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Based on document review and staff interview, facility staff failed to complete and document a medical screening examination for 1 (#20) patients (See C2406) and failed to properly coordinate transfers for 3 (#s 10, 13, and 20) of 27 emergency room patients (see C2409). Findings include:

The Hospital failed to complete an appropriate medical screening examination for 1 patient transfer and transferred three patients (#s 10, 13, and 20) of 27 sampled patients without proper documentation of risks and benefits and informed patient/responsible party consent.

Based on document review and staff interview, the facility staff failed to complete a medical screening examination for 1 (#20) of 27 sampled emergency room patients. Findings include:

Patient #20, a 75 year old male, was brought to the emergency room on 9/24/13 with complaints of chest pain for three days. Documentation on the emergency room log shows that the patient had an emergent condition. The patient was seen by the provider and was transferred to another facility capable of a higher level of care.

The clinical record did not include documentation of a medical screening examination by the provider or a qualified medical person. The clinical record lacked documentation by the provider that an examination of the patient occurred and the determination of the presence or absence of an emergency condition.

On 12/12/13, at 10:55 a.m., staff members A, the Administrator, B, the Director of Nursing, and E, the facility provider, were interviewed. Staff member E, the provider stated that "the facility is small and there only two of us to complete the work. Sometimes things get missed."

Based on document review and staff interview, facility staff transferred three patients (#s 10, 13 and 20) to other facilities without documentation of explanation of risks and benefits and without completing proper informed consents for the transfers. Findings include:

1. Patient #10, a 9 year old male was brought to the emergency room 7/9/13 following an automobile accident with a suspected neck injury. A medical screening examination was completed by the provider. Documented in the emergency room log was that the patient had an emergent condition. The provider completed arrangements to transfer the patient to another facility capable of a higher level of care.

The clinical record included a copy of the facility form labeled "Interfacility Transfer Authorization". The form did not include documentation of the mode of transport, any necessary support equipment for the transfer, documentation of records to be sent with the patient, and the risks and benefits of the transfer were not documented on the form signed by the parent of the patient.

2. Patient #13, a 56 year old male, came to the emergency room on 8/5/13 with complaints of dizziness and near collapse. A medical screening examination was completed by the provider. Documented in the emergency room log was that the patient had an emergent condition. The provider completed arrangements to transfer the patient to another facility capable of a higher level of care capability.

The clinical record included a copy of the facility form labeled "ER Transfer Form." The form did not include documentation of any necessary support equipment for the transfer, documentation of the risks and benefits of the transfer, and lacked the signature of the patient or responsible party authorizing the transfer.

3. Patient #20, a 75 year old male, was brought to the emergency room on 9/24/13 with complaints of chest pain for three days. Documented in the emergency room log was that the patient had an emergent condition. The patient was seen by the provider and was transferred to another facility with a higher level of care.

The clinical record did not include documentation of the medical screening examination, communication with the accepting facility, the name of the accepting physician, or evidence of the initiation or completion of the required informed consent for transfer forms. No properly completed consent for transfer signed by the patient or responsible individual was included in the record.

On 12/12/13, at 10:55 a.m., staff members A, the Administrator, B, the Director of Nursing, and E, the facility provider, were interviewed. Staff member E, the provider stated that "the facility is small and there only two of us to complete the work. Sometimes things get missed."