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A. Based on a tour of the Sussex Satellite Emergency Department (SED), and staff interview conducted on September 3, 2013 at approximately 11:30 AM, it was determined that the facility failed to conspicuously post signage, specifying the rights of individuals under section 1866 of the Act with respect to examination and treatment of emergency medical conditions and women in labor.

Findings include:

1. Observation of the ambulance entrance to the SED revealed no signage posted.

2. Observation of the Treatment/Trauma room revealed one sign. The sign was obstructed by a cardiac monitor, making visualization difficult.

3. Observation of the SED entrance revealed one sign. The sign was obstructed by a bassinet, making visualization difficult.

4. Observation of the main entrance waiting room, revealed one sign posted in an area that is not visible from where patients are seated.

5. Observation of the SED Triage room revealed no signage posted.

6. Observation of the SED isolation room revealed no signage posted.

7. The above findings were confirmed by Staff #1.

B. Based on a tour of the Denville Emergency Department (ED) and staff interview, conducted on September 6, 2013 at approximately 11:20 AM, it was determined that the facility failed to conspicuously post signage specifying the rights of individuals under section 1866 of the Act with respect to examination and treatment of emergency medical conditions and women in labor.

Findings include:

1. Observation of the ambulance entrance to the ED revealed no signage posted.

2. Observation of the Critical Care ED revealed one sign which was obstructed by a crash cart, making visualization difficult.

3. The above findings were confirmed by Staff #3.

Based on medical record review, it was determined that the facility failed to enter the name in the log, of each patient that arrives to the ED seeking medical treatment.

Findings include:

1. On 9/09/13, Medical Record #31 indicates on the ambulance run sheet, that Patient #31 arrived at the Saint Clare's Sussex SED on 8/24/13. The First Aid Squad EMS Patient Care Report indicates, "Diverted by doctor in ER to go to [name of the other facility]." Page 2 of the EMS Patient Care Report has an unsigned notation that states "2035, EMS - states that they were told by MD at Saint Clare's Sussex not to bring the pt into ED - EMS was refused to let pt come into ED. EMS was told to come to [other acute care facility]..."
2. The St. Clare's Sussex SED log lacked evidence of Patient #31's arrival to the SED via ambulance on 8/24/13, as reflected on the EMS Patient Care Report.

Based on medical record review and review of facility policy and procedure, it was determined that the facility failed to provide a Medical Screening Exam (MSE) to all patients that arrive on hospital property seeking examination or treatment.
Findings include:
Reference: Facility policy and procedure, "Emergency Medical Treatment And Labor Act (EMTALA): Hospital-Wide Compliance with. Policy Statement: States, ..."This policy pertains to emergency services sought, and provided at the dedicated emergency departments (DEDs) in Saint Clare's Hospitals in Denville and Dover and the Satellite ED in Sussex. All individuals who present to the hospital, including the hospital emergency departments or another department of the hospital, in hospital owned facilities (excluding off campus outpatient facilities), on hospital grounds (defined as within 250 yards of the hospital building) or in hospital transport vehicles shall be entitled to emergency medical care as defined in the provisions of EMTALA, and referred to in this policy and provided for in other Saint Clare's policies. ... Patients will be considered to "have sought treatment" if they present seeking care, or, in the determination of a prudent lay person, by appearance or behavior, seem to require examination or treatment for a medical condition."
1. Upon review of Medical Record #31 on 9/09/13, the ambulance run sheet indicates that Patient #31 arrived at the Saint Clare's Sussex SED on 8/24/13. The First Aid Squad EMS Patient Care Report indicates, "Diverted by doctor in ER to go to [name of the other facility]." Page 2 of the EMS Patient Care Report has an unsigned notation that states "2035, EMS - states that they were told by MD at Saint Clare's Sussex not to bring the pt [patient] into ED - EMS was refused to let pt come into ED. EMS was told to come to [other acute care facility]..."
2. The facility failed to provide a MSE to a patient that arrived to their SED seeking medical evaluation, as per the above policy.

Based on staff interviews and review of facility documentation, it was determined that the facility failed to ensure a reasonable registration process for patients seeking treatment, unduly discouraging individuals from remaining for further evaluation.

Findings include:

1. During interview, Staff #2 stated that during pre-triage registration, staff asks for the patient's name and date of birth. If the information doesn't cause the rest of the screen to populate, the registrar is prompted to ask for the patient's social security number.

a. Review of facility document "St. Clare's Health System Trauma Registration" indicates, "Social Security Number ________",

b. Patient screening or treatment may be delayed while verifying the information provided by an individual.

c. This is a possible deterrent to individuals seeking treatment, unduly discouraging patients from remaining for further evaluation.

2. Staff #1 and #3 confirmed the above findings.