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Based on record review and interview the facility staff failed to provide a Medical Screening Exam (MSE) to patients presenting to the Emergency Department (ED) for treatment as per EMTALA (Emergency Medical Treatment and Active Labor Act) in 1 of 20 medical records reviewed (Patient (Pt) #1), in a total sample of 20 medical records reviewed; and failed to post EMTALA signage in entrances used by patients seeking treatment in the ED in 3 of 4 hospital entrances observed (ED, Main Entrance, Women's Pavilion), in a total sample of 4 hospital entrances observed.

Findings include:

The facility staff failed to provide a Medical Screening Exam (MSE) to patients presenting to the Emergency Department (ED) for treatment as per EMTALA. See Tag A-2406.

The facility staff failed to post EMTALA signage in entrances used by patients seeking treatment in the ED. See Tag A-2402.

Based on observation, interview, and record review staff failed to post EMTALA (Emergency Medical Treatment and Labor Act) signage in entrances used by patients seeking treatment in the Emergency Department (ED) in 3 of 4 hospital entrances observed (ED, Main Entrance, Women's Pavilion), in a total sample of 4 hospital entrances observed.

Findings Include:

Review of policy and procedure #19290 titled, "...EMTALA" last reviewed 04/24/2023 revealed:
- "Signs shall be posted in all DEDs (Dedicated Emergency Departments) and in those places where the signage is likely to be noticed by individuals entering the ED, as well as by individuals waiting for examination and treatment in areas other than a traditional ED (i.e., entrance, admitting area, waiting room, and treatment areas)."

Per observations on 10/31/2024 beginning at 10:55 AM, while touring the hospital with President B and Chief Nursing Officer (CNO) F, there were no EMTALA signs located in the hospital Main entrance, Women's Pavilion entrance, and the ED entrance.

Per interview with President B on 10/31/2024 at 11:00 AM, President B and CNO F confirmed there were no EMTALA signs present at the Main entrance, Women's Pavilion entrance, and ED entrance; President B stated that patients could potentially come through the Main entrance and Women's Pavilion when seeking treatment in the ED and Labor and Delivery.

Based on record review and interview the facility staff failed to provide a Medical Screening Exam (MSE) to patients presenting to the Emergency Department (ED) for treatment as per EMTALA (Emergency Medical Treatment and Active Labor Act) in 1 of 20 medical records reviewed (Patient (Pt) #1), in a total sample of 20 medical records reviewed.

Findings Include:

Review of policy and procedure #19290 titled, "...EMTALA" last reviewed 04/24/2023 revealed:
- "A MSE shall be performed for each individual (including...minors and persons brought in by law enforcement...) who presents...To a Dedicated Emergency Department."
- "If a minor or someone legally authorized to make a request on a minor's behalf, requests examination or treatment for an EMC (Emergency Medical Condition), hospital staff will not delay the provision of the MSE by waiting for parental consent."
- "Behavioral Health Patients: The MSE should include an assessment of suicide or homicide attempt or risk, orientation, or assaultive behavior that indicates a danger to self or others. Such information must be documented in the medical record."
- An EMC is a "medical condition manifesting itself by acute symptoms of enough severity (including...and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in...acute psychiatric or acute substance abuse symptoms are manifested...the individual is expressing suicidal or homicidal thoughts or gestures and is determined to be a danger to self or others."

Review of Pt #1's medical record at the transferring hospital (Hospital #1) revealed that Pt #1 (15 years old) arrived to the ED (with Police Officers) on 09/19/2024 at 12:40 AM with the Arrival Complaint of "med (medical) screening." Pt #1 was documented as "dismissed" at 09/19/2024 at 12:50 AM. There was no documentation of a RN assessment or a Provider assessment in Pt #1's ED medical record.

Review of Incident Report #SE-24-0261035 (Reported by RN J at Hospital #2) revealed that on 09/19/2024 "(Pt #1) arrived to (Hospital #2) via West Allis Police at approximately 01:15 (AM) on 09/19/24. During chart review it was discovered that (Pt #1) was at (Hospital #1) just prior to coming to (Hospital #2)...call was placed to (Hospital #1) for coordination of care secondary to no call or report received from (Hospital #1). Writer spoke with...(ED Provider H)...(Provider H) stated that the pt was brought to (Hospital #1) by West Allis Police voluntarily 'for something to do with alcohol' however since the pt was a minor and the guardian was not present they told West Allis Police they could not see (Pt #1) until West Allis PD contacted the guardian for consent. (Provider H) stated they never even triaged the patient because they did not have the guardian's consent to see or treat her and 'she wasn't on a hold (Chapter 51) when they brought her here.' Writer inquired if (Hospital #1) staff attempted to contact the guardian for consent prior to the patient leaving (Hospital #1) and (Provider H) stated they did not, they requested West Allis PD contact the guardian and when they turned around West Allis PD just ended up leaving with the patient."

Review of Incident Report's #SE-24-0261035 "Suggestion for Error Prevention" revealed, "When police arrive to the ER (Emergency Room) with a patient for medical evaluation, the patient should at least be triaged by the medical ER to ensure no medical emergency regardless of consent."

Per interview with Triage RN I (Hospital #1) on 10/31/2024 beginning at 3:25 PM, RN I stated that she was the triage RN on 09/19/2024 at the time of the incident involving the West Allis PD and Pt #1. RN I stated that on 09/19/2024, 2 police officers entered the ED and asked if they could "run something by her," the Police Officer stated that Pt #1 was in the squad car and they wanted to sign in Pt #1 voluntarily for alcohol detox (detoxification). RN I stated that she asked if the Police Officers obtained parental consent and they responded "No, Mom is not being cooperative." RN I stated that she informed Provider H, and Provider H stated that the hospital would need parental consent for voluntary alcohol detox. RN I stated that she never laid eyes on Pt #1 and stated, "Obviously that's a huge mistake, I should have had the police bring her in." RN I stated that she informed the Police Officers that they could take Pt #1 to Children's Hospital or (Hospital #2), which in hindsight was a "poor decision." Per RN I, the Police Officer stated that Pt #1 was tearful and crying and did not want her to come in and "cause a scene."

Per interview with Provider H on 10/31/2024 beginning at 2:34 PM, Provider H stated that she was the ED physician on duty on 09/19/2024 at the time of the incident involving the West Allis PD and Pt #1. Provider H stated that the Police Officer did not bring Pt #1 into the ED and after their questions were answered, the Police Officers left the ED and did not return. Provider H stated that she was not sure if the West Allis PD brought Pt #1 to the ED for suicide ideations or detox concerns. Provider H confirmed that she did not see Pt #1 and did not request Pt #1 be brought in to the ED. Provider H stated that if the minor is coming in for mental health issues they would try to get a hold of the guardian, but they would still see the patient even if they are unable to obtain consent.

Per interview with Director of Quality C and ED Manager D on 10/31/2024 beginning at 1:15 PM, Director C stated that the Police Officers wanted to register Pt #1 for voluntary alcohol detox and Provider H was made aware by RN I. RN I and Provider H did not request that Pt #1 be brought in for an evaluation due to Police Officers stating that Pt #1 was voluntary and her mother would not consent to alcohol detox treatment. Per Director C, the Police Officers left due to being told that the hospital needed permission from the guardian to treat Pt #1. ED Manager D confirmed that RN I and Provider H did not contact the guardian and did not request that police bring Pt #1 into the ED to be evaluated; Manager D stated that this is something that should have been done. Director C stated that a meeting is set up with West Allis PD to address the incident but this meeting has not occurred yet.