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Based on findings at A2405 and A2406, the facility failed to ensure compliance with Code of Federal Regulations (CFR) 489.24.

Based on interview and document review, the facility failed to register 1 of 42 sampled patients in the central log upon arrival to the emergency department by ground ambulance (Patient 42).

Findings include:

Patient 42

A Patient Care Report Summary provided by Community Ambulance dated 12/28/2024, revealed documentation that upon arrival to the Emergency Department (ED) at 2:23 AM, Patient 42 was wheeled into ED via a gurney and ED staff refused to accept the patient, register the patient, treat the patient and in quotes, "You guys can take him back to the street corner."

A facility policy entitled, Emergency Medical Treatment and Labor Act (EMTALA), revealed under Central Log Procedure C. The Central Log must contain at a minimum, the name of the individual, date, arrival time, means of the individual's arrival, age, sex, individual's complaint, disposition, time of departure, and whether the individual was refused treatment.

On 03/11/2025 at 4:10 PM, interview with Community Ambulance Employee 1 acknowledged upon arrival, ED staff refused to accept, register, and treat the patient and asked to have the patient rolled back out of the ED. Community Ambulance Employee 1 refused and did not want to be a part of an EMTALA violation.

On 03/12/2025 at 10:15 AM, interview with Community Ambulance Employee 2 acknowledged the ED Charge Nurse would not allow the patient to be registered. Community Ambulance Employee 2 stated, "the Charge Nurse, two Registered Nurses (RN), and ED Technician all approached us "very upset" with the patient and at us for transporting Patient back to the ED."

On 03/12/2025 at 2:20 PM, a Certified Nursing Assistant/ED Technician (Employee 6) confirmed a directive from the ED Charge Nurse not to register Patient 42. Employee 6 indicated the Charge Nurse instructed the ambulance crew to transfer the patient to a wheelchair, which they refused. The Employee confirmed transferring the patient off a gurney to a wheelchair and rolling the patient out of the ED to a police car.

Upon request, the facility was unable to produce evidence the patient was registered or had an encounter with a Licensed Independent Practitioner (LIP) following the transport to their facility by ground ambulance on 12/28/2024 at 2:23 AM.

Complaint NV00073094

Based on interview and document review, the facility failed to provide a medical screening exam and treatment for 1 of 42 sampled patients (Patient 42). The failure to provide a medical screening exam and treatment for this patient had the potential to place the patient at increased risk of harm or illness.

Findings include:

Patient 42

A facility policy entitled, Emergency Department Triage, revealed that all patients presenting to the Emergency Department will have an initial triage assessment performed by a Registered Nurse (RN).

A facility policy entitled, Emergency Medical Treatment and Labor Act (EMTALA), revealed to comply with EMTALA, the hospital will provide an individual with an appropriate medical screening examination (MSE) within the capacity of the hospital's emergency department (ED), including ancillary services available to the ED.

In a Patient Care Report Summary provided by Community Ambulance dated 12/28/2024, it was documented that upon arrival to ED at 2:23 AM, Patient 42 was wheeled into ED via a gurney and ED staff refused to accept the patient, register the patient, treat the patient and in quotes, "You guys can take him back to the street corner."

On 03/11/2025 at 4:10 PM, interview with Community Ambulance Employee 1 revealed Patient 42 was observed lying on the roadway near the hospital. Community Ambulance Employee 1 stated the patient had a recent amputation below the right knee and complained of pain in left lower leg. Community Ambulance Employee 1 acknowledged upon arrival to the ED, staff refused to accept, register, and treat the patient and asked to have the patient rolled back out of the ED.

On 03/12/2025 at 10:15 AM, interview with Community Ambulance Employee 2 acknowledged finding Patient 42 in the roadway near hospital property. Community Ambulance Employee 2 confirmed the lower left leg and ankle of Patient 42 was "very swollen". Community Ambulance Employee 2 indicated the ED Charge Nurse would not allow the patient to be registered. Community Ambulance Employee 2 stated, "the Charge Nurse, two RNs, and ED Technician all approached us "very upset" with the patient and at us for transporting Patient back to the ED."

On 03/12/2025 at 2:20 PM, a Certified Nursing Assistant/ED Technician (Employee 6) confirmed a directive from the ED Charge Nurse not to register Patient 42. Employee 6 indicated the Charge Nurse instructed the ambulance crew to transfer the patient to a wheelchair, which they refused. The Employee confirmed transferring the patient off a gurney to a wheelchair and rolling the patient out of the ED to a police car.

On 03/13/2025 at 8:30 AM, the ED Medical Director acknowledged that patients who may have been trespassed during an earlier visit, were eligible to return to the ED. The ED Medical Director stated, "we would be required to re-assess the patient if they asked to be seen."

Upon request, the facility was unable to produce evidence the patient was registered or had an encounter with a Licensed Independent Practitioner (LIP) following the transport to their facility by ground ambulance on 12/28/2024 at 2:23 AM.

Complaint NV00073094