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Based on interview and record review, the hospital failed to ensure compliance with 489.24(a) Medical Screening Exam in that 1 of 1 patient (Patient #1) returned to the emergency department of the hospital on 10/28/15 at 1728 and was not provided a medical screening examination.

Cross refer to A2406.

Based on record review and interview, the hospital failed to provide an appropriate medical screening examination to 1 of 1 patient (Patient #1) in that, the patient returned to the emergency department of the hospital on 10/28/2015 at 1728 and was not provided a medical screening examination.

Findings:

1. Review of the emergency records for Patient #1:
First presentation: 10/28/2015 at 10:51, Patient #1 presented to the emergency department with complaints of abdominal pain in the lower abdomen with dysuria. Review of systems: Positive for pain at rest, of the left low back and right low back. Positive for urinary frequency, burning with urination, negative for vaginal bleeding, vaginal discharge, vaginal itching. Diagnosis: Ureterolithiasis, urinary tract infection, pyelonephritis. Sepsis. Pregnancy. Patient was not aware that she was pregnant and stated that she had a normal period two weeks earlier.
Discharged to home: Impression: Urinary tract infection. Patient #1 to follow up with
OB/GYN in 2 to 3 days.
Patient prescribed Cephalexin 500 mg. oral capsule; one every 8 hours for 10 days. Tylenol-
Codeine #3 300/30 mg. oral tablet; one every 6 hours as needed for pain.

Second presentation: 10/28/2015 at 1728, Patient #1 returned to the emergency room.
Presenting complaint: "Patient returns within a few hours of leaving here. Patient #1 stated for persistent pain unresolved. Staff #7 met her in triage and reviewed earlier discharge instructions and follow up instructions and expected course. Patient and spouse verbalized understanding and declined to represent. Will followup with the OB/GYN this week as directed and take prescriptions as directed."
Patient did not receive a medical screening examination.

Third presentation: On 10/29/2015 at 10:20, Patient #1 arrived via emergency medical system (EMS). Patient was a direct admit for precipitating delivery. Delivery: 10/29/2015
10:40 AM; Baby weight: 7 lbs. 4 oz., 18/.5 inches./ APGARS: 4/5/4. Fetal death: 1:41 PM.

2. During an interview on 1/13/2016 at 5:00 PM, Staff #7 was asked if the patient was given a medical screening examination during her visit of 10/28/2015 at 1728. Employee # 7 stated, "No." Staff #7 stated that upon her return her pain was more in the flank and low back than the abdomen.