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Based on policy review, medical record reviews, surveillance video review, Central Log review and interviews, it was determined the facility failed to ensure that an appropriate medical screening examination was provided 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 existed for 1 (Patient#1) of 21 sampled patients.

Please refer to citation at A Tag A 2406.

Based on policy review, medical record reviews, surveillance video review, Central Log review and interviews, it was determined the facility failed to ensure that an appropriate medical screening examination was provided 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 existed for 1 (Patient#1) of 21 sampled patients.

The findings included:


Facility policy, titled, EMTALA Medical Screening Examination and Stabilization, last revised 10/2024 revealed, in part, "Procedure: ... An MSE (Medical Screening Examination) is required when: a. A request is made by the individual or on the individual's behalf for examination or treatment for a medical condition ... 1. When an MSE is Required: A hospital must provide an appropriate MSE within the capability of the hospital's emergency department, including ancillary services routinely available to the DED (Dedicated Emergency Department), to determine whether or not an EMC (Emergency Medical Condition) exists: (i) to any individual ... (ii) an individual who has such a request made on his or her behalf; or (iii) an individual whom a prudent layperson observer would conclude from the individual's appearance or behavior needs an MSE. An MSE shall be provided to determine whether or not the individual is experiencing an EMC."


Observation of the surveillance video in the security office while accompanied by Vice President of Quality, the Director of Patient Safety and the ED Director conducted on 12/10/24 at 12:18 PM revealed the following:
On 10/27/24 at 02:51 AM, Patient #1 and parents arrived at the ED and interact with Staff A. Staff A is seen leaving the triage desk.
At 02:53 AM, ARNP (Advanced Registered Nurse Practitioner) and Staff A returned to the triage desk and the practitioner is seen interacting with the family and leaves the area at approximately 02:55 AM.
At 02:55 AM, Family interacts with Staff A and then leave the ED at 02:57 AM.


Review of the central log indicated Patient #1 returned to the ED on 10/27/24 at 02:51 AM.

The medical record for Patient #1's second visit to the hospital's ED was reviewed. The stated complaint was listed as "Abdominal Pain." Review of the Nurse's notes dated 10/27/24 at 02:59 AM documentation revealed, "Parents of patient do not want child to be seen by a doctor at this time." Patient #1 left the ED at 03:03 AM. The record failed to provide evidence that a medical screening examination was provided. The facility failed to ensure that their policy and procedure was followed as evidenced by failing to ensure that an appropriate medical screening examination was provided that was within the capability of the hospital's emergency department, including ancillary services routinely available to the DED, to determine whether or not an EMC existed for Patient #1 when a request made on her behalf for medical examination or treatment of a medical condition on 10/27/2024.

Medical record review revealed that Patient #1 arrived a Hospital B on 10/27/24 at 3:37 AM with chief complaint of Shortness of breath, left side pain, cough and previously diagnosed with Pneumonia.
Medical screening exam 10/27/2024 0356
Chief Complaint
Sob (shortness of breath), left side pain, coughing/ diagnosed with pneumonia
Arrival Mode to Facility: Walking (10/27/24 03:37:00)
History of Present Illness
6-year-old female who was diagnosed with pneumonia earlier tonight brought in for
complaint of left-sided chest pain. The family state that the child developed cough and fever for which she was evaluated at a peripheral facility where she was diagnosed with pneumonia and discharged home on Augmentin (antibiotic used to treat infections) few hours ago. They state that on returning home she complained that her left side was hurting and was short of breath for which they brought her in for reevaluation. No medication was given prior to arrival. The child currently has no such complaints. Physical Exam: Triage Vitals and Measurements: 10/27/24 03:37
T: 36.7 Deg (degrees) C (Centigrade) Temperature Oral; HR (heart rate):141(HI) bpm (beats per minute)Peripheral Pulse; Rate RR (respiratory rate); 22; and SpO2 (oxygen saturation): 97 %: Room air Oxygen
General: Alert, no acute distress
Head: Atraumatic
ENMT(ear,nose, mouth and throat): Normal inspection
Respiratory: No respiratory distress
Cardiovascular: Regular rate and rhythm
Gastrointestinal: Abdomen is soft
Skin: No rash
Medical Decision Making/Documents Reviewed
6-year-old female who was diagnosed with pneumonia earlier tonight brought in for
complaint of chest pain/shortness of breath. Physical exam is unremarkable, the child
is in no obvious distress. Family was counseled on supportive care and follow-up
Reevaluation
Reassessed 10/27/24 04:27
HR: 108 bpm Peripheral Pulse Rate RR: 20 SpO2: 98 %
Assessment/Plan
1. Upper respiratory tract infection Acute upper respiratory infection, unspecified
2. Pneumonia: Pneumonia, unspecified organism
DISCHARGE INFORMATION
ED Discharge Disposition: Home
ED Checkout Date and Time: 10/27/2024 04:29:46


Interview with the Vice President of Quality, the Ethics and Compliance Officer and the ED Director conducted on 12/09/24 at 11:14 AM revealed the facility identified the incident and self-reported the possible violation. The nurse was not clear on the medical screening process, suggested to the patient's parents to go to Hospital B for pediatric care, and corrective actions have been initiated.

Interview with Staff A, the Registered Nurse who triaged Patient #1 was conducted on 12/10/24 at 11:19 AM. Staff A explained his recollection of the events as follows: the family arrived with a little girl around 11:00 PM, the parents were scared as she was having shortness of breath, the nurse was placing patients and put the child in the fast-track area. The patient was treated and discharged. Then they came back, a couple of hours later, saying they were having the same symptoms, and that the child was not better. Staff A advised the practitioner (ARNP) who previously treated the patient of the child's return and asked her to speak to the patient. The practitioner then explained to the parents that the child had Pneumonia and that she has to take her medication. Staff A stated to the family that they could see her again, or if they would like to go to a pediatric hospital and the family replied yes, that they would like to go to a pediatric hospital, and Staff A then gave them the information about Hospital B. Staff A realizes that he made a mistake, and no patient should be deterred from being seen and receiving a medical screening exam.

Interview with the ARNP conducted on 12/10/24 at 11:38 AM revealed the practitioner had no recollection of Patient #1. After review of the electronic record, she recalled the first visit when the patient was treated and discharged but stated she does not see patients in the lobby, she would see them in the back and does not recall talking to the family during the second visit to the ED.

Interview with the ARNP conducted on 12/10/24 12:55 PM revealed, after seeing the video, recalled the child returned, she had received the first dose of antibiotic, the family was concerned that they could not get the medication during the night, she explained that the child did not need the medication until the next morning, and that was it. The ARNP stated she would have seen the patient, but they left.