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Based on record review, staff and patient interviews it was determined the hospital failed to comply with 42 CFR 489.24, medical screening examination.

Based on record review, staff and patient interviews it was determined the hospital failed to provide a medical screening examination to the extent necessary in order to determine if an emergency medical condition existed. This was found for one patient (Patient #1) out of a selected sample of twenty (20) during a complaint investigation conducted on 10/7-8/13.

Review of the medical records for Patient #1 revealed this 72-year-old person presented to the emergency department (ED) on 6/8/13 at approximately 1:55 AM by ambulance. The chief complaint listed on the ED face sheet was listed as "fall with facial pain and skin tears". The record contained evidence of nursing documentation revealing possible loss of consciousness along with visible abrasions and bruising to the face related to a fall. The physician also documented injuries to the face related to a fall although no loss of consciousness was identified. There was no evidence of pain scale documentation although the physician documented the patients pain as "mild". The final clinical impression was listed as "skin tears/abrasion" and the patient was discharged home at 3:05 AM. Other than a fingerstick blood glucose level, no other diagnostic studies were ordered or performed.

An additional ED record for Patient #1 was reviewed. This record revealed Patient #1 presented to the ED by ambulance the following day on 6/9/13. The chief complaint listed on this record was DIZZY BLOOD IN STOOL VOMITING BLOOD". Laboratory studies revealed the patient to have a hemoglobin of 6.8 g/dl (normal reference range 12 - 16 g/dl) and a hematocrit of 21.2% (normal reference range of 36 - 46%) The patient was diagnosed with upper gastrointestinal bleeding and "profound anemia". The patient was admitted to the hospital as an inpatient for further treatment. A review of the inpatient record for Patient #1 revealed radiology studies were performed related to the patients complaints of neck pain. These studies revealed fractures to the cervical spine air in the cranial cavity suggesting fractures to the maxillary sinus or skull.

An interview with the ED physician who provided care for Patient #1 was conducted on 10/8/13 at approximately 1:15 PM. This person could provide no additional information other than to say he would have ordered a CAT scan if he had been aware of a loss of consciousness by the patient prior to the fall.

A telephone interview was conducted on 10/8/13 at approximately 1:35 PM with the registered nurse who provided care to Patient #1 on 6/8/13. This person also could not offer any additional information other than to surmise that her charting did indicate a possible loss of consciousness by the patient.

A telephone interview was conducted with Patient #1 on 10/8/13 at approximately 4:12 PM. This person stated that, prior to the ED visit, the patient experienced a loss of consciousness that lased for approximately five hours. When the patient regained consciousness, he/she called an ambulance and was taken to the ED. The patient stated rated his/her head pain at "9.5" out of a possible 10 (whereas "0" represents no pain and "10" represents excruciating pain). The patient stated he/she informed the staff of these symptoms but was sent home with no diagnostic testing or studies having been performed.