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Based on review of documentation and interviews, it was determined that the Hospital failed to provide a Medical Screening Evaluation [MSE] to Patient #1 when he/she presented to the Hospital's Emergency Department seeking treatment.

Findings include:

Medical Record review indicated that Patient #1 presented to the Hospital's Emergency Department (ED) on 11/19/2011 and was triaged at 11:44 A.M. Triage documentation indicated that per the ED Physician's instructions, the Triage Nurse informed Patient #1 that he/she was banned from the Hospital's Emergency Department in Peabody and the Emergency Department in Burlington. Patient #1 was instructed to contact the Hospital ' s Patient Advocate. Patient #1 was not evaluated or treated. Patient #1 was escorted off the grounds in a wheelchair by a Security Guard to his/her car. Documentation did not indicate that Patient #1 was given an opportunity to explain why he/she had presented to the ED.

The Associate Chief of ED Nursing was interviewed in person on 12/15/11 at 3:00 P.M.. The Associate Chief said that she was informed that Patient #1 did not receive a Medical Screening Examination the day after the incident. The Associate Chief said that an immediate investigation was conducted.

Review of the Hospital's internal investigation indicated that a Corrective Action Plan, including EMTALA education, was developed and implemented which included the following:

-Medical and Nursing Staff involved in the incident were counseled and placed on administrative leave while the incident was fully investigated. Subsequently, nursing and medical staff involved in the incident were placed on unpaid leave for 30 days and required to complete mandatory EMTALA re-training.

-EMTALA training was reviewed and reinforced with all ED Medical and nursing staff. All ED physicians have completed or provided documentation of completion of the Sullivan Group EMTALA training course as of November 26, 2011. ED nurses, with the exception of 2 nurses out on extended sick leave and 1 per diem nurse who had not recently worked, had completed an on-line EMTALA course as of November 30, 2011. Completion of the on-line course is required prior to any of the three nurse's return to work.

-An e-mail, emphasizing the staff member's duties and responsibilities for patient assessment and care, was sent to all ED medical and nursing staff, nursing supervisors and on-call administrators on November 23, 2011.

-A review of EMTALA requirements was scheduled for presentation to all administrative leaders and Department Chairs at the monthly management meetings scheduled in December 2011 and January 2012.

-ED Medical Staff members will be required to complete an annual EMTALA review each October.

-All ED nursing staff will be required to complete an annual EMTALA on-line training course each October.

- A meeting was held with Patient #1 during which an apology was provided for the incident and to reassure Patient #1 that he/she may always seek care at the Hospital at the either of the Hospital's Emergency Departments.