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Based upon medical record review, policy review, document review and interview, the facility did not comply with all the provisions for maintaining a central log and conducting a medical screening exam.

Please reference findings under Tag A 2405 and 2406.

Based on policy review, document review, and interview, the facility failed to ensure all individuals presenting to the Emergency Department (ED) are entered into the central log for 1 of 20 patients (Patient #1). This failure could result in the patient not receiving a medical screening exam.

Findings include:

Review of policy "Patient Transfer and Medical Screening" last reviewed 05/15/17 revealed a central log shall be maintained, for at least 5 years, on all individuals who come to the ED seeking assistance. The log must indicate whether the individual refused treatment, was refused treatment, was transferred, was admitted and treated, was stabilized and transferred, or was discharged.

Review on 09/25/19 of the ED central log dated 08/21/19 revealed no evidence that Patient #1 presented to the ED.

Interview on 09/25/19 at 11:20 AM with Staff (A), Manager of Regulatory Affairs revealed Patient #1 left the ED was not enter onto the ED log.

Based on policy review, document review and interview, the hospital clinical staff did provide a medical screening exam (MSE) for 1 of 20 patients (Patient #1), who presented to the Emergency Department (ED). A lack of a MSE could result in an emergency medical condition not being identified and treated.

Findings include:

Review of policy "Medical Screening Examination Requirement" last reviewed 11/06/18 revealed all patients presenting to the ED for evaluation or treatment must be evaluated by a triage nurse and must receive a MSE by a qualified medical personnel to determine if an emergency medical condition (EMC) exists. This includes patient's referred to the ED for lab testing, drug testing, and other directed interventions.

Review of policy "Patient Transfer and Medical Screening" last reviewed 05/15/17 revealed except in the case of scheduled tests/procedures or a direct admission, all persons who present to the hospital or come to the ED requesting examination or treatment, will be provided an MSE. No individual presenting to the ED will be denied timely triage or MSE by any employee. Except in the case of a documented refusal, leave against medical advice, or voluntarily leaving without being seen, no individual shall be discharged without receiving an MSE.

Review of the ED triage sign in slip (no date) at 10:47 AM revealed Patient #1 listed her name, date of birth, last 4 digits of her social security number and the reason for the visit as "Blood or urine request for pesticide/herbicide/insecticide toxicity identification due to exposure to applicator's spraying machine on the job." USDA is written on the top of the slip.

Review of the Quality Assurance "STARS" Event report revealed on 08/21/19 at 10:47 AM, Patient #1 signed in (filled out a slip at the triage window in the ED). Staff (F), Triage Nurse, reviewed Patient #1's complaint requesting blood and urine testing for on the job (USDA worker) possible exposure to pesticide/herbicide/insecticide toxicity (see above). At 11:10 AM, Staff (F) spoke with Patient #1 in the waiting room, telling her the facility doesn't provide those services and she would have to go somewhere else. Staff (F) walked into the triage room where Staff (B), ED Nurse Manager had just entered and stated that she "got rid of this one, we don't do that here" and produced Patient #1's sign in slip for the ED. Staff (B) explained that it was an EMTALA violation and that Staff (F) needed to try to find Patient #1. Staff (F) was unable to find Patient #1.

Interview on 09/25/19 at 11:20 AM with Staff (A), Manager of Regulatory Affairs revealed Patient #1 left the ED and did not receive an MSE.