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Based on review of policies and procedures, video recording and staff interviews, it was determined that the facility failed to ensure that one (P#2) of 20 patients reviewed received an appropriate medical screening examination.

Findings included:

Cross refer to A2406 as it relates to the facility's failure to provide a Medical Screening Examination when P#2 was informed that minor children were not allowed in the Emergency Department by hospital staff.

Based on review of policies and procedures, video recording and staff interviews it was determined that the facility failed to provide a medical screening examination for one (P#2) of 20 sampled patients when P#2 presented to the emergency department for complaints of an increased blood pressure and facility staff turned her away because she had minor children with her.

The findings include:

A review of the facility's "Emergency Department Continuum of Care Policy" policy #14063113, last revised 6/18/21 revealed that the policy's purpose was to define patient care management as part of the integrated system moving across the continuum and to coordinate all process and activities along the continuum of patient care.

1. Access to Appropriate Care: the Emergency Department (ED) would accept patients based on presentation to the department, by physician order and by the scope of services needed. This process is carried out in a timely manner.
2. Assessment: Patients entering the department receive a medical screening exam. Their visit will include determining their needs and the care setting in which it may take place.

A review of the facility" Emergency Department Scope of Care" policy #17049248, last revised 3/23/21 revealed that the purpose of the policy was to define the scope of care facility Emergency Department would provide, and to define procedures not performed in the Emergency Department. Scope of Care: The scope of service provided by facility's Emergency Department (ED) would include assessment of the patient complaint, appropriate medical screening examination by qualified medical provider, treatment based on assessment, drug therapy, management of critically ill patients, and patient education for care upon discharge in the event the patient does not require hospitalization.

A review of the facility's "Emergency Department Physician and Advanced Practice Provider Responsibilities Policy" policy #14063125, last revised 6/18/21 revealed that the facility would adhere to all ED and provider policies and procedures and adhere to the regulations of the current EMTALA regulations. Evaluate all patients that register as emergency department patients and assist as requested by private staff or attending physicians and assist in the management and disposition of those patients. Evaluate patients in the ED as requested by the RN if they appear too ill to wait for the private physician to arrive. Speak to any ED patient who calls back if requested by the RN.

A review of the facility's "Triage Policy" policy #14063255, last revised 3/12/24 revealed that the primary goals of triage were to quickly assign those patients with emergent, life limb threatening conditions to expedite the flow of patient through the Emergency Department (ED), and to assist visitors to the ED or other health care professionals.
It was the policy of the facility that all patients presenting to the ED for evaluation will be triaged by a qualified RN. It will be necessary for ED personnel to identify all patients presenting complaints in a manner best preserving the confidentiality of said patients.

A review of a video recording of the outside ED entrance revealed the following:
The video recording was dated 11/1/24.
At timestamp 8:21 a.m. P#2 was seen arriving at the ED via the valet lane accompanied by two children (minors).
At timestamp 8:22 a.m., P#2 was observed talking to the valet service representative.
At timestamp 8:22:19 a.m., Public Safety Officer (PSO) GG was seen at the entrance of the ED (by the door) and appeared to be talking to P#2 while she (P#2) remained at the valet desk.
At timestamp 8:23 a.m., P#2 was seen walking back to her vehicle with two children and drove off.
Further review of the video revealed that P#2 came back to the ED alone at timestamp 8:55 a.m.

An interview took place during the tour on 11/1/24 at 10:30 a.m. with Public Safety Officer (PSO) BB who stated that they do not allow kids to come into the ED due to the severity of the cases seen at the ED. PSO BB stated that if a patient presented to the ED with minor children, and the patient stated she had no one to pick up the children, she (PSO BB) would talk to the medical staff (nurses), and make informed decisions based on what the nursing/medical staff told her (PSO BB) to do.

An interview took place during the tour with ED Medical Director (MD) AA on 11/1/24 at 10:45 a.m. who stated that patients with children were allowed to come in and would still be seen, that the facility did not exclude a patient with children. MD AA stated that he would expect the public safety officers to know that they do not turn away patients from the ED because the patients have minors with them.

An interview took place at the facility's board room on 11/12/24 at 3:02 p.m. with Nurse Manager, Daytime (NM) DD who stated that the facility's staff do not turn away patients with children. NM DD stated that patients with minors would still be taken care of, and she (NM DD) would expect that the public safety officers would know not to turn away patients for that reason.

An interview took place at the facility's board room on 11/12/24 at 3:20 p.m. with Nurse Manager, Night (NM) EE who stated that public safety officers do not have the authority to turn back patients because the patients have minors with them. NM EE stated that they would ask the patient if they had someone that could come pick up the children, and if the patient said no, they would still allow the children to stay with the parent (patient).

An interview was conducted on 11/12/24 at 3:30 p.m. with Manager, Public Safety (MPS) FF who stated that during COVID there were restrictions on children in the Emergency Department and these restrictions remained in place. MPS FF said that generally, families were discouraged from bringing children into the ED, but he was unaware that persons seeking emergency care were being prevented from entering the ED.

An interview was conducted on 11/12/24 at 4:00 p.m. with Public Safety Officer (PSO) GG who confirmed that he told P#2 that children were preferably not allowed in the ED, and he (PSO GG) put it forward as a suggestion to P#2 to find an alternative place for her children. PSO GG stated that shortly after his interaction with P#2, she (P#2) got back in her car with the children and left the facility. PSO GG stated that he did not talk with medical staff before he told P#2 that the children were not allowed in the ED because it was his understanding that children were not allowed in the ED and that visitors were limited to one person per patient.

An interview took place at the facility's board room on 11/13/24 at 10:00 a.m. with Director of Operations (DO) MM who stated that since Covid, the facility limits the number of visitors at the bedside due to infection prevention. However, patients were allowed to come to the ED with their children. DO MM stated that she did not expect PSO GG to send P#2 away from the ED because she had her children with her.

An interview took place at the facility's board room on 11/13/24 at 10:20 a.m. with Registered Nurse (RN) JJ who stated that she was not aware of P#2's initial visit, and did not know the security sent her (P#2) back. RN JJ stated that even though the facility had visitor's restrictions, there were exceptions to the rule.

A telephone interview took place on 11/13/24 at 1:00 p.m. with Registered/Charge Nurse (RN) OO who stated that she was not aware of any incident where a patient was told she could not come into the ED because she had minors with her. RN OO stated that anyone that presented to the ED had to be seen even though there's no one that could take care of their children (if they presented to the ED with children). RN OO stated that the general rule post-COVID was one care partner per patient, but it was based on discretion, and the security officers had no authority to send a patient back because they (security officers) are not clinical and cannot decide any medical emergency interventions.

A telephone interview took place on 11/13/24 at 1:52 p.m. with Registered Nurse (RN) II who stated that she was not aware P#2 was at the ED prior and had been refused entry into the ED because she had minors with her. RN II stated that the security officer should not have turned P#2 back.