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Based on review of facility documents and interview with staff (EMP), it was determined the facility failed to ensure every individual presenting to the emergency room for treatment was entered into the emergency room log ( PT1).

Findings include:

Review of the facility's pre hospital record revealed the ambulance called the facility on April 13, 2014, at 14:46 to notify them they were en route to Moses Taylor Hospital with PT1.

Review on April, 28, 2014, of facility policy "COBRA\EMTALA" [Consolidated Omnibus Budget Reconciliation Act\ Emergency Medical Treatment and Active Labor Act], dated reviewed June 2012, revealed "Definitions Central Log means a log the Hospital maintains of all individuals who present tot the Hospital seeking emergency medical assistance and the disposition of such individuals, whether the person refused treatment, was transferred, was admitted and treated, was stabilized and transferred, or discharged. The purpose of the central log is to track the care provided to each individual who comes to the Hospital seeking care for an Emergency Medical Condition. The Central Log must include patient logs from other areas of the Hospital including Labor and Delivery where a patient might present for emergency services or receive a Medical Screening Examination instead of in the dedicated emergency room department."

Review on April 28, 2014 of the emergency room log for April 13, 2014, revealed no documentation PT1 presented to the emergency room for treatment.

Interview with EMP1 on April 28, 2014, at 09:00 AM confirmed PT1 presented to the emergency room via ambulance on April 13, 2014, at approximately 16:55 with complaints of weakness. EMP1 confirmed the emergency room department was notified by the ambulance that PT1 was en route, and the emergency room received a copy of PT1's cardiogram completed in the field. The emergency room physician reviewed the cardiogram, noted changes, and instructed the staff to divert the ambulance to the nearest cardiac center, as this facility does not perform cardiac catheterizations. EMP1 confirmed the communication center was told this and was to notify the ambulance. Communication with the ambulance did not occur. PT1 was brought into the emergency room via ambulance.

Continued interview with EMP1 confirmed EMP2 instructed the ambulance to transport PT1 to another hospital. EMP1 confirmed PT1 was not entered on the emergency room log.

Interview with EMP2 on April 28, 2014 via phone at 10:10 AM confirmed PT1 was brought to the hospital on April 13, 2014, by ambulance at 16:45, and EMP2 instructed the ambulance to transport the patient to another hospital. EMP2 confirmed PT1 was not entered on the emergency room log.

Based on review of facility documents and interviews with staff (EMP), it was determined the facility failed to provide a medical screening exam for PT1.

Findings include:

Review on April 28, 2014, of facility documentation revealed an electrocardiogram (EKG) of a patient complaining of chest pain was transmitted to the Emergency Department (ED) for interpretation on April 13, 2014, at 16:45 PM. The physician determined the patient had EKG changes and should be taken to a facility that offered advanced cardiac services. The hospital does not have advanced cardiac services available. The Communication Center (EMS -Emergency Medical Services Communications Center) was notified immediately to divert the patient to another hospital. The ED nurse (EMP2) that received the transmission was not aware of the physician's decision to divert the patient. The Communication Center was not able to get in touch with the ambulance, and PT1 presented to the ED. EMP2 told the ambulance crew to take PT1 to another hospital. PT1 did not receive a medical screening examination.

Review on April 28, 2014, of the facility policy "COBRA\EMTALA" [Consolidated Omnibus Budget Reconciliation Act\ Emergency Medical Treatment and Active Labor Act], dated reviewed June 2012, revealed "Introduction: All individuals presenting on Hospital property requesting emergency medical services, individuals presenting to a Dedicated Emergency Department requesting medical services, and patients arriving/presenting via ambulance requesting medical services shall receive an appropriate Medical Screening Examination and Stabilization services as required by the Emergency Medial Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. Section 1395 and all Federal regulations and interpretative guidelines promulgated thereunder. ... Policy: Each Hospital must have written guidelines outlining the requirement for appropriate medical screening and stabilization procedures comply with applicable federal and state law. ... Medical Screening Examination is the process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an Emergency Medical Condition exists or a woman is in labor. Such screening must be done within the Hospital's capabilities and available personnel, including on-call physicians. The Medical Screening examination is an ongoing process and the medical records must reflect continued monitoring based on the patient's needs and continue until the patient is either stabilized or appropriately transferred. ..."

There was no documentation a medical screening examination was performed on PT1 for the presentation to the ED on April 13, 2014.

Interview with EMP1 on April 28, 2014, at approximately 9:00 AM confirmed the patient (PT1) presented to the Emergency Department on April 13, 2014, at approximately 16:45. EMP1 confirmed a medical screening examination was not performed on PT1. EMP1 confirmed the physician interpreted the EKG for PT1 had changes, and the patient should be diverted to a facility with advanced cardiac services. The Communication Center was notified of the same and was to notify the ambulance to divert the patient to another hospital. The communication did not occur, and PT1 presented to the Moses Taylor Hospital ED. EMP1 confirmed EMP2 instructed the ambulance crew to take PT1 to the other hospital. EMP1 confirmed a medical screening examination was not performed for PT1.

Interview with EMP2 on April 28, 2014, via phone at 10:10 AM confirmed PT1 presented to the ED at Moses Taylor Hospital by ambulance on April 13, 2014, at 16:45, and EMP2 instructed the ambulance to transport PT1 to another hospital. EMP2 confirmed a medical screening examination was not performed for PT1.