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Based on review of medical records, policy review, Medical Staff Rules and Regulations, and staff interviews it was determined the facility failed to ensure that each individual who presented to the Emergency Department and requested services were provided a medical screening examination and timely reassessment for 13 of 20 sampled patients (Patients # 1,2,4, 5, 6, 7, 8, 13, 14, 15, 17, 18, and 19). Refer to A2406.

Based on review of medical records, policy review, Medical Staff Rules and Regulations, and staff interviews it was determined the facility failed to ensure that each individual who presented to the Emergency Department and requested services were provided a medical screening examination and timely reassessment for 13 of 20 sampled patients (Patients # 1,2,4, 5, 6, 7, 8, 13, 14, 15, 17, 18, and 19).

Findings included:

Review of facility policy titled "Emergency Medical Treatment and Labor Act", last approved 07/1999 states that patients are entitled to an MSE (medical screening exam). The policy states that when a patient comes to the emergency department and the request is made on the patient's behalf for examination or treatment of a medical condition the hospital must provide for an appropriate medical screening examination to determine if an emergency medical condition exists."

Review of the facility policy titled "Assessment/Reassessment" last revised on 07/2020 states, "all patients that present to the emergency department are provided a medical screening exam and stabilizing treatment by the emergency department physician and/or independent license practitioner." The policy further states that based on the patient's emergency severity index (ESI) acuity level designation, and the triage nurse's overall clinical impression, place the patient in the appropriate location to assure that a medical screening examination (MSE) by qualified medical personnel is completed in a timely manner.

Review of the facility's Rules and Regulations, adopted by the medical executive committee and approved by the governing body, dated September 17, 2021 states "the emergency medical treatment and active labor act (EMTALA) requires that for all patients who present to the emergency department, the hospital must, at a minimum, 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.

Interview with staff (G) Medical Director of the Emergency Department on 1/19/2022 at 13:50 confirmed the facility has a goal of 30 mins (minutes), "from door to provider for all patients to receive their Medical Screening Examination."

(Patient #1) Review of the medical record for patient #1 revealed the patient presented to the facility ED (Emergency Department) on 1/10/22 at 10:12 am for a complaint: cough, fever, hoarseness x 2 days and Covid testing. Review of the record revealed the patient was triaged by an RN (registered nurse) at 10:38 am. The patient's vital signs were blood pressure 128/87, temperature 98.3, pulse 95 bpm (beats per minute), respiratory rate 20, oxygen saturation 98% on room air and pain level not documented. Review of the triage assessment revealed the RN assigned the patient an acuity level of 5 - non-urgent. The Emergency Severity Index (ESI) is a five-level emergency department (ED) triage algorithm that provides clinically relevant stratification of patients into five groups from 1 (most urgent) to 5 (least urgent) on the basis of acuity and resource needs. Review of the record reveals no further assessment of the patient. Review of the record revealed the patient was not reassessed for more than 9 hours. Review of the record reveals no medical screening examination was done and at 19:00 pm the patient left without receiving medical treatment.

(Patient #2) Review of the medical record for patient #2 revealed the patient presented to the facility ED on 1/10/21 at 16:25 pm for a complaint of suture removal to left hand. Review of the record revealed the patient was triaged by an RN (registered nurse) at 17:18 pm. The patient's vital signs were blood pressure 101/67, temperature 99, pulse 60 bpm, respiratory rate 20, oxygen saturation 100% on room air and pain level not documented. Review of the triage assessment revealed the RN assigned the patient an acuity level of 5 - routine. Review of the record reveals no further assessment of the patient. Review of the record revealed the patient was not reassessed for more than 4.5 hours. Review of the record reveals no medical screening examination was done and at 20:56 pm the patient left without receiving medical treatment.

(Patient #4) Review of the medical record for patient #4 revealed the patient presented to the facility ED on 1/10/22 at 14:05 pm for a complaint of Left posterior leg swelling, pain, and redness x 3 days with fever. Review of the record revealed the patient was triaged by an RN (registered nurse) at 14:57 pm. The patient's vital signs were blood pressure 110/64, temperature 98.7, pulse 79 bpm, respiratory rate 20, oxygen saturation 99% on room air and pain level 8/10. Review of the triage assessment revealed the RN assigned the patient an acuity level of 4-stable.
Review of the record reveals no further assessment of the patient. Review of the record revealed the patient was not reassessed for more than 7 hours. Review of the record reveals no medical screening examination was done and at 20:56 pm the patient left without receiving medical treatment.

(Patient #5) Review of the medical record for patient #5 revealed the patient presented to the facility ED on 1/10/22 at 21:35 pm for a complaint of flu like symptoms with nausea and vomiting. Review of the record revealed the patient was triaged by an RN (registered nurse) at 14:57 pm. The patient's vital signs were blood pressure 147/68, pulse 88 bpm, respiration rate 16, oxygen saturation 97% on room air, temperature 99.1 and pain Level 9/10. Review of the triage assessment revealed the RN assigned the patient an acuity level of 4-stable. At 21:38 orders for labs were placed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 5:25 hours. Review of the record reveals no medical screening examination was done and at 20:56 pm the patient left without receiving medical treatment.

(Patient #6) Review of the medical record for patient #6 revealed the patient presented to the facility ED on 1/10/22 at 20:23 pm for a complaint of midsternal chest pain, right sided ribcage pain, productive cough with string of blood in mucus x 4 days. Review of the record revealed the patient was triaged by an RN (registered nurse) at 20:33 pm. The patient's vital signs were blood pressure, not documented, pulse 78 bpm, respiration rate 20, oxygen saturation 98% on room air, temperature 98.5 and pain Level 9/10. Review of the triage assessment revealed the RN assigned the patient an acuity level of 3- urgent. At 20:31 pm orders for ECG (electrocardiogram), Labs, troponin, chest X-ray were placed and completed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 3 hours. Review of the record reveals no medical screening examination was done and at 23:30 pm the patient left without receiving medical treatment.

(Patient #7) Review of the medical record for patient #7 revealed the patient presented to the facility ED on 1/9/22 at 19:47 pm for a complaint of Covid test and some meds for cough. Review of the record revealed the patient was triaged by an RN (registered nurse) at 1957 pm. The patient's vital signs were blood pressure 139/86, pulse 68 bpm, respiration rate 18, oxygen saturation 96% on room air and temperature 99.7. Review of the triage assessment revealed the RN assigned the patient an acuity level of 5-routine. No orders were placed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 5.25 hours. Review of the record reveals no medical screening examination was done and on 1/10/22 at 01:02 am the patient left without receiving medical treatment.

(Patient #8) Review of the medical record for patient #8 revealed the patient presented to the facility ED on 1/10/22 at 21:31 pm for a complaint of lower abdominal cramping that radiates around to left back along with nausea and vomiting. Review of the record revealed the patient was triaged by an RN (registered nurse) at 22:10 pm. The patient's vital signs were blood pressure 127/80, pulse 75 bpm, respiration rate 16, oxygen saturation 99% on room air, temperature 98.1 and pain Level 7/10. Review of the triage assessment revealed the RN assigned the patient an acuity level of 3-urgent. Orders were placed at 22:13 pm for labs and completed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 3.5 hours. Review of the record reveals no medical screening examination was done and on 1/11/22 at 01:00 am the patient left without receiving medical treatment.

(Patient #13) Review of the medical record for patient #13 revealed the patient presented to the facility ED on 1/20/2022 at 04:37 am for a complaint of sinus congestion and pressure, has had multiple medications with no improvements. Review of the record revealed the patient was triaged by an RN (registered nurse) at 04:49 am. The patient's vital signs were blood pressure 178/91, pulse 83 bpm, respiration rate 18, oxygen saturation 99 % on room air, temperature 98.6 and pain Level 8/10. Review of the triage assessment revealed the RN assigned the patient an acuity level of 4-stable. No orders were placed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 10 hours. Review of the record reveals no medical screening examination was done and on 1/20/22 at 14:44 pm the patient left without receiving medical treatment.

(Patient #14) Review of the medical record for patient #14 revealed the patient presented to the facility ED on 1/11/2022 at 01:51 am for a complaint of Opioid withdrawal. Review of the record revealed the patient was triaged by an RN (registered nurse) at 01:57 am. The patient's vital signs were blood pressure 137/80, pulse 105 bpm, respiration rate 17, oxygen saturation 100% on room air and temperature 97.9. Review of the triage assessment revealed the RN assigned the patient an acuity level of 3- urgent. Orders for lab and urine were placed at 02:03 am and completed. Review of the Urine Toxicology tests dated 1/11/22 resulted positive for Cocaine and Opiate. Review of the record reveals no further assessment or reassessment of the patient for the duration of 5 hours. Review of the record reveals no medical screening examination was done and on 1/11/2022, 06:42 am the patient left without receiving medical treatment.

(Patient #15) Review of the medical record for patient #15 revealed the patient presented to the facility ED on 1/11/2022 at 0224 for a complaint of psychiatric needs. Review of the record revealed the patient was triaged by an RN (registered nurse) at 02:45 am. The patient's vital signs were blood pressure 154/94, pulse 99 bpm, respiration rate 18, oxygen saturation 100 % on room air and temperature 98.5. Review of the triage assessment revealed the RN assigned the patient an acuity level of 3-urgent. No orders were placed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 5 hours. Review of the record reveals no medical screening examination was done and on 1/11/2022, 0659 am the patient left without receiving medical treatment.


(Patient #17) Review of the medical record for patient #17 revealed the patient presented to the facility ED on 01/09/2022 at 14:55 pm for a complaint of sore throat x 2 weeks. Review of the record revealed the patient was triaged by an RN (registered nurse) at 15:37 pm. The patient's vital signs were blood pressure 129/61, pulse 86 bpm, respiration rate 18, oxygen saturation 100 % on room air and temperature 98.4. Review of the triage assessment revealed the RN assigned the patient an acuity level of 4-stable. An order for a rapid strep swab was placed at 18:24 pm and completed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 6.5 hours. Review of the record reveals no medical screening examination was done and on 1/9/2022, 21:22 pm the patient left without receiving medical treatment.

(Patient #18) Review of the medical record for patient #18 revealed the patient presented to the facility ED on 01/09/2022 at 15:59 pm for a complaint of sore throat. Review of the record revealed the patient was triaged by an RN (registered nurse) at 16:11 pm. The patient's vital signs were blood pressure 161/80, pulse 59 bpm, respiration rate 18, oxygen saturation 99 % on room air and temperature 98.4. Review of the triage assessment revealed the RN assigned the patient an acuity level of 4-stable. No orders were placed. Review of the record reveals no further assessment or reassessment of the patient for the duration of 5.5 hours. Review of the record reveals no medical screening examination was done and on 1/9/2022, 21:24 pm the patient left without receiving medical treatment.

(Patient #19) Review of the medical record for patient #19 visit #2 revealed the patient presented to the facility ED on 1/13/2022 at 14:04 pm for a Chief Complaint of "Patient arrives to ED after leaving AMA (Against Medical Advice) on yesterday with complaint of general unwellness." Review of the record revealed the patient was triaged by an RN (registered nurse) at 14:06 pm. The patient's vital signs were blood pressure 127/84, pulse 93 bpm, respiration rate 19, oxygen saturation 97 % on room air and temperature 100.7 (febrile). Review of the triage assessment revealed the RN assigned the patient an acuity level of 4-stable. No Laboratory tests orders were placed. An Infectious Disease Alert order was placed on 1/2/2022 at 2:10 pm and discontinued. Review of the record reveals no further assessment or reassessment or follow- up of the Infection disease alert of the patient for the duration of 5 hours. Review of the record reveals no medical screening examination was done and on 1/13/2022, 19:00 pm the patient left without receiving medical treatment.


Interview with Staff (G) MD, Medical Director of Emergency Department, Staff (A), RN Director of Emergency Department and Staff (H) Risk Manager on 01/19/21 at 13:50 PM verified the above findings.

The facility failed to ensure that their Policies and procedures were followed for patient numbers 1, 2, 4, 5, 6, 7, 8, 13, 14, 15, 17, 18 and 19, as evidenced by failing to ensure that their policies and procedures were followed as evidenced by failing to ensure that when patients presents to the ED, the facility must provide an appropriate medical screening examination within the capability of the hospital's ED to determine weather or not an emergency medical condition exists.