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Based on record review and interview, the hospital failed to provide a medical screening exam on all patients who presented to the emergency department with an emergency complaint for 1 (#1) of 20 (#1-20) patients sampled. This deficient practice is evidenced by Patient #1 presenting to the emergency department seeking medical treatment and being escorted off of hospital property by hospital staff prior to receiving a medical screening exam.

Findings:

Review of the hospital's policy titled "Emergency Medical Treatment and Active Labor Act (EMTALA) Policy" revealed in part, II. Policy: To ensure that all patients coming to the Hospital requesting emergency services receive an appropriate medical screening examination within the Hospital's capability to determine whether or not an emergency medical condition exists.

Review of the hospital's emergency department central log revealed Patient #1 arrived in the emergency department on 04/01/2023 at 4:31 a.m. Further review revealed Patient #1's chief complaint was "My meds aren't working" with the disposition of sign-in error.

Review of Patient #1's medical record on 04/19/2023 revealed an ED triage note dated 04/01/2023 at 4:44 a.m. by S5RN. 4:34 a.m.: Patient brought to triage and patient is holding a bicycle seat. Stated that the medications he was prescribed yesterday aren't working. Recently here with psychiatric complaints and evaluated by psychiatry - unable to fully speak to patient as when patient was brought to triage, he flipped over a lab table filled with medical supplies and threw the table into a wall in triage. SORT provider witness to events in triage booth. Hospital police called/close to triage and hospital police escorted patient off of hospital property. While patient was throwing supplies and lab table in triage booth, he yelled, "I am gonna kill somebody".

Video Review:

In an interview on 04/19/2023 at 12:50 p.m. S1VPQ verified the time stamp on all the video surveillances do not correlate with Patient #1's actual visit time and each video surveillance had different times.

On 04/19/2023 at 12:40 p.m. hospital video revealed video surveillance #1 started with date and time stamp of 04/01/2023 at 3:53.01. S1VPQ verified that this camera view was Post 6 ED ambulatory entrance. Patient #1 was seen walking into the entrance of the ED at 3:53.04. The security officer was seen approaching Patient #1 at the ED entrance at 3:53.15. Patient #1 was seen with an object in his hand which he laid on the table and then emptied his pockets and put his belongings in a bin at the ED entrance. The security officer was seen wanding Patient #1 at 3:53.35. Patient #1 was seen putting his belongings back into his pockets and picking up the object off table at 3:53.45. Patient #1 was seen walking toward the ED waiting room/registration area at 3:54.15

Video Surveillance #2 which was dated and time stamped 04/01/2023 at 4:13.44. Patient #1 was seen walking up to the ED registration desk talking to the ED clerk at 4:13.50. Patient #1 was seen walking away from the ED registration desk toward the hallway to the triage room at 4:15.16. Patient #1 was seen hitting the wall with what appears to be a bicycle seat at 4:15.22. The security officer was seen walking towards the hallway to the triage room while 3 patients in the waiting room were seen looking and walking away from the hallway that is leading to the triage room at 4:15.40. The security officer was seen walking Patient #1 through the ED waiting room at 4:16.03. The security officer and Patient #1 were both seen walking out of the ED waiting room at 4:16.09. The security officer was seen walking back into the ED waiting room at 4:18.36.
In an interview on 04/19/2023 at 12:50 p.m. S1VPQ verified Video survailance #2 was a camera view of the ED waiting room.

Video Surveillance #3 which is dated and time stamped 04/01/2023 at 4:04.46. Patient #1 was seen walking from the waiting room into the hallway by the triage room at 4:04.50. Patient #1 was seen walking into the triage room at 4:04.55. Staff that was standing in the hallway near the triage room was seen running away from the triage room at 4:04.56. The security officer was seen entering the hallway from the waiting room and going into the triage room at 4:05.01. The security officer was seen escorting Patient #1 out of the triage room into the hallway and out through the door into the waiting room at 4:05.11. The security officer was seen entering the hallway from the ED waiting room and through the door of the triage room alone at 4:09.07
In an interview on 04/19/2023 at 1:00 p.m. S1VPQ verified Video Survailance #3 was a camera view of the ED hallway by the triage room.

Video Surveillance #4 which is dated and time stamped 04/01/2023 at 3:56.42. The security officer was seen escorting Patient #1 out of the ED entrance at 3:56.46. The security officer was seen walking back into the ED entrance alone at 3:59.00.
In an interview on 04/19/2023 at 1:13 p.m. S1VPQ verified Video Survailance #4 was a camera view of Post 6 ED ambulatory entrance.

In an interview on 04/19/2023 at 1:22 p.m. S1VPQ stated the security officer indicated in an interview that he watched Patient #1 walk down the ED ramp leaving hospital premises.

In an interview on 04/19/2023 at 3:59 p.m. S3RN stated she was the triage nurse in room #4. S3RN stated Patient #1 came into the ED for a psych complaint and Patient #1 was in possession of bicycle seat. S3RN stated Patient #1 was brought straight back to the triage booth. S3RN stated upon entering the triage booth, Patient #1 raised the seat above his head and stated "I just wanted to kill somebody". S3RN stated Patient #1 trashed the triage booth. S3RN stated Patient #1 threw a Mayo stand with supplies on it into the wall. S3RN stated she got out of the triage booth and hospital security responded and escorted Patient #1 out of the triage booth. S3RN stated she asked the security officer where he had secured Patient #1 so that he could be seen by the doctor. S3RN stated the security officer told her that he escorted Patient #1 off the property. S3RN stated she asked the security officer why he did that. S3RN stated the security officer told her that he didn't want Patient #1 to hurt anyone else. When asked if the hospital security officer should have secured Patient #1 inside the ED for a doctor to examine him, S3RN stated "correct".

In an interview on 04/19/2023 at 4:20 p.m. S4SO stated he was the security officer working the night of 03/31/2023 from 10:30 p. m. to 6:30 a.m. when Patient #1 arrived to the ED around 4:30 a.m. S4SO stated he was assigned to Post 6 which is the ambulatory ED entrance on 03/31/2023. S4SO stated when he encountered Patient #1, he had a calm demeanor. S4SO stated Patient #1 took everything out of his pockets and was wanded with no issues. S4SO stated Patient #1 had a bicycle seat in his hand, but that is a common thing to see when patients leave a bike outside. S4SO stated 8-10 minutes after Patient #1 arrived, he heard loud chaos and saw staff members running away from triage room 4 in the hallway so he walked that way to investigate. S4SO stated he found Patient #1 in the triage room with the bicycle seat in his hand and after asking Patient #1 to drop it, Patient #1 refused. S4SO stated he grabbed the bicycle seat out of Patient #1's hand and escorted him out of the ED. S4SO stated "escorted out" means to get someone off of hospital property. S4SO stated after he escorted Patient #1 off of hospital property, he went to check on the ED staff who informed him Patient #1 was homicidal and needed to stay at the hospital. S4SO stated he thought Patient #1 was normal and he didn't realize Patient #1 was homicidal. When asked if he has ever received EMTALA training, S4SO stated "no". When asked if he has received any trainings since this incident, S4SO stated "no".

In an interview on 04/19/2023 at 12:52 p.m. S1VPQ and S2EDM verified Patient #1 did not receive a medical screening exam on 04/01/2023.

In an interview on 04/19/2023 at 11:35 a.m. S1VPQ stated once the administration was alerted of this incident occurring, the hospital called the police department and requested a wellness check be done on Patient #1. S1VPQ further stated the police department was unable to locate Patient #1 at the address that was provided by the hospital. S1VPQ stated this address was the address in Patient #1's medical record.






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