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Based on interview and policy and procedure review the facility failed to comply with 489.24. See Tag C 2406.

Based on interview and policy and procedure review the facility failed to provide an appropriate medical screening examination within the capability of the hospital's department, to determine whether or not an emergency medical condition exists for 1 of 1 (#1) patients. Findings include:

On 9/24/10 at approximately 0300 a patient presented to the facility's Emergency Department complaining of numbness and weakness in his right arm. RN #1 upon taking the patient to a room was asking the patient about his complaint and assumed the patient would need a CT scan to rule out certain conditions. The facility's CT scan machine was not operating at this time. The nurse then consulted the physician on duty via the telephone and questioned if it would be alright to ask the patient if he wished to be treated at a facility that has a CT scan operating at this time. The physician agreed, because he implied that he would want a CT scan for the patient. The patient left the Emergency Department with his wife and was taken by wife to a different hospital for evaluation and treatment.

On 9/28/10 at approximately 1015 during the entrance conference with the Risk Manager revealed patient #1 did not have any medical record that correlated with the visit and request for treatment at the facility.

On 9/28/2010 an interview with RN #1 was conducted at 1030. When queried about the incident RN #1 stated "I was bringing back the patient and asked him about what was going on and he said that his hand is losing strength and getting numb and that he needed his hand. He said that it has been like this since Wednesday and not going away. I asked him if he had any shortness of breath and chest pain or any other symptoms and he said that his hand was just getting more and more numb. I had him squeeze my hands and his right hand had a weaker grip." Then RN #1 went on to state "His wife was with him and knowing we didn't have a CT Scan I talked with all nurses and I called and asked the doctor and he said that I will need a CT Scan and I asked the doctor if he wanted me to ask them what they want to do and he said yes. I asked them and they said they want to go where they can get everything done at once. So his wife took him to another hospital. " RN #1 was then queried if any of the assessment she performed or conversation with the physician was documented and she replied "No, I didn't. I didn't know if I was doing the right thing. We didn't have a CT scan and most of our patients get one."

On 9/28/2010 at approximately 1300 an interview with Physician #1 was conducted. When queried about Patient #1 he stated "That night I fell asleep about 1:30, and then I received a call from the nurse. I didn't understand if patient was here or calling in. The nurse said the patient is having numbness in his hand, it was from 3 days ago, he is fine. She said she wanted to ask them if they wanted to go to another hospital because we don't have a CT scan, I said that's fine." Then physician #1 went on to say "When I woke up in the morning I felt bad, so I asked them to call the patient and see how he is doing."

Upon review of the facility's policy and procedure titled "EMTALA Screening, Stabilization and Outgoing Patient Transfers" it is written "It is the policy of Deckerville Community Hospital to provide a medical screening examination to all individuals who come to the dedicated emergency department requesting examination or treatment of a medical condition...".