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Based on document review and staff interview, the Critical Access Hospital (CAH) administrative staff failed to ensure Emergency Department (ED) staff followed CAH policies and procedures, and provided 1 of 35 patients selected for review, from July 2011 to January 2012 a Medical Screening Examination. The hospital administrative staff identified an average of 250 patients presented to the ED seeking care per month.

Failure to follow policies and procedures and provide a medical screening examination delayed the care patient # 1 required and potentially placed her health in serious jeopardy.

Findings include:

1. Review of the policy "Individuals who request Emergency Medical Services", effective 1/11, revealed in part, "POLICY: ... To provide a medical screening examination by a physician ... to any individual who comes to the hospital seeking an examination or medical treatment ... to determine if the individual has an emergency medical condition."

2. Review of Patient #1's medical record from 1/15/12 revealed Patient #1 presented to the Emergency Department at 3:51 AM. Further review revealed Patinet #1 "... did not complete [the] check in process ... [Patient #1 was] not seen"

3. During an interview on 1/24/12 at 3:45 PM, Patient #1 stated she went to the ED on 1/15/12 at 3:51 AM because whenever she ate food, she felt it got stuck in her chest, and would then throw up. Patient #1 went to the ED to see if the CAH ED staff could identify the cause of the problem, since Patient #1 had similar problems in the past. Patient #1 stated that during the registration process, the ED Physician overheard her describing the medical condition that Patient #1 had requested to be evaluated. Patient # 1 confirmed that prior to completing the registration process ED Physician B stated the CAH lacked the equipment and staff to evaluate Patient #1's medical condition, and instructed Patient #1 to go to Hospital A for evaluation and treatment.

4. During an interview on 1/24/12 at 12:30 PM, ED Physician B stated he recognized Patient #1 when she presented to the ED on 1/15/12. ED Physician B heard Patient #1 describe the medical condition, and request an examination. ED Physician B confirmed he did not examine Patient #1. While Patient #1 was completing the registration process, ED Phsyician B stated he instructed Patient #1 to go to Hosptial A for examination and any necessary treatment. ED Physician B stated the CAH lacked the ability to diagnose or treat Patient #1's medical condition.

5. During an interview on 1/25/12 at 10:30 AM, the Cheif Nursing Officer acknowledged Patient #1 did not receive an Medical Screening Examination when she presented to the ED on 1/15/12. The Chief Nursing Officer also acknowledged that the ED staff and ED Physician failed to follow the CAH's policy that required Patient #1 to receive a Medical Screening Examination.

Based on document review and interviews, the Critical Access Hospital (CAH) emergency department staff failed to provide a medical screening examination to one patient (Patient #1), who presented to the emergency department requesting care, out of 40 cases selected for review from July 2011 to January 2012. The hospital administrative staff identified an average of 250 emergency department visits per month.

Failure to provide a medical screening examination delayed the care patient # 1 required and potentially placed her health in serious jeopardy.

Findings included:

1. Review of the policy "Individuals who request Emergency Medical Services", effective 1/11, revealed in part, "POLICY: ... To provide a medical screening examination by a physician ... to any individual who comes to the hospital seeking an examination or medical treatment ... to determine if the individual has an emergency medical condition."

2. Review of Patient #1's medical record from 1/15/12 revealed Patient #1 presented to the Emergency Department at 3:51 AM. Further review revealed Patinet #1 "... did not complete [the] check in process ... [Patient #1 was] not seen"

3. During an interview on 1/24/12 at 3:45 PM, Patient #1 stated she went to the ED on Friday 1/13/12 and was examined, " they gave me some IV fluids and medication to stop my vomiting and told me to eat and drink soft foods. " " I could feel the food stop in my throat, and then I would throw it up. " " I went back to the ED on 1/15/12 to see if they could look into my throat because of my history of GI (gastrointestinal) problems. " " I came in and told the registration nurse that I wasn ' t feeling well, I wasn ' t passing food down my throat. " " Before I finished checking-in the doctor said they didn ' t have the tool to look down my throat and I needed to go to a better hospital. " " It was better for me to go directly there, since they would just transfer me. " " They said it would take longer to see me than for me to just drive to [Hospital A]." Patient # 1 stated she waited in the ED waiting area approximately 35 minutes before a family member arrived to drive her to Hospital A.

4. During an interview on 1/24/12 at 10:30 AM, ED Technician A stated Patient #1 presented to the ED on 1/15/12, and ED Technician A began the registration process. During the process, Patient #1 stated she felt like she had food stuck in her chest. ED Physician B overheard Patient #1's statements, and asked where Patient #1 had previously received care for the problem. Patient #1 stated she had received care at Hospital A. ED Physician B then instructed Patient #1 to go to Hospital A for emergency care.

5. During an interview on 1/24/12 at 12:30 PM, ED Physician B stated he recognized Patient #1 when she presented to the ED on 1/15/12. ED Physician B heard Patient #1 describe her medical condition, and request an evaluation. ED Physician B confirmed he did not examine Patient # 1. While completing the registration process, ED Phsyician B instructed Patient #1 to go to Hospital A for an examination and treatment. ED Physician B stated the CAH lacked the ability to diagnose or treat Patient #1's medical condition and that Hospital A had the capability to diagnose and treat Patient #1's medical conditon, and going directly to Hospital A would save Patient #1 time.

6. During an interview on 1/31/12 at 1:50 PM the CAH's Chief Nursing Officer confirmed that the ED staff did not enter any information about Patient # 1's request for care into the ED log when she presented on 1/15/12.

7. Review of Patient #1's medical record revealed Patient #1 presented to the ED at Hospital A on 1/15/12 at 5:09 AM complaining of severe pain. Documentation revealed Patient # 1 stated she felt like something was stuck in her throat and was concerned because she continued to be unable to eat or drink.