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Based on record review and interview, the hospital failed to ensure a medical screening examination was conducted for one (Pt #21) of 23 patients. This failed practice had the likelihood for an emergency medical condition to go unidentified and untreated; thereby increasing the risk of undesirable health outcomes. (see 2405)

Based on record review and interview, the hospital failed to ensure a medical screening examination was conducted for one (Pt #21) of 23 patients. This failed practice had the likelihood for an emergency medical condition to go unidentified and untreated; thereby increasing the risk of undesirable health outcomes and resulting in no identification of patients requiring immediate care. (see 2406)

Based on record reviews and interview, the hospital failed to ensure patients presenting to the ED for treatment were documented in a central log for one (Pt #21) of 23 patients ED patients reviewed.

This failed practice resulted in a lack of documentation from the patient encounter and subsequent inability to track the patient across the care continuum.

Findings:

On 03/28/25 at 10:00 am, the surveyor reviewed the previous six months' entries in the ED log. Patient #21 was not listed for any ED visits during this time, despite the reported ED visit on 03/14/25.

On 03/28/25 at 12:15 pm Staff F stated:
1. On 3/14/25 EMS called report.
2. Our power was down. We were on CT divert.
3. The provider told the nurse to call EMS back to divert them.
4. Three to four minutes later EMS arrived. I met them and told them they had to go to another facility.
5. The provider told them they had to go to another facility.
6. EMS left and returned a minute later, unloaded the gurney containing the patient from the ambulance.
7. The provider met EMS outside and again told them they needed to go to another facility.
8. EMS loaded the patient back in the ambulance and transported to another facility.
9. The provider spoke to the EMS director and told them EMS was delaying care for the patient.

Based on record review and interview, the hospital failed to ensure a medical screening examination was conducted for one (Pt #21) of 23 patients.

This failed practice had the likelihood for an emergency medical condition to go unidentified and untreated; thereby increasing the risk of undesirable health outcomes.

Findings:

A review of a telephone recording dated 03/14/25 at 1:28 pm found the complainant was talking to the EMS crew and later Staff G. The EMS crew reported the driving conditions were poor (wind gust up to 70 miles per hour) and was instructed by the complainant to return to the ED. The complainaint stayed on the telephone and when Staff G went outside the ED entrance, the complainanat asked to speak with Staff G. The complainant told Staff G that refusing to complete an MSE and provide treatment to the patient was an EMTALA violation. Staff G reported that the hospital was on CT divert and the EMS crew needed to go to a hospital with a working CT scan.

A review of a security camera footage from the facility dated 3/14/25 from 1:28 pm to 1:37 pm showed two views. One view captured the outside of the facility and the other view captured the ED inside at the entrance doors to the ED.

The outside ED view showed the following:
1:28 pm The ambulance arrived at the facility.
1:32 pm The ambulance left the ED.
1:34 pm The ambulance returned to the ED and opened the back door of the ambulance.
1:35 pm The ambulance crew removed Patient #21 from the ambulance. Staff G was shown outside speaking with theEMS crew.
1:37 pm The ambulance crew reloaded Patient #21 into the ambulance, closed the doors, and walked around (outside the camera view).

Inside the ED view showed the following:
1:28 pm The ambulance arrived at the ED and Staff F went outside.
1:29 pm Staff F and EMS Staff #1 walked into the ED where Staff G met them. It appeared a conversation was conducted with the EMS Staff #1, Staff F and Staff G, the EMS Staff #1 then exited the ED.
1:34 pm The ambulance was seen pulling into the ED entrance area.
1:35 pm Staff F went outside followed by Staff G. Patient #21 was on a gurney with EMS Staff #1 visible at the end of gurney.
1:36 pm Staff F returned to the ED, Staff G stepped inside, Staff G went back outside, and Staff G stepped back into the ED.

A review of the EMS Prehospital Report dated 3/14/25 read in part:
"Dispatched for a male complaining of dizziness and weakness...Went to the doctor yesterday and put back on all... medications... Patient denies having fallen, denies chest pain and difficulty breathing... does not appear to have any injuries... Medical history of HTN, severe seasonal allergies, bipolar disorder, depression, anxiety, ADD (an attention deficit disorder), ADHD (an attention deficit with hyperactivity disorder), scoliosis, and arthritis... Patient's daily medications include pantoprazole, montelukast, abilify, hydrochlorothiazide, buspirone, and nifedipine... Patient states I want to go to Cordell...Cordell Memorial Hospital is called at 1:22 pm and given prehospital patient care report and ETA of 3-5 minutes... Hospital notifies EMS personnel That CT is down due to power outage caused by extreme winds during call... 1:26 pm Cordell Memorial Hospital calls EMS personnel back at 1:26 pm and states Dr. on duty is calling for a CT, so you guys will need to take him somewhere else... Burns Flat unit 4 arrives at ER at 1:27 pm as the call ends... EMS personnel enter Cordell memorial Hospital and was informed that Cordell Hospital ED cannot take the patient. Patient is advised that we are being diverted... Medical direction is called at 1:28 pm , and EMS personnel are advised to take the patient back to Cordell Memorial Hospital... Medical direction remains on the phone. Patient is unloaded from the back of the ambulance and physician and RN on duty meet the EMS crew and patient outside of the ER. Physician on Duty approaches EMS personnel and begins to point at the patient and yell we are declining this patient!! WE ARE DECLINING THIS PATIENT!!... Physician was advised by EMS personnel that medical direction is on the phone and we have been advised to bring the patient back. Physician on duty takes the phone and begins to yell into the phone. Physician on duty advises that his name is XXXX and that this is not an EMTALA violation. Physician on duty turns around and screams you are the reason for delay of care at this point!!"

The EMS Prehospital Report dated 3/14/24 showed Patient #21 was taken to another hospital with a working CT scan.

A review of the State EMResource record dated 3/14/25 showed no notification of divert status was reported by the hospital that day.

The ED log did not have show Pt #21 was logged in or assessed at the hospital on 03/14/25 at or around 1:35 pm.

On 03/28/25 at 10:15 am Staff A stated:
1. On 3/14/25 the EMS presented with a patient who had a possible head diagnosis.
2. The provider didn't feel comfortable examining without a CT scan.
3. We did not have use of our (CT Scan) due to a power outage.
4. Our generator did not support the use of the CT scan.
5. The EMS was notified prior to leaving with the patient that we were on divert.

On 03/28/25 at 12:15 pm Staff F stated:
1. On 3/14/25 EMS called report.
2. Our power was down. We were on CT divert.
3. The provider told the nurse to call EMS back to divert them.
4. Three to four minutes later EMS arrived. I met them and told them they had to go to another facility.
5. The provider told them they had to go to another facility.
6. EMS left and returned a minute later, unloaded the gurney containing the patient from the ambulance.
7. The provider met EMS outside and again told them they needed to go to another facility.
8. EMS loaded the patient back in the ambulance and transported to another facility.
9. The provider spoke to the EMS director and told them EMS was delaying care for the patient.

On 03/28/25 at 1:00 pm Staff G stated:
1. No ambulance was turned away while on hospital property, but there was one that was diverted due to CT divert.
2. EMS was told to divert.
3. EMS showed up and we told them to divert. (Name omitted - another hospital) was called and told to expect patient.
4. EMS was delaying patient care.
5. EMS came twice - the first time they arrived the nurses told them they were on divert and they drove off.
6. They came back and offloaded the patient in a hurry like they were trying not to delay care.
7. They could have been to (name omitted - another hospital) by this time.
8. I didn't performed an MSE on the patient.

Based on record review and interview, the hospital failed to ensure notice of patient rights for 22 (Patients # 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 22, and 23) of 22 records reviewed.

Findings:

A Review of a facility document titled, "Notice of Privacy Practices" (page 4) showed no contact information for the SSA .

On 03/28/25 at 10:15 am Staff A stated the "Notice of Privacy Practices" contact information for the Oklahoma State Department of Health was not included in their patient rights documents.