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Based on medical record review, facility policy review, review of emergency department video footage, and staff interview, the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists (A2406).

Based on medical record review, staff interview, and review of the Emergency Department (ED) log, the facility failed to maintain a central log on each individual who comes to the emergency department seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for one of 20 patients reviewed (Patient #3). The facility's census was 350.

Findings include:

Staff C and Staff D were interviewed on 06/26/23 at approximately 10:30 AM and asked to provide a list of patients presenting to the ED for treatment from 04/15/23 through 06/26/23. The ED log from the requested time period was provided on 06/26/23 at approximately 5:00 PM. Patient #3 was not listed as having presented to the facility ED.

Staff C and Staff D were interviewed on 06/27/23 at 11:40 AM. According to Staff C, as soon as a patient presented to the ED desk and was triaged, the patient should be identified in the ED log. Staff C stated even if the patient left without being seen, their name should still appear in the log. Staff C searched the ED log for Patient #3 confirming that the name was not listed as required.

This deficiency represents non-compliance investigated under Substantial Allegation OH00143111.

Based on medical record review, facility policy review, review of emergency department video footage, and staff interview, the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists for one of 20 patients reviewed (Patient #3). The facility's census was 350.

Findings include:

Review of the medical record of Patient #3 revealed the patient presented to the emergency department (ED) on 05/03/23 at 1:11 AM with complaints of a severe headache. At 1:22 AM, the patient's vital signs included a blood pressure of 137/85, a heart rate of 106 beats per minute, respirations of 18 breaths per minute, and oxygen saturation of 99%. A nurse's triage note at this time stated the patient denied a history of migraines and quoted the patient saying: "I feel like someone hit me in the back of the head with a baseball bat." The patient reported the headache started that night and also stated he had some anxiety. The patient acuity was designated a 3 High, patients requiring two or more resources with vital signs not in the danger zone. At 1:24 AM, the patient's temperature was 98.2 degrees Fahrenheit. A note at 2:30 AM revealed the patient was sitting in a chair by the triage desk asking to speak with someone in charge. The note stated that the patient appeared to be video taping with his cell phone. A charge nurse was notified. A note 10 minutes later, at 2:40 AM, stated Staff B with a security officer entered the ED lobby to speak with the patient. He continued to video tape. The note stated that the patient was yelling at security that he was going to sue the hospital due to not getting a cup of water. The note stated that when the security officer put a hand on the patient's shoulder, the patient accused the officer of battery. The note revealed that more security personnel arrived in the lobby and the patient was asked to leave multiple times. The patient was "escorted out of the hospital by security." At 3:02 AM the patient's disposition was set to left without being seen (LWBS) after triage. The note was silent to any staff member requesting that the patient discontinue the video taping.

The facility policy titled, EMTALA-Emergency Care and Transfer of Patients with an Emergency Medical Condition, review/revised on 08/2022, was reviewed. According to the policy, "triage" means the clinical assessment of the individual's presenting signs and symptoms at the time of arrival at the Hospital, in order to prioritize when the individual will be seen by Qualified Medical Personnel. Triage is not the same as a Medical Screening Examination. For all individuals who come to the ED and all individuals who present on hospital property requesting examination or treatment of an Emergency Medical Condition or who reasonably appear to need examination or treatment for an Emergency Medical Condition, the hospital will provide a Medical Screening Examination by Qualified Medical Personnel to determine whether or not the patient has an Emergency Medical Condition.

Staff C was interviewed on 06/27/23 at 5:30 PM. It was confirmed that the patient did not receive a Medical Screening Examination.

The ED video footage from 1:24 AM to 3:16 AM on 05/03/23 was viewed with Staff E and Staff F on 06/28/23 at 10:00 AM. The video further confirmed the patient did not receive a Medical Screening Examination as he was removed from the ED at 2:45 AM when two security officers picked him up by his arms, lifting him out of the chair, and carried him out of the ED door. He was taken away in a police cruiser by city police officers at 3:16 AM.

The facility policy titled, Photography, Films/Video and/or Vocal Recordings of Staff, reviewed/revised on 12/2020, was reviewed. According to the policy, the facility reserves the right to restrict or refuse the photographing, filming, or audio/vocal recording of staff by patients or visitors based upon the possible impact on the staff concerned or other patients, possible disturbance to the atmosphere or environment, or any other detrimental impact. This decision may be made by the unit supervisor or manager on duty. However, if a conflict arises between the patient or visitor and staff, and it cannot be resolved, the Administrator on Call should be consulted.

Staff C was interviewed on 07/03/23 at 9:30 AM and asked to provide a list of Administrators on Call for the month of May, 2023. The name of the Administrator on Call was listed on 05/02/23 for the 24 hour period of 8:00 AM to 8:00 AM on 05/03/23. Staff C was asked for documentation the Administrator on Call was consulted due to the conflict between staff members and Patient #3. Staff C revealed there was no documentation as the Administrator on Call was not consulted.

This deficiency represents non-compliance investigated under Substantial Allegation OH00143111.