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Based on review of hospital documents, the emergency room department (ER or ED) central log, policies and procedures and medical records and interviews with hospital staff, the hospital failed to enforce policies and procedures to ensure compliance with the requirements of 42 CFR 489.24. The hospital failed to enforce its policies concerning providing a medical screening examination. This occurred for one of twenty-one patients (Patients #A of Patients #A and 1 through 20) who presented to the hospital requesting examination for a perceived emergency medical condition and whose records were reviewed.

Findings:

1. Policies:
a. The hospital's ER medical screening policy, entitled Triage and Medical Screening Examinations, with an effective date of January 2012, documented, "...It is the policy of Memorial Hospital that all persons presenting to the Emergency Department will be triaged and receive a medical screening and be provided treatment in a timely manner...". The policy further states, "...Patients will not be denied evaluation, treatment or stabilization of their medical condition on the basis of ...actual or perceived disability, presenting complaint, condition, or lack of a professional relationship to a physician on the medical staff of this hospital...".

b. The hospital's ER transfer policy, entitled Transfers, with an effective date of December 2011, also addressed medical screening examinations. It documented, "...Hospitals have three obligations under EMTALA; a. All individuals must receive a medical screening examination to determine whether an Emergency medical Condition (EMS [sic]) exists...".

2. Patient #A presented to the hospital via ground ambulance on the morning of 10/17/2013. At first the ground ambulance was awaiting air ambulance transportation for the patient. The ground ambulance learned the air transport cancelled due to weather conditions. The patient started to develop respiratory failure. The ER physician came out to the ground ambulance and told the ambulance staff the hospital did not have the necessary ventilation equipment. The patient was taken away by ambulance without receiving a medical screening examination by a qualified medical person.

The hospital did not follow its policy and provide a medical screening examination to Patient #A.

Based on review of hospital documents and the emergency room (ER) log and interviews with hospital staff, the hospital failed to maintain a complete ER log with the required information.

Findings:

1. The ER log did not contain an entry for Patient #A's 10/17/13 visit.

2. On 11/05/13, administrative and ER staff told the surveyors that the ER physician on duty on 10/17/13 went out to the ambulance and talked with the ambulance staff. The patient was not brought into the ER and no paperwork was completed. Patient #A's 10/17/13 visit was not recorded in the ER log.

Based on review of hospital documents, the emergency room (ER) department central log, policies and procedures and medical records and interviews with hospital staff, the hospital failed to provide a medical screening examination by a qualified medical person in order to determine whether an emergency medical condition existed to one of twenty-one patients (Patients #A of Patients #A and 1 through 20) who presented to the hospital requesting examination for a perceived emergency medical condition and whose records were reviewed.

Findings:

1. Patient #A presented to the hospital via ground ambulance. At first the ground ambulance was awaiting air ambulance transportation for the patient. The ground ambulance learned the air transport cancelled due to weather conditions. The patient started developing respiratory failure. The ER physician came out to the ground ambulance. The patient was taken away by ambulance without receiving a medical screening examination by a qualified medical person at the hospital.

a. According to 10/17/13 documentation on the ambulance report for Patient #A, "a Dr. (name removed) came outside to the back of unit advised paramedic do not bring pt. (patient) into ED because they will not accept a intubated pt. Paramedic advise doctor pt was not intubed (sic) at this time only Versed was giving (sic), advised of medical assistance needed. Doctor advised do not come in they are not going to vent and have to ship out pt..."
b. The receiving hospital documented the patient arrived on 10/17/13 at 0814, "fully arrested, intubated, no pulse and the ECG (electrocardiogram) identified a STEMI (ST segment elevation myocardial infarction)." The patient expired at the receiving hospital.

2. On the morning of 11/05/13, administrative staff stated they had been made aware and shared information about an incident that occurred on 10/17/13.

A typed statement by the ER physician documented he went outside to the ground ambulance. The statement recorded he "...asked if they needed anything and they stated that he was not yet intubated but intended to do so. I offered that he would need higher level of care as we do not have a ventilator... There was no other conversation about the patient's condition or their intent were known or discussed with me...I went in to check on the arrival of Air Ambulance...I was informed by nursing upon my return that the Air ambulance was not coming and when I went back out to check the ambulance had driven off...".