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Based on EMS record review, hospital bylaws, policy and procedure review, and interview, the facility failed to provide a medical screening exam by a physician for a patient who had presented themselves at the emergency department parking lot for treatment.

Findings include:

Review of the EMS (Emergency Medical Services) documentation, interview with hospital staff, and written statements, revealed that on 11/20/13 the patient presented at the E.D. (Emergency Department) room entrance located outside the hospital in the parking lot for medical treatment. During interview with the E.D. nurse manager and the hospital paramedic on 12/3/13 it was reported that the patient was a good historian and had reported falling down twenty stairs at home and hitting head several times, and had been transported by a family member in their private vehicle to the emergency room, the patient also stated they were able to ambulate to the car at the time of the occurrence. At the E.D. the patient was unable to get out of the car due to their condition changes complaining of Left shoulder pain, and not being able to feel left leg. At this time the hospital E.D. nurse manager, and hospital paramedic attended to the patent in the car. The patent was well know to the hospital staff and based on the nursing assessment and past medical history (history of strokes, transient TIA's and MI's and being on coumadin)which could not be confirmed on any hospital documentation pertinent to this incident. Interview on 12/3/13 with hospital E.D director and hospital paramedic identified that considering the possible deterioration of neurological status coupled with the trauma from fall with resulting pain that was reported the hospital staff E.D nurse and hospital paramedic felt that it was in the patents best interests to transport them to a higher level care facility.

The hospital staff E.D. nurse, and hospital paramedic returned to the E.D. and gave report to the E.D. physician at which time the physician agreed with the assessment and felt that the transfer was appropriate. At this time the patent was extracted from the car to a back board with the assistance of the local fire department and transported to a level one trauma center. During this period of time the patent did not receive a medical screening by the E.D. physician as stated below; however, the physician was told of the patient's medical condition before transport occurred.

The facility's policy for "Patient Transfer to Other Acute Facilities-EMTALA (Emergency Medical Treatment Labor Act) States:

The transfer of a patient to or from another facility will occur when:

1. The physician determines after an appropriate medical screening examination that the clinical area of the facility does not have the capability/capacity necessary for treatment of the patient.
2. In situations where the patient or family/legal representative requests such a transfer.

Procedure 1 a. All patients presenting to New London Hospital for treatment shall have a medical screening examination appropriate to the individuals' presenting signs and symptoms, as well as the capability and capacity of the hospital by qualified personnel. Medical professionals qualified and designated to perform a medical screening examination at ...Hospital are physicians.

During the survey it was confirmed that the facility had self reported this incident, and had completed a root cause analysis and corrective action plan. The corrective action included policy and procedure review and updating, re-education of all department staff, 100% audit of all transfers and bypass transfers and ongoing data delivery to quality improvement program for quarterly improvement review.