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Based on interview and review of Emergency Department (ED) logs, 72 Hour Return logs, Medical Records, Staff and Physician On-Call Schedules and video surveillance, the facility failed to enter one patient (#12) into the ED log, and failed to provide the patient with a medical screening examination (MSE) sufficient to determine the presence of a medical and or psychiatric emergency, within its capacity and capability, of 25 patients' ED records reviewed.

Patient # 12 presented to the hospital ED on 4/21/16 at 12:39 AM and stated he needed psychiatric help. The patient was informed that if he needed psychiatric hospitalization, he would be transferred to hospital B. The patient left the ED without receiving an examination and without any attempts by staff to get the patient to stay. Staff did not enter any information about patient # 12's request for care into the ED log or that patient # 12 left the ED prior to receiving an examination based upon staff suggestion.

During an interview on 4/27/16 at 3:13 PM, Staff A, Associate Partner stated she "had no idea you couldn't turn a patient away from the ED."

Review of patient # 12's medical record from Hospital B showed that the patient presented to the ED on 4/21/16 at approximately 11 minutes after leaving the Saint Francis Medical Center ED requesting care for an emergency medical condition.

During an interview on 05/02/16 at 11:40 AM, Staff I, Hospital B ED Charge Nurse stated that when Patient #12 presented to Hospital B ED, he stated that he went to
Saint Francis Medical Center's ED and was told that he needed to come to Hospital B, because Saint Francis did not have a psychiatric unit. Staff I stated that she contacted Saint Francis Medical Center regarding the incident and spoke to a staff member (unsure of who), who confirmed what the patient reported.

Saint Francis Medical Center had the capacity and capability to provide a MSE to patient # 12 to determine if the patient had an emergency medical condition and a mental health evaluation by a Mental Health Professional (MHP) to determine whether the patient was suffering from a psychiatric emergency.

See 2406 and 2407 for further details.

Based on interview, record review and review of video surveillance, the facility failed to enter into the Emergency Department (ED) log one patient (#12) of 25 patients' medical records reviewed, who presented to the ED. This failure had the potential to affect all patients who presented to the ED. The ED sees approximately 3851 patients per month.
Findings included:
1. Review of the facility's policy titled, "Emergency Services Registration Policy - Ambulatory Patient Presenting for Treatment," revised 04/2016, showed that when a patient arrives at triage/registration area, all patients are asked their name and date of birth, and this information is entered into the electronic medical record (EMR) databank/log (ED log) without exception.
During an interview on 04/27/16 at 3:13 PM, Staff A, Associate Partner, stated that she was responsible for "checking in" all patients who presented to the ED for emergency care, which placed the patients on the ED log. Staff A stated that a patient (unknown name, but identified by Saint Francis Medical Center staff as Patient #12) presented to the ED on 04/21/16 sometime after midnight, and said he needed psychiatric help. Staff A informed the patient that if he needed inpatient psychiatric care, he would be transferred to Hospital B, so the patient left the ED. Staff A stated that she did not obtain the patients name or date of birth, and did not check the patient in, therefore the patient was not placed on the ED log. Staff A stated she "had no idea you couldn't turn a patient away from the ED", and therefore did not obtain the patient's name or date of birth.

2. Review of video surveillance dated 04/21/16 showed that at 12:39 AM, a patient (identified by Saint Francis Medical Center staff as Patient #12) presented to the ED, spoke with a staff member (identified by Saint Francis Medical Center as Staff A), then turned and exited the ED at 12:40 AM.
3. Review of the ED log, dated 04/21/16 showed no evidence of Patient #12's arrival to the ED, that he requested care or that he left the ED without receiving an examination based on staff A's suggestion.

Based on record review, video surveillance and interview, the hospital failed to provide a medical screening examination sufficient to determine the presence of a medical and or psychological emergency, within its capacity and capability, for one patient (#12) of 25 patients' Emergency Department (ED) records reviewed. This had the potential to affect all patients who presented to the ED. The ED sees approximately 3851 patients per month.

Findings included:

1. Review of the facility's policy titled, "Emergency medical Treatment/Active Labor Act (EMTALA)," dated 03/01/15, showed that all patient's presenting to the ED requesting medical care and treatment must be given a medical screening exam. A medical screening exam will include, as appropriate, the full capabilities of the ED, including all ancillary services routinely available to the ED and the services of staff specialists and subspecialists on-call to the ED as may be necessary to determine with reasonable clinical confidence whether an emergency medical condition exists (EMC). An EMC is a medical condition manifesting itself by acute symptoms of sufficient severity (including psychiatric disturbances) such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual in serious jeopardy.

Review of the facility's policy titled, "Evaluation and Disposition of Psychiatric Patient," dated 04/09/14, showed that a medical screening examination (MSE) would be provided to any patient presenting with a mental health issue as a primary or secondary complaint sufficient to rule out the presence of an EMC and provide appropriate disposition. The ED Physician will inform the patient that the hospital does not provide psychiatric services, after a full medical and psychiatric screening, and the hospital will facilitate the transfer of the mentally disordered patient who is in danger to self or others.

2. Review of video surveillance dated 04/21/16 showed that at 12:39 AM, a patient (identified by Hospital A staff as Patient #12) presented to the ED, spoke with a staff member (identified by Saint Francis Medical Center's staff as Staff A), then turned and exited the ED at 12:40 AM.

During an interview on 04/27/16 at 3:13 PM, Staff A, Associate Partner, stated that a patient (unknown name, identified by Saint Francis Medical Center staff as Patient #12) presented to the ED on 04/21/16, and said he needed psychiatric help. Staff A informed the patient that if he needed inpatient psychiatric care, he would be transferred to Hospital B, so the patient left without a medical screening examination. Staff A stated she "had no idea you couldn't turn a patient away from the ED".

3. Review of the ED census on 04/21/16 showed there were six patients in the 32 room ED at the time of Patient #12's arrival.

4. Review of the ED Physician Schedule from 04/20/16 through 04/21/16, showed there were three ED Physicians working in the ED at the time Patient #12 arrived.

During an interview on 04/28/16 at 2:00 PM, Staff E, ED Director, stated that patients who present with a psychiatric complaint would receive a medical screening examination upon arrival. After the patient was cleared medically, the ED Physician would contact the Social Worker on-call, who would conduct a psychiatric assessment to determine, along with the ED Physician, if the patient required inpatient psychiatric care and transfer.

5. Review of Social Services On-Call Schedule from 04/20/16 through 04/21/16, showed there was one Social Worker on-call to the ED for psychiatric assessments, at the time of Patient #12's arrival.

6. Review of Patient #12's ED record from Hospital B, showed that the patient presented on 04/21/16 approximately 11 minutes after leaving the ED at Saint Francis Medical Center and requested care for a psychiatric emergency.

During an interview on 05/02/16 at 11:40 AM, Staff I, Hospital B ED Charge Nurse stated that when Patient #12 presented to Hospital B ED, he stated that he went to Saint Francis Medical Center's ED and was told that he needed to come to Hospital B, because Saint Francis did not have a psychiatric unit. Staff I stated that she contacted Saint Francis Medical Center regarding the incident and spoke to a staff member (unsure of who), who confirmed what the patient reported.