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Based on review of hospital policies/procedures, documents, personnel records, and interview with staff, it was determined that the hospital failed to enforce policies/procedures to comply with the requirements of 42 CRF 489.24.

Findings include:

Hospital policy titled "EMTALA-Medical Screening Examination and Stabilization Treatment" revealed: "...When an EMS provider brings an individual to the Hospital with a Dedicated Emergency Department and the Hospital does not have the capacity or capability to provide an immediate medical screening exam and if needed, stabilizing or an appropriate transfer, the Hospital must still assess the individual upon arrival to ensure that the individual is appropriately prioritized based on presenting signs and symptoms. Hospital should assess whether the EMS can appropriately monitor the individual ' s condition...."

1 of 1 patients did not receive an appropriate MSE upon arrival at the facility and there was no record that the patient was assessed and monitored according to the facilities policy.

Based on review of policies and procedures, hospital documents and staff interviews, it was determined that the hospital failed to provide a Medical Screening Examination to a patient who presented to the ED via Emergency Medical Services (EMS) ambulancefor examination and treatment (Patient #1).

Findings include:

Hospital policy titled "EMTALA - Medical Screening Examination and Stabilization" revealed: "...Medical Screening Examination (MSE): An appropriate MSE will be offered to individuals on the Campus of Banner Hospitals with a Dedicated Emergency Department who request emergency medical services...When an EMS provider brings an individual to the hospital with a Dedicated Emergency Department and the hospital does not have the capacity or capability to provide immediate medical screening exam and if needed, stabilizing or an appropriate transfer, the hospital must still assess the individual upon arrival to ensure that the individual is appropriately prioritized based on presenting signs and symptoms. Hospital should assess whether the EMS can appropriately monitor the individual's condition ...Triage establishes the order in which an individual will be evaluated and is not considered an emergency MSE ...An MSE and Stabilizing Treatment, within the capabilities of the Hospital, will be provided to all individuals regardless of their ability to pay ...."

Hospital policy titled " Emergency Department Patient Care " revealed: " ...An Emergency Severity Index (ESI) score is assigned when the triage assessment is completed. ESI 1= Requires immediate life-saving interventions; ESI 2= High risk or confused/lethargic/disoriented or severe pain distress; ESI 3= Two or more resources may be needed; ESI 4= One resource may be needed; ESI 5= No resources needed ...A medical screening exam (MSE) is completed by an Emergency Physician or QMP .... "

Patient #1 arrived at the hospital ED on 08/01/2022 at 20:51 via EMS transport after sustaining a fall at home with a 4-day history of weakness and dark bowel movements. Patient #1 was triaged at 22:38 with an assigned ESI score of 3. Patient #1 received an MSE at 22:26.

Patient #1 EMS Report Form (Patch call form) dated 08/01/2022 at 20:38 revealed an ETA of 6 minutes with patient complaining of ground level fall, and weakness without head strike or loss of consciousness.

Patient #1 SFMD-Prehospital Care Report (EMS Run Sheet) dated 08/01/2022 at 20:51 revealed "Upon arrival to the hospital M261 was staged in the hallway for a hospital bed assignment, several attempts were made to give report to charge RN, however all attempts to communicate the needs of the pt were unsuccessful. While staged in the hospital hallway it was observed that the Pt was still experiencing hypotension, lung sounds were assessed and the pt was administered a second fluid bolus of NS to which the pts blood pressure began to respond positively to treatment, during this time the pt remained A&Ox4 with a GCS of 15, pts HR and room air O2 sats remained within normal limits. Several more attempts were made to communicate with charge RN, however on several occasions the charge RN was not at their desk or would not acknowledge M261 for updated pt report. Upon receiving a room assignment the pt was moved from gurney to hospital bed via sheet slide."

An interview was conducted on 08/29/2022 with EMS Paramedic #1 who confirmed that EMS to ED room offload time varies. EMS Paramedic #1 confirmed that offload times can be less than a half an hour but other times it can be as long as an hour.

An interview was conducted 08/29/2022 with EMS Paramedic #3 who confirmed that EMS to ED room offload times are an issue. EMS Paramedic #3 confirmed that offload wait times can be a half hour to as long as 2 hours. EMS Paramedic #3 stated offloads are consistently slow with long offload times. EMS Paramedic #3 confirmed that the EMS crew is responsible for monitoring the patient until the hand off to the ED RN has occurred. EMS Paramedic #3 confirmed that the EMS crew will notify the charge nurse if the patient's condition changes and the charge nurse will arrange to have the patient roomed at that time.

Employee #3 confirmed during an interview conducted on 08/29/2022 that the facility policy was not followed as patient # 1 did not receive triage or an MSE until Patient #1 was assigned a room which was nearly 2 hours after presenting to the ED.