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Based upon interview and document review, it was determined that the facility failed to ensure compliance with 42 CFR 489.24 and the related provisions at 42 CFR 489.20.

Findings include:

Interviews and document review revealed the facility did not comply with all of the provisions of maintaining a central log and conducting a medical screening exam. Please reference findings under Tag A2405 and 2406.

Based on document review and interview, the facility failed to ensure that all individuals presenting to the Emergency Department (ED) are entered into the central log for 1 of 12 Patients (Patient A).

Findings include:

Review on 7/13/15 of the Rural Metro Patient Care report dated 7/5/15 revealed Patient A was picked up at the Air Base at 9:29pm and transported to the ED arriving at 9:50pm.

Interview on 7/13/15 at 9:00am with Staff # 3, Risk Manager revealed no medical record was found for Patient A.

Interview on 7/13/15 at 10:20am with Staff # 7, MD, Chief of ED Services and with Staff #5, RN ED Charge Nurse confirm Patient A presented via ambulance on 7/5/15 but they did not document the event.

Review on 7/13/15 of the ED Daily Log dated 7/5/15 revealed no evidence Patient A presented to the facility's ED.

Review on 7/13/15 of policy "Screening, Stabilization and Transfer of Patients to Other Institutions- EMTALA/COBRA" last revised 1/2015 revealed a central log will be maintained for all persons who come to the emergency department.

Based upon interview and document review, the hospital did not provide an appropriate medical screening examination for 1 of 12 Patients (Patient A) who presented to the Emergency Department (ED).

Findings include:

Review on 7/13/15 of the Rural Metro Patient Care report dated 7/5/15 revealed Patient A was picked up at the Air Base at 9:29pm and transported to the ED arriving at 9:50pm. The ED was phoned while enroute advising them of the situation. The ED denied EMS entry into the facility because they felt Patient A has Ebola and told them to stay outside in the ambulance. After an hour and 10 minutes of waiting with no response from the ED, Patient A had enough of waiting and signed out. At no point during the hour and 10 minute wait outside did any MD or nurse make contact with Patient A to actually see what was going on. The ambulance was back in service at 11:24pm.

Interview on 7/13/15 at 10:20am with Staff # 7, MD, Chief of ED Services and with Staff # 5, RN ED Charge Nurse revealed Patient A was not triaged or medically screened while present at the facility on 7/5/15.

Review on 7/13/15 of policy "Screening, Stabilization and Transfer of Patients to Other Institutions- EMTALA/COBRA " last revised 1/2015 revealed a medical screening examination must be provided to all patients who present to the ED by "qualified medical personnel" present at the hospital upon the patient's arrival to determine whether an emergency medical condition exists. Hospital property is the hospital's campus defined as an area that is 250 yards around the main hospital building.

Review on 7/13/15 of the Medical Staff Rules and Regulations last revised 4/23/15 revealed a medical screening examination will be provided to all patients who present for care, treatment and services at the Hospital. This examination can be performed by an ED or Attending Physician, a Physician Assistant, a Nurse Practitioner or Nurse Midwife.