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Based on interview and record review, it was determined that the hospital's dedicated Emergency Department (ED) failed to comply with the requirements for the Emergency Medical Treatment and Labor Act (EMTALA) at 42 CFR §489.20 (Patient identifier is #1).

Findings include:

The hospital failed to provide an appropriate medical screening examination to an individual who presented to the hospital campus ED for 1 of 20 patients reviewed for presenting to the ED between 10/14/24 to 12/3/24. (Refer to C2406: Medical Screening Exam).

Based on record review and interview, the hospital failed to provide an appropriate medical screening examination (MSE) to an individual who presented to the hospital campus of the emergency department (ED) for 1 of 20 patients reviewed for presenting to the ED between 10/14/24 to 12/3/24 (Patient identifier is #1).

Findings include:

Interview on 11/21/24 at approximately 10:23 a.m. with Patient #1 revealed that he/she was in a motor vehicle accident on 11/11/24. Patient #1 stated that he/she went to the Concord Hospital Laconia Emergency Department on 11/11/24 to seek treatment and was refused treatment because of his/her service dog.

Review on 12/4/24 of the facility's form titled "Patient Acknowledgement of Departure Prior to Completion of Medical Evaluation and Treatment - Leaving without being seen", dated 11/11/24, and signed by Staff A (Registrar) revealed the following: "...Explanation/reason patient left: Other (explain): Patient had "Companion Service Dog", no identifiers of animal - left due to possibly not being able to be seen..."

Review on 12/4/24 of Patient #1's nursing note, dated 11/11/24, and signed by Staff C (Registered Nurse) revealed the following: "...Pt presents to registration with his leashed dog. States [pronoun omitted] was in a rollover car accident and has left shoulder pain. Dog is stated to be a service animal, does not have any vests/patches, ect [sic]. I advised [pronoun omitted] that security may not allow the dog in at which point [pronoun] started yelling that that's illegal, is [pronoun omitted] serious? I can't believe you are refusing to see me after an accident" and stormed out. Lead made aware."

Interview on 12/4/24 at 11:25 a.m. with Staff B (Director of Nursing) confirmed the above findings. Interview further revealed that Staff B had called Patient #1 the next day and Patient #1 was treated at another hospital's emergency department on 11/11/24.

Interview on 12/4/24 at 1:48 p.m. with Staff A revealed that Staff A had told Patient #1 that his/her dog needed to be cleared by security first before he/she would be seen. Patient #1 got angry and left the emergency department.

Interview on 12/4/24 at 12:56 p.m. with Staff D (Director of Compliance) revealed that the above events were discussed at the organization's compliance meeting on November 25, 2024, no corrective action was put in place.

Review on 12/4/24 of the facility's policy and procedure titled, "EMTALA [Emergency Medical Treatment and Active Labor Act] - Medical Screening Examination and Patient Transfer Policy", effective 2/21/2-24, revealed the following: "4.1 Medical Screening Examination", 4.1.1 Any individual who comes to... Concord Hospital - Laconia... Emergency Departments... requesting examination or treatment shall be provided with an appropriate medical screening examination by a QMP [Qualified Medical Provider]."