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Based on document review and interview, the facility failed to provide an appropriate medical screening by ancillary service to determine if an emergency medical condition existed, for one (1) of twenty (20) medical records reviewed.

Findings include:

1. See findings cited at 42 CFR 489.24, A2406 Medical Screening Exam.

Based on document review and interview, the facility failed to provide an appropriate medical screening by ancillary service to determine if an emergency medical condition existed in one (1) instance. (Patient # 1)

Findings include:

1. Review of the hospital policy titled, "Management of Psychiatric Patients in the Emergency Department Policy", PolicyStat ID 6683006, indicated consultation services may be contacted to assist with the evaluation of patients if ordered by the Emergency Department (ED) physician. This policy was last revised in 08/2019.

2. Review of the hospital policy titled, "Patients Presenting to the Emergency Department for ECS Evaluation", PolicyStat ID 6211988, indicated patients who presented to triage requesting an ECS (Emergency Consult Service) would be seen by a triage nurse who would ask the patient if they "would like to be seen by an ED physician". This policy was last revised in 04/2019.

3. Review of the hospital policy titled, "Emergency Medical Treatment" at H # 2 (Acute Care Hospital), PolicyStat ID 5822413, indicated patient's presenting to the ED will receive an appropriate medical examination and evaluation to determine whether an emergency condition exists. This policy was last revised in 08/2019.

4. Review of patient # 1's medical record (MR) indicated the following:
A. The patient arrived in the ED on 12/06/2021 at 5:06 pm with arrival complaint of bladder infection/ECS evaluation.
B. The ED Provider Note dated 12/06/2021 at approximately 6:10 pm by MS # 1 (ED Doctor of Osteopathy-DO), indicated the patient presented with his/her family member concerned he/she may have a bladder infection. The patient really had no complaints at that time although he/she appeared to be quite anxious and a bit paranoid. The patient's family member stated he/she would like a psychiatric evaluation. Patient kept insisting that he/she wanted "to go home now", but couldn't give MS # 1 a good reason why he/she wanted to leave immediately. MS # 1 discussed with the patient that they would need to check a urine as well as a blood test. MS # 1 informed the nurse caring for the patient that the patient should be seen by ECS after the medical evaluation.
C. The Patient Care Timeline dated 12/06/2021 at 6:14 pm, indicated MS # 1 (ED/DO) ordered urine/blood tests.
D. The Patient Care Timeline dated 12/06/2021, indicated the following:
a. Urine test resulted abnormal at 6:55 pm.
b. Urine Microscopic test resulted abnormal at 7:05 pm.
c. Cephalexin (Keflex) antibiotic was ordered at 7:09 pm.
d. Complete Blood Count (CBC) resulted at 7:31 pm, Comprehensive Metabolic Panel (CMP) resulted at 7:35 pm, Alcohol Serum Plasma and Estimated Glomerular Filtration Rate resulted at 7:35 pm, Urine Drug Screen resulted at 7:38 pm.
E. The Patient Care Timeline dated 12/06/2021 at 10:15 pm by NS # 1 (Registered Nurse-RN), indicated he/she had notified ECS of consultation.
F. The MR lacked documentation a consultation was completed by ECS.

5. In interview on 02/09/2022 at approximately 11:30 am with administrative staff member A # 7 (RN Manager ECS), confirmed the evaluation was not done. The facility had no trained midnight ECS staff available on midnights.