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Based on clinical record reviews and staff interview, the facility to ensure an appropriate medical screening examination was performed for 1 of 20 sampled patients (#1) who presented to the hospitals's Dedicated Emergency Department as required at 489.24(r) and 489.24(c). In addition the facility failed to comply with the regulations at 489.24(d)(1-3) for the provision of stabilizing treatment, the regulations at 489.24(d)(4-5) which specifies, a participating hospital may not delay examination and or treatment to inquire about insurance status and 489.24(e)(1-2) which specifies the conditions for an appropriate patient transfer, These failures affected 1 of 20 sampled patients (#1).

Please refer to the deficient practices cited in this report at A2406, A2407, A2408 and A2409 for details.

Based on clinical record reviews,central log, and staff interviews, the facility failed to provide an appropriate medical screening examination that was within the capability of the Dedicated Emergency Department for 1 of 20 patients (#1) who presented to the hospital's Dedicated Emergency Department.

The findings include:

Review of the hospital's central log reveal patient #1, a minor child, was presented to the hospital's designated emergency department on 4/2/11 at 1:00 PM by the police. There is an assessment consent, signed by the patient's mother, that indicates the patient is "fully autistic and going through issues of new behavior; fought with mother, biting, scratching, hitting and running away. There is another form signed by the patient's mother, dated 4/02/11 at 1:20 PM, that states as follows: I understand that my Insurance provider is not contracted with Fort Lauderdale Hospital and that I will have to seek services at one of the two following facilities. The Form then lists 2 different facilities. There is no medical screening examination(MSE) document contained in the patient's clinical/medical record to support that one (MSE) was provided, and no further information is documented on the patient. The patient left the hospital in the care of his mother and was transported to one of the alternate listed hospitals by his mother. The facility failed to ensure that a medical screening examination was provided for patient #1 to determine if an emergency medical/psychiatric condition exists.

Patient #1's medical record from the another acute care hospital was reviewed. Review of the History and Physician dated 4/2/2011 indicated in part, "This patient a 13 year old...Nursing notes indicates the patient was aggressive and had hit his mother . The patient has a history of autism dating to age two. He has had past psychiatric hospitalization ... of this year... The patient is non communicative. Was able to follow simple commands but will not answer questions... In summary . . admitted to the facility because of aggressive violent behavior towards mother ."

During an interview with the facility's Social Service Director on 4/15/11 at 11:00 AM, she stated, when the facility found out about "this issue" they had an EMTALA inservice for all admissions staff. Review of the facility's staff meeting minutes reveal that an EMTALA inservice was held on 4/11/11 and 4/12/11.

During an interview with the Admissions Supervisor on 4/15/11 at 2:00 PM, she stated that her knowledge of the patient was that the mother brought him in for an evaluation and the clinical psychologist referred them to another facility. She stated that the clinical psychologist had been employed with the facility for 7 months prior to this incident and that he was terminated on 4/05/11 for failure to follow hospital procedures and violation of Federal EMTALA regulations and State Baker Act regulations. She stated that to her knowledge, the patient was not under the Baker Act and was not brought to the facility by the police. When asked why then is the clinical psychologist's reason for termination includes failure to follow State Baker Act regulations, she responded that he should have initiated the Baker Act due to the mother's statement of aggressive behavior in the patient. She stated that the facility became aware of the incident when they were notified by the alternate hospital that the mother transported the patient to. She stated that the incident was then confirmed with the clinical psychologist and the facility self reported the incident to the State Agency on 4/12/11.

Based on clinical record reviews and staff interviews, the facility failed to provide further medical examination and treatment as required to stabilize the medical condition for 1 of 20 patients (#1) who presented to the hospital's Dedicated Emergency Department with an emergency medical condition.

The findings include:

Review of the hospital's central log reveals patient #1, a minor child, presented to the hospital's Dedicated Emergency Department on 4/2/2011 at 1:00 PM escorted by the police. There is an assessment consent, signed by the patient's mother, that indicates the patient is "fully autistic and going through issues of new behavior; fought with mother, biting, scratching, hitting and running away. There is another Form signed by the patient's mother, dated 4/02/11 at 1:20 PM, that states as follows: I understand that my insurance provider is not contracted with Fort Lauderdale Hospital and that I will have to seek services at one of the two following facilities. The Form then lists 2 different hospitals to which the patient was referred. There is no supportive evidence of the provision of stabilization treatment documented in the clinical record to support the provision that stabilizing treatment was provided for patient #1 on 4/2/2011. The facility failed to ensure that stabilizing treatment was provided for patient #1 when he presented to the dedicated emergency department.

During an interview with the facility's Social Service Director on 4/15/11 at 11:00 AM, she stated, when the facility found out about "this issue" they had an EMTALA inservice for all admissions staff. Review of the facility's staff meeting minutes reveal the EMTALA inservice was held on 4/11/11 and 4/12/11.

During an interview with the Admissions Supervisor on 4/15/11 at 2:00 PM, she stated that her knowledge of the patient was that the mother brought him in for an evaluation and the clinical psychologist referred them to another facility. She stated that the facility became aware of the incident when they were notified by the alternate hospital that the mother took the patient to. She stated that the incident was then confirmed with the clinical psychologist and the facility self reported the incident to the State Agency on 4/12/11.

Based on clinical record reviews, Central Log, and staff interviews, the facility failed to provide an appropriate medical screening examination and stabilizing treatment due to insurance coverage for 1 of 20 patients (#1), as this resulted in delay in examination and treatment of the patient's care.

The findings include:

Review of the hospital's central log reveal patient #1, a minor child, presented to the hospital's Dedicated Emergency Department on 4/2/11 at 1:00 PM by the police. There is an assessment consent, signed by the patient's mother, that indicates the patient is "fully autistic and going through issues of new behavior; fought with mother, biting, scratching, hitting and running away. There is another Form signed by the patient's mother, dated 4/2/11 at 1:20 PM, that states as follows: I understand that my insurance provider is not contracted with Fort Lauderdale Hospital and that I will have to seek services at one of the two following facilities. The Form then lists 2 different hospitals. The facility's Dedicated Emergency Department failed to provide patient #1 on 4/02/2011 the benefits of a medical screening examination or stabilizing treatment based on the patient's insurance coverage, the patient was referred to 2 other facilities.

During an interview with the Admissions Supervisor on 4/15/11 at 2:00 PM, she stated that her knowledge of the patient is, the mother brought him in for an evaluation and the clinical psychologist referred them to another facility. She stated that the clinical psychologist had been employed with the facility for 7 months prior to this incident and that he was terminated on 4/5/11 for failure to follow hospital procedures and violation of Federal EMTALA regulations and State Baker Act regulations. She stated that the facility became aware of the incident when they were notified by the alternate hospital that the mother took the patient to. She stated that the incident was then confirmed with the clinical psychologist and the facility self reported the incident to the State agency on 4/12/11.

Based on clinical record review, central log, and staff interviews, the facility failed to provide an appropriate transfer for 1 of 20 patients (#1) who presented to the hospital's Dedicated Emergency Department with an emergency medical condition.

The findings include:

Review of the hospital's central log reveal patient #1, a minor child, presented to the hospital's Dedicated Emergency Department on 4/02/11 at 1:00 PM escorted by the police. There is an assessment consent signed by the patient's mother that indicates the patient is "fully autistic and going through issues of new behavior; fought with mother, biting, scratching, hitting and running away. There is another Form signed by the patient's mother, dated 4/02/11 at 1:20 PM that states as follows: I understand that my Insurance provider is not contracted with Fort Lauderdale Hospital and that I will have to seek services at one of the two following facilities. The Form then lists 2 different hospitals. There is no documentation that the patient or mother were informed of the hospital's obligations under Federal regulations or the risks and benefits of transfer. There is no physician written certification of the risks and benefits of transfer. There is no indication that a receiving facility was contacted for acceptance of the patient. The patient was permitted to leave the hospital in the care of his mother for transport to another facility.

During an interview with the facility's Social Service Director on 4/15/11 at 11:00 AM, she stated that when the facility found out about "this issue" they had an EMTALA inservice for all admissions staff. Review of the facility's staff meeting minutes reveals that the EMTALA inservice was held on 4/11/11 and 4/12/11.

During an interview with the Admissions Supervisor on 4/15/11 at 2:00 PM, she stated that her knowledge of the patient was that the mother brought him in for an evaluation and the clinical psychologist referred them to another facility. She stated that the facility became aware of the incident when they were notified by the alternate hospital that the mother took the patient to. She stated that the incident was then confirmed with the clinical psychologist and the facility self reported the incident to the State Agency on 4/12/11.