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Based on a review of the facility's medical staff bylaws, a review of policy and procedures, video surveillance review, patient advocate notes, and interviews with the complainant and staff members, the facility failed to provide a Medical Screening Exam (MSE) in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) and Chapter 42 of the Code of Federal Regulations (42 CFR; Part 489.24); Responsibilities of Medicare Participating Hospitals in Emergency Cases.

Findings included:

Refer to A2406.

Based on a review of the facility's Emergency Department Central Log, a review of a log labeled chief complaint summary Emergency Department (ED) Management, a review of the facility's policy and procedures, and a video submission review, the facility failed to log Patient (P) #17 into the ED Central log.

Findings included:

A review of the Emergency Department Central Log and Patient Register Forms failed to reveal P#17 signed into the ED.

A review of the Central Log, that included affiliated urgent care centers, revealed that Patient P#17 presented to an urgent care center affiliated with the hospital on 9/10/21 at 4:33 p.m.

A review of the facility ' s policy titled EMTALA - HHC - ED STANDARDS: LEAVE WITHOUT TREATMENT effective 1/22/2019 does not address patients being placed in the central ED log who left without being seen or left without treatment.

A review of a video provided by the complainant no date or timed noted, revealed a video beginning with an unidentified individual (presumed to be P#17) talking to the Registered Nurse (RN) DD at a COVID screening tent in front of the ED. RN DD told P#17 that she had spoken to the house supervisor and the policy stated the patients would have to wear a mask. P#17 asked if he was being denied services without a mask. RN DD told P#17 that he could wear a mask. When P#17 told RN DD that he could not wear a mask, RN DD asked for the medical reason. P#17 told RN DD that he was not going to give that out in public, because it was medical information and HIPAA. RN DD said the hospital policy stated he would have to wear a mask when in there (the ED.) P#17 said, "So, I'm being denied service." RN DD raised both arms, turned her back to the patient, and walked away. P#17 asked to speak to Human Resources. After RN DD walked away from the video, she was heard telling P#17 to call the hospital and she would call the house supervisor to come talk to him. RN DD returned to the tent and told P#17 the charge nurse would be out to speak to him as soon as the charge nurse was done with the emergency that was coming into the ED. RN DD said anytime P#17 decided to come in with a mask, she would be glad to see him. P#17 told RN DD that he could not wear a mask because of medical. RN DD said they were at a "catch 22," all their patients had to wear masks. After being told to wait for the charge nurse and house manager, P#17 told the COVID screeners that he was going to leave the ED because of "delay tactics," and that he was being denied treatment for not wearing a mask.

The patient was not recorded in the hospital's central log for his arrival.

Based on a review of the facility's medical staff bylaws, a review of policy and procedures, video surveillance review, patient advocate notes, and interviews with the complainant and staff members, the facility failed to provide a Medical Screening Exam (MSE) in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) and Chapter 42 of the Code of Federal Regulations (42 CFR; Part 489.24); Responsibilities of Medicare Participating Hospitals in Emergency Cases.

Findings included:

A review of the Medical Staff Bylaws and Rules and Regulations approved 11/20/2019, revealed that patients presenting to the facility will have a Medical Screening Examination (MSE), consistent with EMTALA regulations.

Review of the facility's "Emergency Medical Treatment and Labor Act Transfer" policy, effective 11/19/2020, revealed that if any individual presents to a hospital's emergency department, and a request is made on the individual's behalf for examination or treatment of a medical condition, the hospital must provide an appropriate medical screening examination (MSE) within the capability of the hospital's emergency department to determine if an emergent medical condition (EMC) exists. Hospital property is defined as the entire main hospital campus. This includes the parking lot, sidewalk, driveway, hospital departments, and any building owned by the hospital including outlying property within a 250-yard radius of the outermost boundaries of the hospital property.

During a telephone interview with Patient (P)#17 on 9/10/21 at 5:24 p.m., P#17 said he went to the Emergency Department (ED) after a car accident because his arm and back were hurting, and he stopped by a tent with security and a National Guard member. P#17 was told the policy of the hospital was to wear a mask, but the complainant was exempt from wearing a mask under federal guidelines. The complainant was told, he would not be allowed to go into the ED without a mask and security would get the charge nurse. The charge nurse said the policy required masks and started asking questions in front of everybody about why P#17 could not wear a mask. P#17 said he did not want to answer personal questions in front of others. The charge nurse told the complainant that he would have to wear a mask. P#17 asked if he was being denied service, and the nurse said they were in a "catch 22." P#17 asked if he was going to be allowed to come into the ED, and the charge nurse said if P#17 did not wear a mask, the ED could not treat him. P#17 said substitutes or alternatives to wearing a mask were not offered. P#17 spoke to the patient advocate, who put a supervisor on the phone. P#17 explained the situation, that he was not allowed to come into the ED without a mask, and the supervisor told P#17 that wearing a mask was the policy P#17 said he left that facility and went to an urgent care center. The urgent care also had a mask policy. When P#17 urgent care he could not wear a mask, P#17 was told he could wait in his car until the urgent care was ready to call him back.

An interview took place during the tour of the ED with Registered Nurse (RN) DD on 9/21/21 at 12:40 p.m. RN DD said there was an incident recently where a patient absolutely refused to wear a mask, and the patient said he would go somewhere else where he did not have to wear a mask. The house supervisor brought the patient a shield to wear, but the patient had already left the ED.

During an interview with the House Supervisor (HS) KK on 9/21/21 at 3:39 p.m., HS KK said he received a call from either the front desk or charge nurse that a patient wanted to sign into the ER and was refusing to wear a mask. The patient had an exemption letter. HS KK said the patient could sign in and would have to wear a mask while in the waiting room.

During an interview with the Service Excellence Coordinator (Patient Advocate) (PA) PP on 9/22/21 at 9:25 a.m. in the Conference Room, PA PP said she had spoken to HS KK prior to speaking to the patient. HS KK had told the patient he would have to wear a mask. PA PP said she got involved to reiterate what the HS KK was saying. PA PP said the patient asked if the ED was refusing to see him. PA PP told the patient the ED would see him, but he would need to wear a mask or face shield. The patient said he could not have anything on his face. The patient wanted to know if he was being denied services. PA PP told P#17 he was not being denied services; he would just need to wear a mask to sign in and then he could wait outside the ED. The patient kept saying he could not wear a mask. PA PP told the patient that house and healthcare policy was that the patient had to have a mask or something over his face. The patient's name and number were taken for the house supervisor to contact the patient. After the call was terminated, Risk Management was contacted. Risk management said to contact the administrator on call. The administrator on call said the patient had to wear a face covering, and it could be the shield. HS KK said he would take the face shield and meet the patient at his car to offer him the shield.

An interview took place with the Security Guard (SG) GG on 9/22/2021 at 1:36 p.m. in the Conference Room. SG GG said a patient came to the COVID screening tent, and the screener asked the patient questions and offered him a mask. The patient said he could not wear a mask for medical reasons. SG GG told the patient everyone had to have a mask, and then SG GG called the charge nurse. The charge nurse told the patient to wait for her to call the house supervisor.

A Review of a video provided by the complainant no date or timed noted, revealed a video beginning with an unidentified individual (presumed to be P#17) talking to the RN DD at a COVID screening tent in front of the ED. RN DD told P#17 that she had spoken to the house supervisor and the policy stated the patients would have to wear a mask. P#17 asked if he was being denied services without a mask. RN DD told P#17 that he could wear a mask. When P#17 told RN DD that he could not wear a mask, RN DD asked for the medical reason. P#17 told RN DD that he was not going to give that out in public, because it was medical information and HIPAA. RN DD said the hospital policy stated he would have to wear a mask when in there (the ED.) P#17 said, "So, I'm being denied service." RN DD raised both arms, turned her back to the patient, and walked away. P#17 asked to speak to Human Resources. After RN DD walked away from the video, she was heard telling P#17 to call the hospital and she would call the house supervisor to come talk to him. RN DD returned to the tent and told P#17 the charge nurse would be out to speak to him as soon as the charge nurse was done with the emergency that was coming into the ED. RN DD said anytime P#17 decided to come in with a mask, she would be glad to see him. P#17 told RN DD that he could not wear a mask because of medical. RN DD said they were at a "catch 22," all their patients had to wear masks. After being told to wait for the charge nurse and house manager, P#17 told the COVID screeners that he was going to leave the ED because of "delay tactics," and that he was being denied treatment for not wearing a mask.

Review of notes initialed by the Patient Advocate (PA) NN, revealed that on 9/10/21 at 4:43 p.m., PA NN had received a phone call from P#17. The patient was upset that they were not going to see him the in ER unless he put on a mask. PA NN said he apologized to P#17 and let him know that was the current policy. PA NN called the House Supervisor (HS) KK, and HS KK clarified that the information was correct. Risk Management (RM) QQ was contacted, and RM QQ made the concession that a face shield would suffice. The Patient Advocate (PA) PP spoke to P#17 and offered the face shield. P#17 told PA PP that he could not have anything on his face, and the facility was refusing him care and service. HS KK spoke to the administrator on call and the administrator advised HS KK that a mask or shield would be required. The house supervisor (KK) went to talk to the patient.

The patient did not receive an appropriate medical screening examination. The patient was not stabilized prior to his disposition.