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Based on document review an interviews, it was determined that the Hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The Hospital failed to maintain an accurate ED Log. Refer to A-2405.

2. The Hospital failed to ensure that a medical screening examination was completed to determine if a medical emergency existed. Refer to A-2406.

Based on a document review and interview, it was determined for 1 of 20 patients (Pt #1) presenting to the emergency department (ED), the Hospital failed to ensure the patient was documented in the Emergency Department Log.

Findings include:

1. The ED Log was reviewed from 2/1/25-4/8/25 with the ED Director (E #3) on 4/7/25 at 11:00 AM. There was no evidence that Pt #1 was included on the ED log.

2. On 4/8/2025 a policy titled, "ED Electronic Log (Revised 9/2012) was reviewed. The review revealed, "Each patient presenting to the Emergency Room requesting medical care will be triaged, a chart created and will be entered into the ED Registry Electronic Log."

3. On 4/7/25 at 1:30 PM an interview was conducted with ED Medical Director/ED Physician (E #9). E#9 was asked if he could recall a patient that presented on 3/1/25 with an eye injury, E#9 remembered (Pt#1). E#9 stated, "(Pt#1) was a Spanish speaking man who came in with (Pt#1's) brother's girlfriend. (Pt#1) had a piece of wood in the upper lid of (Pt#1's) eye, going into (Pt#1's) eyeball. (Pt#1) appeared inebriated. I (E#9) told (Pt#1's) brother's girlfriend, that (Hospital A) can see the patient, but (Pt#1) would be transferred because (Hospital A) does not have ophthalmology. (Hospital A) doesn't even have a slit lamp (machine that examines eye structure). I (E#9) told the (Pt#1's) brother's girlfriend that (Pt#1) would either be transferred to (three other outside facilities named), and as soon as (Pt#1's brother's girlfriend) heard the word 'transfer,' (Pt#1's brother's girlfriend) yanked (Pt#1) away and out of the hospital. We (Hospital A) did not log (Pt#1) into the ED log but should have." E #9 verbally agreed that the Facility did not log in Pt#1.

Based on document review and interview, it was determined that in 1 of 20 (Pt #1) Emergency Department (ED) records reviewed, the Hospital failed to ensure that all patients who came to the Emergency Department (ED) were provided an appropriate medical screening examination (MSE).

Findings include:

1. The policy titled, "EMTALA Medical Screening (Revised 3/2021)" was reviewed. The policy noted, " ... General requirements A. In general when an individual comes by him or herself or with another person to the Emergency Department of the Hospital, and a request for a medical examination or treatment is made by the individual or on the individual's behalf, the Hospital must 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 an emergency medical condition exists, or with respect to a pregnant woman having contractions whether the woman is in labor ... B. The Hospital is obligated to perform the medical screening examination to determine if an emergency medical condition exists. It is not appropriate to merely 'log in' a patient and not provide a medical screening examination ... E. The hospital must provide screening and stabilizing treatment within the scope of its abilities, as needed, to the individuals with emergency medical conditions who come to the hospital for examination and treatment. F. All refusals for medical screening or leaving without being seen shall be documented in accordance with the Hospital's Against Medical Advice policy. Such documentation should include a statement that the patient was informed by hospital staff of the risk and benefits of being screened and the types of examinations refused. All reasonable steps to secure refusal in writing will be made."

2. The ED Log was reviewed from 2/1/25-4/8/25 with the ED Director (E #3) on 4/7/25 at 11:00 AM. Pt#1 was not included on the on log. A request was made for Pt#1's record at Hospital A. No record was provided as Pt#1 was not included on the ED log and was never registered at Hospital A. There was no medical screening exam (MSE), no lab work completed, or any other treatment/stabilization done for Pt#1. During the log review, E #3 confirmed that Pt #1 was included on the ED Log and had never been registered. Therefore Pt #1 had no medical screening exam, no testing and no treatment completed.

3. Pt#1's record at Hospital B was reviewed throughout survey. Pt#1 arrived by car on 3/1/25 at 12:11 PM for eye trauma. The ED RN triage note (by complainant) on 3/1 at 12:21 PM stated, '"I was cutting some trees and a branch hit me (Pt#1) in my eye.' Patient (Pt#1) presents with laceration to his left eyelid with tissue protruding out. No LOC (loss of consciousness) reported." Pt#1's acuity was noted as emergent and a Medical Screening Exam was completed at 12:23 PM by an ED Provider. The ED Provider at (Hospital B) noted, "Eye Trauma: Location: Was cutting tree and a twig got impaled in left eye through eyelid. Severity: Severe ... Duration: 1 hour ... Physical Exam: ... (record showed diagram image of left eye with wording) laceration unable to open lid ... Medical Decision Making: CT (computed tomography) of the orbits with contrast: ... Impression: Nondisplaced fracture of the left frontal sinus/superior extraconal orbit and associated small left frontal extra-axial hematoma and pneumocephalus. Pt#1 received antibiotics and pain medication while in the ED at Hospital B. ED MD contacted (Hospital C - Trauma Center) to arrange transfer at 1:47 PM. Pt #1 was then transferred by helicopter to Hospital C (higher level of care) at 2:02 PM.

4. On 4/7/25 at 1:30 PM, an interview was conducted with (Hospital A) ED Medical Director/MD (E#9). E #9 was asked if he could recall a patient that presented on 3/1/25 with an eye injury, E#9 remembered (Pt#1). E#9 stated, "(Pt#1) was a Spanish speaking man who came in with (Pt#1's family). (Pt#1) had a piece of wood in the upper lid of (Pt#1's) eye, going into (Pt#1's) eyeball. There was nothing I could do as the wood was in the orbital socket, and it would be malpractice to touch it. There was nothing to stabilize." E #9 confirmed that no MSE was completed and no care was provided to Pt #1 at Hospital A.