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Based on medical record review, document review, and staff interview the hospital failed to comply with their provider agreement to provide an appropriate medical screening exam (MSE) to determine if an emergency medical condition exists for 1 of 21 records selected from the Emergency Department (ED) log for review (Patient #1). The ED treated approximately 1,382 patients in the six-month period from July 2016 to December 2016 and transferred approximately 41 patients in the same six months to another healthcare facility.

Failure to conduct an MSE to include ancillary studies and procedures with evidence of continued monitoring and evaluation according to the individual's needs placed the patient at risk for a worsening of conditions that could potentially lead to further complications or death.

Findings include:

- Medical Staff Rules and Regulations reviewed on 1/18/2016 at 6:30 AM directed "...Any individual who presents themselves for emergency treatment in the emergency room shall be provided with an appropriate medical screening examination to determine if an emergency medical condition exists. Depending upon patient complaint and condition, individuals qualified to conduct such a screening examination within (Hospital A) includes physicians, advanced registered nurse practitioners, physician assistants and registered nurses. In addition to physicians, social workers are qualified individuals to perform mental health screenings.

- Policy titled Medical Screening exam reviewed on 1/18/2016 at 6:45 AM directed "... Any person who comes to (Hospital A) requesting assistance for a potential emergency medical condition/emergency service will receive a medical screening performed by a qualified provider to determine whether an emergency medical condition exists...and...A medical screening examination is required when an individual: Seeks care at the hospital Emergency Department, Arrives anywhere on the hospital premises and states that he or she has an emergency ..."

- Documents reviewed on 1/17/2017 at 2:00 PM revealed this facility failed to register a patient (patient #1) in the Emergency Department Log book, lacked any documentation of a medical record for patient #1, failed to perform a medical screening exam for patient #1 prior to the patient departing this hospital and traveling 67 miles or approximately one hour away to Hospital B, and failed to communicate with Hospital B regarding patient #1's arrival.

- Patient #1's medical record from Hospital B reviewed on 1/18/2017 at 7:00 AM revealed the patient arrived on 1/10/2017 at 4:50 PM where they received a medical screening exam.



See further evidence at 2406.

Based on medical record review, document review, and staff interview the hospital failed to comply with their provider agreement to provide an appropriate medical screening exam (MSE) to determine if an emergency medical condition existed for 1 of 21 records selected from the ED (Emergency Department) log for review (Patient #1) from the past 6 months from July 2016 to December 2016.

Failure to conduct an MSE to include ancillary studies and procedures with evidence of continued monitoring according to the individual's needs placed the patient at risk for a worsening of their condition that could potentially lead to further complications or death.

Findings include:

- Registered Nurse Staff F's Report filed on 1/10/2017 and reviewed on 1/17/2017 at 4:00 PM revealed Patient #1 presented to Hospital A via wheelchair with a family member on 1/10/2017. The patient stated they were from a nursing home. The nursing home was contacted to determine why the patient was at their facility and Staff F discovered the patient was supposed to go to Hospital B (located 67 miles or approximately one hour away) per request of their (patient #1's) primary care physician. Staff F informed the patient's family they were at the wrong location. The patient and family member left the facility.

- Document review on 1/17/2017 at 2:00 PM revealed Hospital A lacked documentation of any kind including a medical record for patient #1's ED visit on 1/10/17. Hospital A failed to register patient #1 in the Emergency Department Log book on 1/10/17 when the patient appeared seeking care and failed to show evidence they performed a medical screening exam to determine whether the patient had an emergency medical condition prior to sending the patient to Hospital B.


- Registered Nurse Staff C (Emergency Department Manager) interviewed on 1/18/2017 at 8:45 AM revealed Secretary Staff J, was with the patient, who was in a wheelchair, and asked where s/he should put the patient. Staff C indicated they asked the family member and was told the nursing home called them and said that the patient' s doctor wanted them to go to the emergency department. Staff C stated, "I wasn't even thinking about the MSE or of them being a patient so after we identified s/he was in the wrong place I just didn't think to do the MSE". Staff C stated, "The minute the Director of Nursing Staff B told me; I knew I should have done the MSE" and "My expectation is that anytime a patient presents they will get an MSE".

- Patient #1's family member interviewed by phone on 1/18/2017 between 1:30 PM and 1:45 PM indicated they were called by the patient's nursing home in the afternoon of 1/10/2017 and told the patient's doctor wanted them to go to the hospital for some testing. The family member stated, "I wasn't told to go to a specific hospital and since (Hospital A) was closer I chose to go there". The family member indicated when they got to hospital A they told the staff that the patient needed some tests because s/he had lost weight and was weaker than normal. A lady (nurse) called the nursing home and then told me I needed to go to Hospital B.

- Physician Staff E, ED Medical Director interviewed on 1/18/2017 at 8:55 AM indicated they were aware of the situation, but was not in the ED at the time of the incident. Staff E revealed their expectation is that "Any possible patient needs to be screened and the on call physician should be called".

The hospital failed to complete an appropriate medical screening exam in a timely manner for a patient (patient #1) presenting to the hospital seeking assistance for a potential emergency medical condition. This deficient practice had the potential to cause worsening of the patient's condition including death.