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Based on document review and interview, it was determined the Hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The Hospital failed to provide a medical screening examination. (refer to tag A 2406)

Based on document review and interview it was determined for 1 of 11 (Pt. #1) patients presenting to the emergency department (ED) with shortness of breath or chest pain, the hospital failed to provide a medical screening examination.

Findings include:

1. The hospital policy titled, "Screening, Stabilization and Transfer of Individuals with Emergency Medical Conditions (EMTALA) - (effective 5/15)" reviewed on 6/26/15 required, " To provide a Medical Screening Examination by a physician or other qualified medical person to any individual described below in 3. A. to determine if the individual has an emergency medical condition. ... 3. A. All individuals who present at any Dedicated Emergency Department patients coming to the hospital requesting emergency care shall receive an appropriate medical screening."

2. The hospital medical staff rules and regulations, reviewed on 6/26/15 (effective January 1, 2015), required, "The hospital shall provide an appropriate medical screening examination to any individual who comes to the Emergency Department seeking an examination or treatment for an emergency condition."

3. The paramedic run sheet dated 6/10/15 included, " (Hospital A) contacted with report. No orders given. ... On arrival to hospital, staff met ambulance and stated the doctor wanted patient taken to (hospital B) due to elevation on 12 lead (EKG). Cath lab was not open on arrival. Another EKG taken and sent to hospital B. Crew continued to transport. "

5. The Charge nurse (E#3) was interviewed on 6/26/15 at 3:00 PM. E#3 stated a call was received from the ambulance with a patient complaining of shortness of breath. A short report was given including that an EKG was being transmitted. The EMS staff mentioned the possibility of an elevation (abnormality) on the EKG during report. E#3 stated she retrieved the EKG from the fax machine and gave to the ED physician (MD#2). The ambulance arrived to the hospital and began getting Pt. #1 out of the ambulance. E#3 stated, " The doctor knew the ambulance was here and told me to catch them quickly before they unloaded the patient because our cath lab was not open so the patient needed to go to another hospital (hospital B). The EMS staff questioned why cath lab unavailable and I told them why. They kept the patient in the ambulance and left. " Hospital A did not call hospital B to inform of patient being sent there. The doctor never saw the patient.

4. The clinical record for Pt. #1 from hospital B was reviewed on 6/26/15. Pt. #1 was an 80 year old female that arrived to hospital B on 6/10/15 at 9:57 PM via ambulance with complaints of shortness of breath. Pt. #1 was admitted for Congestive heart failure.

5. The ED Director (E#2) was interviewed on 6/26/15 at approximately 11:30 AM. E#2 stated, " This patient was never seen by a physician or entered the ED. "

Based on document review and interview, it was determined the Hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The Hospital failed to provide a medical screening examination. (refer to tag A 2406)

Based on document review and interview it was determined for 1 of 11 (Pt. #1) patients presenting to the emergency department (ED) with shortness of breath or chest pain, the hospital failed to provide a medical screening examination.

Findings include:

1. The hospital policy titled, "Screening, Stabilization and Transfer of Individuals with Emergency Medical Conditions (EMTALA) - (effective 5/15)" reviewed on 6/26/15 required, " To provide a Medical Screening Examination by a physician or other qualified medical person to any individual described below in 3. A. to determine if the individual has an emergency medical condition. ... 3. A. All individuals who present at any Dedicated Emergency Department patients coming to the hospital requesting emergency care shall receive an appropriate medical screening."

2. The hospital medical staff rules and regulations, reviewed on 6/26/15 (effective January 1, 2015), required, "The hospital shall provide an appropriate medical screening examination to any individual who comes to the Emergency Department seeking an examination or treatment for an emergency condition."

3. The paramedic run sheet dated 6/10/15 included, " (Hospital A) contacted with report. No orders given. ... On arrival to hospital, staff met ambulance and stated the doctor wanted patient taken to (hospital B) due to elevation on 12 lead (EKG). Cath lab was not open on arrival. Another EKG taken and sent to hospital B. Crew continued to transport. "

5. The Charge nurse (E#3) was interviewed on 6/26/15 at 3:00 PM. E#3 stated a call was received from the ambulance with a patient complaining of shortness of breath. A short report was given including that an EKG was being transmitted. The EMS staff mentioned the possibility of an elevation (abnormality) on the EKG during report. E#3 stated she retrieved the EKG from the fax machine and gave to the ED physician (MD#2). The ambulance arrived to the hospital and began getting Pt. #1 out of the ambulance. E#3 stated, " The doctor knew the ambulance was here and told me to catch them quickly before they unloaded the patient because our cath lab was not open so the patient needed to go to another hospital (hospital B). The EMS staff questioned why cath lab unavailable and I told them why. They kept the patient in the ambulance and left. " Hospital A did not call hospital B to inform of patient being sent there. The doctor never saw the patient.

4. The clinical record for Pt. #1 from hospital B was reviewed on 6/26/15. Pt. #1 was an 80 year old female that arrived to hospital B on 6/10/15 at 9:57 PM via ambulance with complaints of shortness of breath. Pt. #1 was admitted for Congestive heart failure.

5. The ED Director (E#2) was interviewed on 6/26/15 at approximately 11:30 AM. E#2 stated, " This patient was never seen by a physician or entered the ED. "