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Based on review of policies/procedures, staff interviews, and review of medical records, the hospital failed to ensure that 1 of 26 patients was seen and received a medical screening examination when they presented at the hospital. Failure to comply with the EMTALA regulations places all patients at risk for not having a medical screening exam in order to determine if the patient has an emergency medical condition.

Refer to C2406.

Based on review of policies/procedures and staff interview, the hospital failed to ensure 1 of 26 patients was seen by a physician and received a medical screening examination upon presentation at the hospital. Failure to provide a medical screening examination places all patients at risk for not having an emergency medical condition identified and treated.

Findings include:

1. The hospital policy/procedure titled "EMTALA and Medical Screening Exams" was reviewed on August 2, 2011. The policy/procedure states "Purpose: To ensure that all patients presenting to the emergency department requesting to see a doctor receive an appropriate medical screening exam (MSE) as required by the Emergency Medical Treatment Active Labor Act (EMTALA), 42 U.S.C., Section 1395 and all federal regulations and interpretive guidelines." and "Policy: The hospital and its staff must provide screening and stabilizing treatment within the scope of its abilities, as needed, to the individuals who come to the emergency department for examination and treatment. Any patient who presents to the hospital requesting emergency services is entitled to and will receive a MSE performed by an individual who is qualified to perform such examination to determine whether an emergency medical condition exists. No one will be refused service.

2. A director of quality services was interviewed on August 1, 2011. The director stated there had been an incident on July 6, 2011 when a patient was not seen in the Emergency Department (ED) after they had presented at the hospital.

S/he stated she received a report to the quality department and the interviewed the staff that were involved. The incident was of a patient who had been seen at an urgent care clinic and who was referred to the hospital by the Advanced Registered Nurse Practitioner (ARNP) to be seen for a probable myocardial infarction (commonly referred to as a heart attack) within the previous 24 hours. The patient chose to come to this hospital.

At the same time the patient was traveling here, the ARNP called the ED and said s/he wanted the patient to go to another hospital which had cardiac catheterization capabilities. The ARNP stated s/he would try to reach the patient as well.

However, the patient came to this hospital, not at the ED, but at the main reception desk in the lobby. S/he stated she spoke with the registration clerk and was told the clerk had first called the ED to see if they were expecting the patient. The ED said they were not; the patient was to go to the other hospital. The clerk stated s/he then called the ARNP as the patient was becoming angry. The ARNP then spoke to the patient and discussed where s/he was to go. The clerk stated s/he gave the patient directions to the other hospital and then notified the other hospital that the patient was in route. The clerk stated s/he called the other hospital later to be sure the patient had arrived safely as s/he was worried.

3. The patient had not received a medical screening examination at the hospital and no medical record had been generated