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Based on documentation review and staff interview the hospital failed to ensure patients presenting to the offsite Emergency Department in New Albany, Ohio receive a medical screening exam (A2406) and failed to provide stabilizing treatment (A2407). The cumulative effect of this systemic practice resulted in the hospital's inability to ensure that all patients arriving at the emergency department would receive a medical screening exam and stabilizing treatment. The facility averaged 1112 patient visits the month of September 2019.

Based on documentation review and staff interview it was determined the hospital failed to provide an appropriate medical screening for a patient (#1) who presented to the hospital's offsite Emergency Department located in New Albany, Ohio. The total sample size was 20 medical records reviewed. The facility averaged 1112 emergency room visits in September 2019.

Findings include:

Review of Policy and Procedure Number: P-100.055 Titled: Compliance with the Emergency Medical Treatment and Active Labor Act ( Effective date 12/19/16) states the hospital must provide for 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, or with respect to a pregnant woman whether the woman is in labor. A medical screening examination is required when:
1). An individual comes by him or herself or with another person to the Emergency Department and a request is made by or on the individuals behalf for the examination or treatment of a medical condition.

1. An interview was conducted with Staff F (Director of Quality and Accreditation) on 10/29/19 at 9:00 AM who reported the hospital may have an (EMTALA) violation at the hospital's offsite Emergency Department (ED) located in New Albany, Ohio. Staff F stated it was reported on 09/27/19 Patient #1 was transported via emergency medical service (EMS) and was not assessed and/or stabilized within the emergency department.

2. A phone interview was conducted with Staff J (Registered Nurse) on 10/30/19 at 8:30 AM who reported receiving the EMS call concerning Patient #1 en-route for breathing issues. Staff J stated when the squad arrived the other nurse on staff was discussing do not resuscitate (DNR) paperwork with the paramedic and then told the paramedic to "carry on" to another facility. Staff J stated he/she advised the nurse that the expectation is that every patient is to be seen, stabilized, and/or transferred to a higher level of care based on the physicians' decision. Staff J stated he/she set up a resuscitative room prior to Patient #1 arriving because the ED has the capability to manage a coding patient. All staff were aware of Patient#1 being en-route via the emergency squad.

3. A phone interview was conducted with Staff D (ED Physician) on 10/30/19 at 9:00 AM who reported he/she was just finishing up the 6:00 PM to 6:00 AM shift and was in the back of the emergency department. Staff D stated there were no patients in the emergency department at this time. Staff D stated he/she did hear the nurse taking report from the emergency squad regarding a hospice patient en-route. The nurse was requesting the DNR paperwork to be faxed to the facility. Staff D stated he/she recalled hearing the paramedic verbalize when departing that he understood and will take the patient to the closest emergency department. Staff D stated the patient did not receive a medical screening examination.

4. A phone interview was conducted with Staff K (Radiology Technician) on 10/30/19 at 12:00 PM who reported the emergency squad arrived to the facility and Patient #1 was seen in the building on the stretcher. One paramedic was witnessed bagging Patient #1 while another paramedic was at the nurses station. Staff K stated the nurses were saying the patient was inappropriate for this Emergency Department and a nurse advised the paramedic to take Patient #1 to another nearby hospital at which time the emergency squad departed the facility with the patient.

5. A phone interview was conducted with Staff L (ED Registrar) on 10/30/19 at 12:30 PM who observed the nurse taking report from the squad of Patient #1 en-route. Staff L stated he/she overheard the nurses talking prior to the squad arriving, saying how inappropriate it was to bring Patient #1 to this emergency department. Staff L stated he/she observed one nurse talking to the paramedic about how Patient #1 should not be at the facility. Staff L stated the physician was in the nurses station and was aware of the patient en-route to the emergency department. No one physically assessed the patient, registered the patient or moved the patient to a room within the emergency department.

6. Staff B (Medical Director) for hospital's offsite ED confirmed in an interview on 10/29/19 at 9:29 AM the expectation is a medical screen should be completed, the patient stabilized, and an appropriate transfer to a higher level of care if needed. Staff B stated this was an EMTALA violation and they should have treated and transferred this patient.

Based on documentation review and staff interview it was determined the hospital failed to provide stabilizing treatment for a patient (#1) who presented to the hospital's offsite Emergency Department in New Albany, Ohio. The total sample size was 20 medical records reviewed. The facility averaged 1112 emergency room visits in September 2019.

Findings include:

Review of Policy and Procedure Number: P-100.055 Titled: Compliance with the Emergency Medical Treatment and Active Labor Act ( Effective date 12/19/16) states if an individual is determined to have an emergency medical condition, the patient will be provided treatment to stabilize the individual's emergency medical condition within the capability of its Emergency Department ( including routinely available ancillary services) or provide an appropriate transfer.

On 10/29/19 at 2:34 PM the medical record for Patient #1 was obtained from the receiving hospital. The medical record review revealed Patient #1 arrived to the emergency department in a code blue status and continued to require resuscitative efforts in the emergency department. Patient #1 expired in the Emergency Room on 09/27/19 at 7:03 AM once it was determined to cease all resuscitative measures per the family request. The discharge diagnosis was noted to be cardiac arrest.

1. A phone interview was conducted with Staff J (Registered Nurse) on 10/30/19 at 8:30 AM who reported receiving the EMS call concerning Patient #1 en-route for breathing issues. Staff J stated when the squad arrived the other nurse on staff was discussing do not resuscitate (DNR) paperwork with the paramedic and then told the paramedic to "carry on" to another facility. Staff J stated he/she advised the nurse that the expectation is that every patient is to be seen, stabilized, and/or transferred to a higher level of care based on the physicians' decision. Staff J stated he/she set up a resuscitative room prior to Patient #1 arriving because the ED has the capability to manage a coding patient. All staff were aware of Patient #1 being en-route via the emergency squad.

2. Staff B (Medical Director) for hospital's offsite ED confirmed in an interview on 10/29/19 at 9:29 AM the expectation is a medical screen should be completed, the patient stabilized, and an appropriate transfer to a higher level of care if needed. Staff B stated this was an EMTALA violation and they should have treated and transferred this patient.