised 1/12 states on page 1: "....Medical screening examinations are completed by the Emergency Department physician. Page 2 paragraph 2 states "Physician responsibilities are summarized as follows:
? seeing patients in a timely manner in the Emergency Department......."

4. Staff member #3 indicated the following in interview beginning at 5:30 p.m. on 8/16/12:
(A) RN #1 told him/her on the morning of 8/10/12 when he/she arrived at work that the facility had a patient come to the ED with a report of a sexual assault. M.D. #1 went into the room with the patient, came back out and told RN #1 to not charge the patient and send the patient elsewhere because "that service" was not provided at facility #1 and the patient needed to go elsewhere. The patient did not receive a medical screening exam.