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Based on review of documents and staff interviews it was determined the facility failed to ensure a medical screening exam was performed on Patient #1. They also failed to ensure hospital policies were written specific to all EMTALA regulations, and failed to ensure EMTALA training was provided to staff working in the Emergency Department in eighteen (18) of thirty (30) personnel records reviewed (#1, 2, 4, 5, 6, 7, 8, 9, 11, 13, 14, 16, 18, 19, 20, 21, 22, 23, 24, 26 and 27). This has the potential to cause an EMTALA violation by staff not being aware of the proper policies or procedures to follow.

Findings include:

1. Patient #1 was found stumbling around the hospital parking lot with abrasions and blood on his face. The patient was not taken into the ED for a medical screening exam.

2. During review of the EMTALA policies, it was discovered the only policies available were specific to the transfer of the patient.

3. During review of twenty seven (27) ED employee records it was determined eighteen (18) of these employees have had no training specific to EMTALA.

a. Employee #1 hired 2/5/07 has had no EMTALA training.

b. Employee #2 hired 9/24/07 has had no EMTALA training.

c. Employee #4 hired 3/14/05 has had no EMTALA training.

d. Employee #5 hired 2/16/09 has had no EMTALA training.

e. Employee #6 hired 8/22/11 has had no EMTALA training.

f. Employee #7 hired 12/13/09 has had no EMTALA training.

g. Employee #8 hired 6/1/09 has had no EMTALA training.

h. Employee #9 hired 11/1/10 has had no EMTALA training.

i. Employee #11 hired 6/2/08 has had no EMTALA training.

j. Employee #13 hired 10/6/08 has had no EMTALA training.

k. Employee #14 hired 4/16/07 has had no EMTALA training.

l. Employee #16 hired 5/19/08 has had no EMTALA training.

m. Employee #18 hired 3/15/04 has had no EMTALA training.

n. Employee #19 hired 5/2/11 has had no EMTALA training.

o. Employee #20 hired 5/2/11 has had no EMTALA training.

p. Employee #21 hired 8/8/11 has had no EMTALA training.

q. Employee #22 hired 12/12/11 has had no EMTALA training.

r. Employee #23 hired 4/18/11 has had no EMTALA training.

s. Employee #24 hired 10/19/09 has had no EMTALA training.

t. Employee #26 hired 2/9/10 has had no EMTALA training.

u. Employee #27 hired 6/4/02 has had no EMTALA training.

4. During an interview with the ED Clinical Nurse Manager on 3/27/12 at 1145 she revealed the ED employees are only given minimal EMTALA training during the orientation process. She stated there has not been any annual competencies relative to EMTALA provided to the employees. She also stated the only EMTALA policies written are those specific to transfers as this is the most important part of EMTALA.

Based on observation and interview the facility failed to ensure appropriate and required signage was posted in and around the Emergency Department (ED) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment of emergency medical conditions and women in labor; and the required information indicating whether or not the hospital participates in the Medicaid program under a state plan approved under Title XIX. This has the potential to negatively affect patient care by not notifying them of their rights in an emergent situation.

Findings include:

1. During a tour of the ED in the afternoon of 3/27/12 at 1530 it was noted the facility had no signage posted informing patients of their rights.

2. During an interview with the ED Clinical Nurse manager on 3/27/12 at 1530, she agreed the signage was not present.

3. During another tour of the ED on 3/28/12 at 0840 a sign, approximately 8 X 10 was noted to be hanging in the triage room. The ED Clinical Director revealed all the surveyors, including herself had missed the sign.

Based on review of logs and staff interview it was determined the facility failed to ensure a medical screening exam was provided for patient #1 in the Emergency Department (ED). This has the potential to negatively affect patients found on the premises who may have an emergent medical condition.

Findings include:

1. During review of the hospital investigation of this complaint, it was noted the patient did not present to the ED, he was in the parking lot. Therefore was not entered into the ED log.

2. During an interview conducted in the morning of 3/27/12 at 0730 with the security guard on duty (3/6/12) he revealed the patient was found stumbling with slurred speech and a bloody face with abrasions, he stated he asked the patient if he needed medical care. He then stated the patient was "stone, cold drunk."

3. During an interview with the police officer called for 'back up' on 3/28/12 at 1430, he revealed when he arrived, he asked the patient if he needed medical care and the security guard said he would not be seen at this facility and if he returned he would "kick his ass." This same information is found documented on the police officer's call log dated 3/6/12.