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Based on record review and interview, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider's agreement which requires hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by the hospital failing to ensure a medical screening examination was provided to each patient presenting to the ED to determine whether or not an emergency medical condition existed. This deficient practice is evidenced by failing to examine a patient who complained of sexual assault for 1 (#2) of 2 (#2, #5) patients presenting with alleged assaults (see findings tag A-2406).

Based on record review and interviews, the hospital failed to ensure a medical screening examination was provided to each patient presenting to the ED to determine whether or not an emergency medical condition existed. This deficient practice is evidenced by failing to examine a patient who complained of sexual assault for 1 (#2) of 2 (#2, #5) patients presenting with alleged assaults.

Findings:

Review of the hospital's policy titled Emergency Room Treatment revealed in part:
1. In general, if any individual comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either
a) within the staff and facilities available at the hospital, for such further medical examination and such treatment as may be required to stabilize the medical condition, or
b) for transfer of the individual to another medical facility in accordance with the section on restricting transfers until individual stabilized.

Review of the hospital's policy titled Rape Victims- Assessment and Collection of Specimens/Possible Evidence revealed in part:
Scope: Any patient who requests/consents to assessment and/or treatment of alleged rape
Policy:
1. Consent for treatment is obtained by physician.
2. The appropriate agencies are notified when the patient consents to the report of an alleged rape:
a) Adult - Jefferson Parish Sheriff's Office
Note: RS 40:2109.1 states "If the victim is physically or mentally incapable of making an intelligent decision, the hospital staff shall immediately notify the appropriate law enforcement officials."

Review of Patient #2's medical record revealed she arrived at the emergency department on 07/16/2021 at 11:54 a.m. with the arrival complaint of Altered Mental Status.

Review of documentation in Patient #2's medical record by S8RN revealed the following:
Psychosocial: Are there signs/clinical indicators of abuse neglect? Yes, signs of abuse/neglect exist (if yes then comment) Elder protective services contacted, patient making comments adamant that a male has violated her with two fingers at the nursing home, add that he is not a doctor.

Review of Patient #2's physician's discharge summary revealed the following:
Patient #2 is a 72 year old female who was sent from her nursing home due to altered mental status. She is currently awake and alert, answers simple questions appropriately and appears to be back to her baseline. This has occurred in the past and was related to a TIA with hypoglycemia. Her blood sugar on arrival was 122. She was hypertensive requiring IV Hydralazine on arrival. During this admission these following conditions were addressed and managed along with her co-morbid conditions.
1. Hypertensive encephalopathy
2. DM type 2
3. Seizure disorders
4. Restless leg syndrome
5. DVT
6. Neck/shoulder pain
Further review revealed no documentation by the attending physician or the resident of an alleged sexual assault against Patient #2.

Review of Patient #2's medical record revealed no documentation that Patient #2's nursing home or family were notified of the alleged sexual assault. There was no documentation Patient #2 was asked if she wanted to be transferred to a participating hospital for a SANE (Sexual Assault Nurse Examiner) assessment or if she wanted the police to be notified.

In an interview on 08/10/2021 at 10:44 a.m. with S4RN ED Director, he verified did not see in Patient #2's medical record that the police were contacted or if Patient #2 was asked if she wanted to contact the police. He also said he did not see where the physician noted her claims of being assaulted or did any assessment for the alleged assault.

In an interview on 08/10/2021 at 1:55 p.m. with S8RN, she said she remembered Patient #2. She said she filed a complaint with the Louisiana Department of Health via the nursing home abuse hotline. She said the patient seemed lucid and adamant that she had been assaulted. She also said the alleged assault was not reported to the police. When asked if she asked Patient #2 if he wanted the police called she said, "I did not ask her". She also said she did not notify Patient #2's nursing home. She said she is a SANE nurse at another local hospital. She said at her other job, if someone presents with an assault they talk to the patient to get the story and if patient consents an exam is done. She said the patient has to consent. She said Patient #2 reported she had been sexually assaulted to herself, another nurse, the physician, a resident and a technician. She said patients at the other hospital where she is a SANE nurse are asked if they would want to notify the police but Patient #2 was not asked. When asked if she had contacted Patient #2's power of attorney or her nursing home, she replied, "No".

In an interview on 08/10/21 at 3:03 p.m. with S9EdDir, he said if a patient tells a staff member they have been sexually assaulted, first they need to make sure the patient medically stable. He said then they are asked if they want to notify police. If so, he said they contact the appropriate agency. He said the police department will send out a detective to see if they want to proceed. If the patient needed a SANE exam, the patient would be transferred to a facility with a SANE nurse. He said if they are not competent to give an adequate report, he said the physician makes a determination.

In an interview on 08/10/21 at 3:39 p.m. with S5MD, he said he remembered Patient #2. He said she was between 70-80 years old and came in with altered mental status. He said she was initially seen by the resident and he was the attending physician. He said Patient #2 said more than once that someone touched her inappropriately at the nursing home. S5MD said he was focused on her elevated blood pressure. He said he figured they could get her blood pressure under control and they could take care of the assault later. S5MD said the nurse said she would file a report so he said he figured it could be addressed after she was admitted and maybe she would become more lucid. He said he thought the nurse said she would do the paperwork so he thought it was taken care of. When asked if anyone asked her if she wanted to call the police, he said, "I did not". When asked if he had done a medical screening exam on Patient #2 for the allegation of sexual assault he said, "I thought the nurse took care of it".