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Based on review of patient medical records, interviews, Hospital A's Medical Staff Bylaws and Medical Staff Rules and Regulations, and Occurrence Event Report, Hospital A failed to provide an appropriate Medical Screening Examination (MSE) for 1 of 1 patient who was 31.5 weeks pregnant when she presented to Hospital A's Emergency Department (ED) on 08/28/2020 and was denied entrance to Hospital A's ED by security personnel responsible for COVID-19 screening process, (Patient #1).

The findings are:

Cross Reference to A 2406: Hospital A failed to provide a Medical Screening Examination(MSE) for 1 of 1 patient who was 31.5 weeks pregnant when she presented to Hospital A's Emergency Department(ED) on 08/28/2020 and was denied entrance to Hospital A's ED by Security personnel responsible for the COVID screening process.

Based on observations, staff interview, and review of the hospital's policies and procedures, Hospital A failed to post signs related to Emergency Medical Treatment and Active Labor Act (EMTALA) specifying the rights of individuals with respect to examination and treatment for emergency medical conditions and women in labor and indicating whether or not the hospital participates in the Medicaid program in all areas of the hospital's Emergency Department.

The findings are:

On 9/21/2020 at 11:00 AM, observations in Hospital A's Emergency Department (ED) revealed two EMTALA signs posted beside each other in the ED waiting area in a hallway area by the triage desk. The wording on one sign was in English, and the wording on the other sign was in Spanish. Neither sign was highly visible and could not be easily read from a distance of twenty feet. On 9/21/2020 at 11:20 AM, observations in the Obstetrics (OB) unit where women who are sixteen weeks pregnant or greater are emergently triaged had no signs regarding EMTALA.

On 9/24/2020 at 9:15 AM, a face to face interview in the Aspen conference room was conducted with Regulatory Compliance Staff #1 who stated, "We have ordered more signs for the Emergency Department and the Obstetrics triage area. The signs in the ED waiting area are not very conspicuous."

Review of the hospital's EMTALA policies and procedures verified the hospital had no policy for posting EMTALA signs.

Based on record reviews and review of the hospital's EMTALA (Emergency Medical Treatment and Active Labor Act) policies and procedures, the hospital failed to ensure that on 08/28/2020 Patient #1's name was entered on the central log when he/she presented to the ED seeking care for a medical condition for 1 of 20 sampled patients who presented to the hospital's Emergency Department (ED) on 08/28/2020, but was denied entrance into the ED by the hospital's security staff responsible for COVID-19 screening.

The findings are:

On 09/22/2020 at 8:35 AM, the facility failed to ensure that on 08/28/2020 Patient #1's name was entered on the central log when he/she presented to the ED seeking care for a medical condition but was denied entrance by security personnel assigned the responsibility for the hospital's COVID-19 screening process. The pregnant patient was denied entrance to the hospital's ED because the patient had her son with her.

On 09/22/2020 at 8:35 AM, review of the hospital's policies and procedures revealed there was no hospital policy and procedure for capturing the names of patients presenting to the ED seeking care for a medical condition in conjunction with the ED's screening process for COVID-19.

Refer to A2406 for additional findings.

Based on review of patient medical records, interviews, Hospital A's Medical Staff Bylaws and Medical Staff Rules and Regulations, and Occurrence Event Report, Hospital A failed to provide an appropriate Medical Screening Examination (MSE) for 1 of 1 patient who was 31.5 weeks pregnant when she presented to Hospital A's Emergency Department (ED) on 08/28/2020 and was denied entrance to Hospital A's ED by security personnel responsible for COVID-19 screening process, (Patient #1).

The findings are:

On 09/23/2020 at 09:00 AM, review of Patient #1's chart for an admission dated 08/29/2020 revealed the patient presented to Hospital A's obstetric department with a chief compliant of a fall onto her abdomen that occurred on 08/28/2020. Documentation in the patient's chart dated 08/28/2020 revealed the patient returned to the hospital on 08/29/2020 at 1:00 PM and was assessed in the hospital's Obstetrical Unit. During the patient's assessment, Patient #1 informed the Triage Nurse that she had come to the ED on 08/28/2020 after the fall but was informed that she could not go into the hospital's ED because she had her child with her. The Triage Nurse notified the Charge Nurse who notified her Supervisor of the incident.

On 09/23/2020 at 11:00 AM, review of Hospital A's Occurrence Event Report for the 08/28/2020 incident revealed: Patient #1 and her son approached Hospital A's ED entrance after she had a fall and landed on her abdomen. Patient #1 presented to the COVID screening area where she was informed by the security personnel who was responsible for the hospital's COVID screening that she could not come into the hospital if she brought her son, unless her son was seeking treatment. The Security Officer told the patient there was a COVID no visitor policy. Patient #1 stated that she did not have anyone to take care of him, and she would not be able to get medical care if she could not bring her son into the hospital. Patient #1 left the hospital without receiving a Medical Screening Examination (MSE) on 08/28/2020.

A face to face interview was conducted on 09/23/2020 at 9:50 AM with the Triage Nurse (Registered Nurse #1) who verified that he/she triaged Patient #1 on 8/29/2020, and stated, "Yes, the patient reported the incident to me. I notified the Charge Nurse."

On 09/23/2020 at 2:15 PM, in the Aspen conference room, in a face to face interview with Security Officer #1, he/she revealed, "Yes, I was working when a woman arrived on 08/28/2020. I was sitting in the lobby entrance when a woman walked up, read our sign, and walked off. Then she turned back around, and I asked her, "How are you? Are you being seen"? She said, "I have my son with me." She asked if anyone could watch her son. I told her if anyone is seen in the emergency room, they could not bring a visitor in. We don't have options. I told her that was our policy. We have had this happen before, and we go to the reception desk and ask them, and they say the same policy. The reception desk said they can not come in. I had EMTALA training, and had EMTALA training since then."

A telephone interview was conducted on 09/24/2020 at 8:45 AM with Charge Nurse #1 who verified he/she was the charge nurse for Obstetrics on 8/29/2020 when Patient #1 arrived, and stated, "Yes, the triage nurse was working triage and triaged Patient #1, and informed me about the incident that happened the day before so I notified the Assistant Director of Nurses."

Hospital A's policy, "Medical and Dental Staff Rules and Regulations", reads, " ....G. Emergency Care ....6. Pursuant to the Emergency Medical Treatment And Active Labor Act (EMTALA), all patients presenting to the Emergency Department will be provided a medical screening examination and stabilization by a Physician, Resident, or Fellow prior to transfer or discharge unless the Medical Executive Committee and Board of Directors have approved exceptions ....".