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Based on observation and interview, the hospital failed to ensure signs were posted conspicuously in places likely to be noticed by all individuals entering the emergency department (ED) specifying the rights of individuals under section 1867 of the Emergency Medical Treatment and Active Labor Act (EMTALA), with respect to examination and treatment for emergency medical conditions and women in labor, and to post conspicuously information indicating whether or not the hospital participated in the Medicaid program under a State plan approved under Title XIX. The hospital did not have EMTALA signage posted in the ambulance entrance to the emergency department.

Findings:

On 09/28/2022 at 8:50 a.m., a tour of the emergency department with S1CNO and S2EDDIR was conducted. The tour revealed there was no EMTALA signage posted in the ambulance entrance to the emergency department.

In an interview on 09/28/2022 at 8:50 a.m. with S1CNO, she verified there was no EMTALA signage in the ambulance entrance to the emergency department and that there should have been.

Based on record review and interview the hospital failed to perform an appropriate medical screening exam which resulted in a delay in treatment as evidenced by Patient #1 presenting with back pain, difficulty ambulating, having had a recent spinal injection, history of diabetes and her inflammatory markers tested, white blood cell count, the neutrophils, the ESR, and the CRP, in the emergency department were markedly positive. The hospital also failed to ensure repeat vital signs were taken and reported prior to discharge and perform radiology test of Patient #1's back. Patient #1 was later diagnosed with an epidural abscess.

Findings:

A review of Patient #1's medical record revealed she was admitted to the emergency department on 7/21/2022 with a chief complaint of uncontrolled back pain.
Patient #1's triage vital signs at 4:00 p.m. were blood pressure 146/67, O2 96%, Pulse 96, respirations 16, Temperature 99.4.
MD exam at 4:19 p.m. complaint of difficulty walking since Epidural Steroid Injection in her lower back the week before. Difficulty with ambulation getting to the bathroom.

Labs: CBC: Abs Neutrophils automated 11900 / uL, Neutrophils automated 87%, Sedimentation rate 71 mm/hr, C- Reactive Protein 15.3 mg/dL and a glucose of 236 mg/dL.

Patient #1 received x-rays of bilateral hips with pelvis. X-rays were normal.

Patient #1 was discharged on 07/21/2022 at 9:55 p.m. via wheelchair.

Further review failed to reveal any nursing pain assessment, discharge vital signs or radiology test of Patient #1's back.

A review of the hospital policy Repeat Vital Signs Department Emergency Department revealed in part:
4. Vital signs will be obtained within 1 hour or before admission/ transfer/ discharge from the Emergency Department.

In an interview on 11/30/2022 at 1:07 p.m. S4RN verified the above vital signs as the only vital signs taken for Patient #1. S4RN also verified the above lab values were out of range and no radiology test were performed on Patient #1's back or spine.

In an interview on 11/30/2022 at 1:20 p.m. S4RN verified no pain assessment was documented.

In an interview on 11/30/2022 at 1:23 p.m. S3RN verified the Emergency Department Vital Sign Policy, reviewed Patient #1's medical record and verified Patient #1 should have had repeat vital signs prior to discharge. S3RN also confirmed the hospital had the capability of performing Magnetic Resonance Imaging.

A review of Patient #1's medical record from Hospital B revealed she was seen on 07/22/2022 and diagnosed with an epidural abscess.