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Based on record reviews and interviews, the hospital failed to provide an appropriate medical screening examination for one (1) of twenty-one (21) patient records reviewed (Patient record #1). All patients in the sample were males who presented with a chief complaint of testicular/groin pain.

Findings:

The hospital's "Emergency Nurse Triage Protocols" Policy, last revised 05/2021, states in part, "TESTICULAR PAIN - Patients presenting with testicular pain, place in room and notify the ED [Emergency Department] provider immediately."

The hospital's "Emergency Department Acuity" Policy, last revised 4/2021, states in part, PROCEDURES: "The Registered Nurse with appropriate triage training will evaluate and categorize each patient upon arrival to the Emergency Department using the ESI [Emergency Severity Index] five level triage scoring system. The nurse will:
- Complete the triage assessment.
- Assign a triage acuity level based on the assessment."
The Policy later states: "Triage: The process of sorting patients as they present to the ED by rapidly collecting relevant subjective and objective data, communicating with the ED Provider as appropriate and assigning an acuity rating per Emergency Nursing Association (ENA) ESI standards. Triage can occur prior to patients being assigned a treatment room or can occur at the bedside."

On 10/02/2022 at approximately 12:38 AM, Patient #1 entered the Emergency Department (ED) at St. Mary's Regional Medical Center seeking treatment for "groin pain/swelling". A review of the hospital medical record for Patient #1 stated on 10/02/2022 at 1:42 AM the patient was discharged with a status of "left without being seen before triage."

On 10/02/2022 at 2:08 AM, Patient #1 presented to the ED at a different hospital with the same complaint. A review of that hospital's medical record for Patient #1 stated the patient received a triage assessment by a Registered Nurse (RN) within six (6) minutes of arrival, and this was followed by an assessment by a physician.

On 10/02/2022, at 3:22 AM, an ED physician from the receiving hospital submitted an email complaint to the Centers for Medicare and Medicaid (CMS) Regional Office, reporting that a patient was treated at his facility and that he was informed that during Patient #1's visit to the SMRMC ED , Patient #1 was advised the services necessary to treat his condition were not available and that the patient should go to another hospital for treatment.

On 12/02/2022, at 9:00 AM a telephone interview was conducted with the original complainant. When asked if he had any further information besides what was included in his email, he added that the patient stated St. Mary's told him that they did not have ultrasound or urology on call, and the patient clearly told the complainant that he never saw a provider at St. Mary's.

On 12/05/2022 at 3:03 PM a copy of Patient #1's ED medical Record from the receiving hospital was received. The patient record showed: "10/2/2022 02:14 EDT Chief Complaint pt went to ST Marys, for swelling of testicals. he said it happened suddenly, did not see a physichian there stated was told that they did not have the services to diagnose him and he needed to come here. pt states very painful also does not feel well ." During triage, Patient #1's medical record states the patient had a rapid pulse, and that Patient #1 was additionally diagnosed with "new-onset atrial fibrillation with rapid ventricular response".

On 12/06/2022 at 8:00 AM, an onsite EMTALA Survey was initiated at SMRMC. The ED log stated Patient #1 arrived by private vehicle on 10/02/2022 at approximately 12:37 AM, with a chief complaint of "Groin Pain/Swelling". The ED log did not contain a diagnosis and stated the patient was discharged on the same day at 1:42 AM. Disposition is recorded as "LWBS [left without being seen] before RN [Registered Nurse] triage".

On 12/06/2022 at approximately 1:50 PM the surveyors received an electronic copy of Patient #1's ED medical record. The record contained documentation of Patient #1 registering in the ED on 10/02/2022 at 12:37 AM, with a chief complaint of "groin pain/swelling". The next entry in the record, on 10/02/2022 at 1:41 AM, indicated "ED Disposition set to LWBS before RN Triage". The record does not include any additional patient encounter information regarding care or treatment.

On 12/07/2022 at 10:08 AM, a telephone interview was conducted with a representative of Patient Registration. This individual was identified in Patient #1's medical record as the person who registered Patient #1 on 10/02/2022 at 12:38 AM. When asked if she remembered a patient waiting more than an hour just to be triaged, she replied, "This happens quite a few times in the past few months. It is dependent on what is going on in the treatment area". When asked what she would do if someone has been waiting a very long time and no one has come out to see the patient, she replied, "If the patient is complaining, I can call out back to the nurse that the patient is complaining". When asked if she would tell a patient that they should go elsewhere she reported that she would never tell a patient to go somewhere else.

On 12/7/2022 at 11:57 AM - Telephone interview with Patient #1, who reported that his vital signs were not checked at St. Mary's, and that St. Mary's told him to go to the receiving hospital. When asked who at St. Mary's told him that, he reported a woman came from "out back" who was "not a nurse" and told him that they do not have what he needs. When asked if the woman from "out back" told him what services he needed, Patient #1 replied "ultrasound and other services". Patient #1 stated he had been persistent during his wait, getting up to ask for updates before getting the message to go to the receiving hospital. Patient #1 said he was told to drive to the receiving hospital, where staff there told him they were very surprised to hear that St. Mary's advised him to drive himself to the receiving hospital.

On 12/7/2022 at approximately 12:40 PM the Emergency Department Manager at SMMRC confirmed that Patient #1's record did not document the patient being triaged or assessed by an RN or a physician.