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Based on observation, record review and interview, the facility failed to ensure compliance with Emergency Medical Treatment and Active Labor Act (EMTALA) regulations in 3 of 11 required areas (Sign Posting, Log Maintenance, and Appropriate Medical Screening). Systemic failures have the potential to affect all patients presenting for emergency services at this facility'

Findings include:

The facility failed to ensure that the required EMTALA signs were placed at the entrance to the ED and the Triage treatment area. (See Tag 2402)

The facility failed to maintain a complete ED Log in 1 of 1 ED logs observed. (See Tag 2405)

The facility failed to provide a Medical Screening Exam for 2 of 2 patients presenting to the ED. (See Tag 2406)

Based on observation and interview this facility failed to ensure Emergency Medical Treatment and Labor Act (EMTALA) signs are posted in places likely to be noticed by all individuals entering the Emergency Department (ED) and receiving treatment in the ED in 2 of 16 ED areas observed (ED entrance and triage room).

Findings include:

During a tour of the ED on 1/25/2022 at 9:40 AM the entrance to the ED was observed to have a sign that read, "If experiencing a possible medical emergency, please proceed to Emergency Department for a medical screening exam." The sign did not contain all of the EMTALA signage requirements including right to receive treatment if in labor, language that if unable to pay treatment would be provided and a statement the the facility participates in the Medicaid program.

Observation in the ED triage Room revealed no posted EMTALA signage. This was confirmed in interview with ED Manager C on 1/25/2022 at 9:40 AM who stated, "It used to be posted in here, not sure who took it down."

In an interview on 1/25/2022 at 9:50 AM with ED Director B, Director B stated that the facility had made a decision to not have the entire EMTALA signage posted at the entrance because they felt it was too confusing with the all of the Covid signage.

Based on record review and interview the facility staff failed to ensure that there was a completed central log entry for each individual who presented to the Emergency Department (Pt. #1 and Pt. #2) in 2 of 21 medical records reviewed and failed to ensure discharge disposition was included in the log in 50 of 5,240 patients entered in the log.

Findings include:

In an interview on 1/19/2022 at 3:50 PM with Pt. (patient) #1, Pt. #1 stated that on 12/15/2021 he and his family were in a confined space and exposed to a bat. On 12/16/2021 Pt. #1 called the Public Health Department for guidance on whether he and his family should receive the rabies vaccine. Public Health advised them to go to the ED to begin the rabies series. Pt. #1 stated that he presented with Pt. #2 to this facility's ED on 12/16/2021 requesting the rabies vaccine.

In an interview on 1/25/2022 at 9:45 AM with ED Registrar F, Registrar F stated, "I remember a father and daughter came to the ED last month requesting rabies vaccines."

A review of the Emergency Department (ED) log was conducted on 1/25/2022 at 11:00 AM. Quality D presented what she/he referred to as, "A report that we run out of Epic (the facility's electronic medical record)." The "report" was from 7/1/2021 to 1/25/2022.

Review of the 12/16/2021 date on the ED Log that Pts. #1 and 2 stated they came to the ED revealed no entry for either Pt. #1 or #2. This was confirmed in interview on 1/25/2022 at 11:00 AM with ED Manager C.

Further review of the ED Log revealed 50 patient entries where the discharge disposition was missing.

In an interview on 1/25/2022 at 11:10 AM with ED Manager C when asked if he/she considered the report the official ED Log Manager C stated, "I guess I would say yes, that is our log." When asked about the missing discharge dispositions Manager C stated, "If the doctor doesn't enter it then it doesn't get pulled to the report."

Based on record review and interview, staff in the ED (Emergency Department) of this facility failed to ensure that patients presenting to the ED with a potential emergent condition receive an appropriate Medical Screening examination in 2 of 2 patients (Pts. #1 and #2) out of a total of 21 medical records reviewed.

Findings include:

Per the CDC (Centers of Disease Control) website (www.cdc.gov) "Postexposure prophylaxis (PEP) consists of a dose of human rabies immune globulin (HRIG) and rabies vaccine given on the day of the rabies exposure, and then a dose of vaccine given again on days 3, 7, and 14. For people who have never been vaccinated against rabies previously, postexposure prophylaxis (PEP) should always include administration of both HRIG and rabies vaccine. The combination of HRIG and vaccine is recommended for both bite and non-bite exposures, regardless of the interval between exposure and initiation of treatment."

In an interview on 1/19/2022 at 3:50 PM with Pt. (patient) #1, Pt. #1 stated that on 12/15/2021 he and his family were in a confined space and exposed to a bat. On 12/16/2021 Pt. #1 called the Public Health Department for guidance on whether he and his family should receive the rabies vaccine. Public Health advised them to go to the ED to begin the rabies series. Pt. #1 stated that he presented with Pt. #2 to this facility's ED on 12/16/2021 requesting the rabies vaccine and states he was told, "If you didn't get bit we won't give the vaccine."

In an interview on 1/25/2022 at 10:10 AM with ED Dr. H, when asked if the ED stocks rabies vaccine Dr. H stated, "Yes we do."

In an interview on 1/25/2022 at 9:45 AM with ED Registrar F, Registrar F stated, "I remember a father and daughter came to the ED last month requesting rabies vaccines." When asked if everyone that presents to the ED registration window gets registered, Registrar F stated, "Yes." When asked why they were not registered Registrar F stated, "I called the nurse to talk with him and after he left, I don't know why we never got them registered."

In an interview on 1/25/2022 at 11:55 AM with RN E, RN stated that he/she remembered the patient and daughter coming to the ED and the Registrar asked him/her to come talk with them. "Since he/she wasn't sure they were actually bit by the bat I told him that I couldn't guarantee that they would receive the rabies vaccine as requested, the doctor would decide and then the patient and his daughter left."

Requested and received medical records from the Urgent Care clinic where Pt. #1 went seeking treatment on 12/17/2022. Record review of those medical records revealed that he and Pt. #2 were seen by a provider and received the first of 4 rabies vaccines.

Patients #1 and 2 were not registered in the ED and were given conflicting information about whether the vaccine could be administered in the ED leading Patients #1 and 2 to leave the ED without the medical screening exam and seek treatment at another provider.