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Based on record review and interview the facility failed to follow policy and EMTALA (Emergency Medical Treatment and Labor Act) regulations by failing to provide a Medical Screening Exam in 1 of 23 patients (Pt. (patient) #1) in a sample of 23 records reviewed, failing to maintain a complete ED (Emergency Department) log in 1 of 1 ED logs reviewed, and failing to provide proper required EMTALA signage at the entrance to the ED in 1 of 1 ED observed.

The facility failed to post required EMTALA signage at the ED entrance. See Tag 2402

The facility failed to maintain a complete ED log. See Tag 2405.

The facility failed to provide a Medical Screening Exam to a patient who presented to the Emergency Department. See Tag 2406.

Based on observation and interview the facility failed to post required EMTALA (Emergency Medical Treatment and Labor Act) signage at the entrance to the ED (Emergency Deparment) in 1 of 1 ED entrances observed.

Findings:

On 9/15/2022 at 9:50 AM during a tour of the the ED with ED Director B it was observed that when patients arrive to the ED they enter into a vestibule. The door to the ED is locked and patients gain access by pushing a button that rings to the ED desk. There is no EMTALA signage posted in the vestibule.

On 9/15/2022 at 9:50 AM in an interview with Director B, Director B stated that the door to the ED was locked since Covid to allow for screening of patients before they enter the ED proper. "I guess we never thought about posting signs there."

Based on record review and interview the facility failed to maintain a complete log to include treating provider in 1 of 1 ED ((Emergency Department) logs.

Findings:

Review of the ED log revealed 45 instances in June 2022, 13 instances in July, 23 instances in August and to date, 10 instances in September without a treating provider listed.

On 9/15/2022 at 3:00 PM in an interview with ED Director B, Director B confirmed that it was the official ED log. "If the doctor doesn't assign themselves in Epic (the facility's electronic medical record) then that field doesn't get populated. We need to work on that."

Based on record review and interview the facility failed to provide a medical screening exam to a patient (Pt. #1) who presented to their ED. (Emergency Department) in 1 of 23 records reviewed.

Findings:

Review of facility policy titled, "EMTALA" #160-008 dated May 2022 revealed, "Policy 1. It is the Spooner Health's policy that all individuals who come to the Emergency Department shall receive an appropriate MSE (Medical Screening Exam) to determine whether an EMC (emergency medical condition) exists, without regard to diagnosis, financial status, race, national origin, disability or ability to pay."

Review of Pt. #1's medical record revealed that she presented by ambulance to the facility on 7/29/2022 at 5:11 AM. Review of the nurses note from RN (Registered Nurse) C revealed, "Pt. report was called in by EMS (Emergency Medical Service) stating patient was physically assaulted and raped. Per report pt. is stable. Report was called in with a 5 minute ETA (estimated time of arrival). Had brief discussion with provider about location of SANE (Sexual Assault Nurse Examiner) nurse in our area and was able to obtain location of SANE nurse that could help patient in Shell Lake, provider was agreeable to having patient go to Shell Lake for evaluation by SANE nurse. She felt that it would be in the patient's best interest to be seen at the Shell Lake facility as they had the appropriate resources. Pt. was not brought into the building, we discussed option of bringing patient to appropriate level of care, i.e. SANE nurse..."

On 9/15/2022 at 2:45 PM in an interview with RN C, RN C confirmed that she was the nurse who wrote the above note on 7/29/2022 and arranged for the patient to be seen in Shell Lake. "I know now that it was a violation and she should have been seen in our ED."