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Based on policy reviews, patient and staff interviews, the hospital failed to ensure 1 (Patient 21) of 21 sampled patients was provided a Medical Screening Examination (MSE) to determine within the hospital's capabilities the presence of an Emergency Medical Condition (EMC) existed, in accordance with the facility Emergency Medical Treatment and Transfer Policy (EMTALA). Patient 21 presented to the Emergency Department seeking medical care and the staff failed to provide a MSE when when refused to wear a face mask. The failure to follow the hospital's policy and procedures for performing a MSE to determine an EMC has the potential to cause harm or death due to a delay in treatment.

Findings are:

See also A 2406.

A. Review of facility policy R107 titled "Emergency Medical Treatment and Transfer EMTALA" last revised 3/2017 states that The Hospital shall provide screening and stabilizing treatment or appropriate transfer within the scope of its abilities, as needed, to individuals with emergency medical conditions who come to the hospital for examination and treatment, regardless of diagnosis, financial status, race, color, national origin, or handicap in accordance with the he Emergency Medical Treatment and Active Labor Act (EMTALA). Individuals on the hospital campus, who request emergency treatment, or appear to need emergency treatment, shall be directed to the emergency department. Hospital staff shall assist the individual as appropriate. All individuals coming to a dedicated emergency department requesting examination or treatment of a medical condition shall receive a medical screening examination (MSE).

B. The hospital failed to follow policy R107 "Emergency Medical Treatment and Transfer EMTALA" and did not provide Patient 21 with a medical screening exam when the patient presented to the dedicated emergency department on 11/16/21 at approximately 11:07 AM requesting care for her hand injury.

C. In an interview on 1/20/22 at 1:40 PM, ED RN A confirmed when Patient 21 was at the facility on 11/16/21 that she was not provided any medical care.

Based on policy review, patient and staff interviews, the hospital failed to ensure 1 (Patient 21) of 21 sampled patients was provided a Medical Screening Examination (MSE) to determine within the hospital's capabilities the presence of an Emergency Medical Condition (EMC). Patient 21 presented to the Emergency Department (ED) seeking medical care and the staff failed to provide a MSE when she refused to wear a face mask. The total sample of 21 patients were reviewed. This failure has the potential for all patients presenting to the Emergency Department (ED) to have an untreated MSE which could result in harm or death due to delay in treatment. According to the facility provided information the ED sees an average of 2681 patients per month.

Findings are:

A. In an interview with the Registrar on 1/19/22 at 3:07 PM revealed, "Yes, I worked on 11/16/21 and I remember the patient [Patient 21] that came in with a broken hand.": The Registrar confirmed that (Patient 21) was not registered into the system (The process is to take their name and date of birth upon presenting for care.) The Registrar requested the patient put on a face mask and the patient said, "NO". The Registrar then asked her to cover her face with the mask and the patient said "NO", the Registrar said "I will call the manager." "The (Lead Registered Nurse-RN A) came out and told the patient, "We need you to wear a mask to protect our staff."

B. In an interview with RN A on 1/20/22 at 1:40 PM revealed, "Yes, I was the Lead RN on 11/16/21 and the Registrar called me from the desk and asked me to come up because [Patient 21] wouldn't put on a mask." RN A reported that she came to the Registrar area and asked "what was the issue?" RN A stated, "I remember her, she had a hand injury. I told Patient 21 it was the facility policy to wear a face mask". When inquired if the patient was provided any medical care at the facility on 11/16/21? RN A said, "No."

C. Review of the 8/2/2021 Universal PPE (personal protective equipment) Guidance and FAQ (frequently asked questions) revealed:
-Regardless of vaccination status: masks will be required in all clinical settings.
-Masks will be required by employees, patients and visitors in indoor public settings on a (facility) campus. This includes hallways, cafeterias, elevators, parking lots, waiting rooms and all clinical areas.
-Patients and Visitors: (The Facility) will require patients and any visitors to wear a mask at all times while on campus regardless of vaccination status. Patients and visitors may wear a mask from home (vented masks, neck gaiters, cloth masks and bandanas are not allowed). Patients needing a mask, upon arrival, may obtain a mask at various entrances across campus.
-Should all patients be wearing face masks?
Yes. Patients with symptoms concerning for COVID-19, or other respiratory illness, will be provided a medical grade face mask and isolated per our existing policies. Patients without symptoms concerning for COVID-19 will be provided medical grade masks.

D. In an interview with Patient 21 on 1/18/22 at 11:35 AM, she revealed that she arrived into the emergency department on 11/16/21 at approximately 11:07 AM, after injuring her pinky finger on the left hand, she was supporting her injured deformed finger with her right hand. The registrar asked me to put on /hold a face mask and I told the registrar "no, I couldn't due to a medical/emotional reason (PTSD) and masks cause me panic attacks that lead to an asthma attack." The registrar than told the patient that she wouldn't "argue with her" and would call her supervisor, the registrar did not ask her name or date of birth. The registrar called the [Lead RN A] and she came to the registrar area and informed Patient 21, it was the facility policy to have the patients wear a face mask. Patient 21 stated, "I felt like they were denying me service, so I went up the street to (Hospital B- 6 miles away) to get her finger looked at." "(Hospital B) looked at my hand, determined I had a fractured pinky, they set it and put a splint on it. They did not try and make me wear a face mask."

E. Review of the 3/2017 policy titled, Emergency Medical Treatment and Transfer Policy revealed:
-All individuals coming to a dedicated emergency department requesting examination or treatment of a medical condition shall receive a medical screening examination (MSE).
-The MSE shall determine whether or not a medical emergency does or does not exist. Depending on the patient's presenting symptoms the MSE may range from a simple process involving only a brief history and physical examination, to a complex process with ancillary and diagnostic tests.

F. An interview with the Nurse Manager of the ED on 1/19/22 at 3:00 PM revealed, that if the patients coming to the ED are not registered that they would not show up on the Central Log or have a chart. (Patient 21) was not registered and therefore not on the log or have a chart.

G. A telephone interview on 1/26/22 at 2:35 PM, with the Quality Manager at Hospital B, verified that Patient 21 did seek care at their facility on 11/16/21 at 11:37 AM. The Quality Manager at Hospital B stated it was their face mask policy to "ask a couple of times, and if the patient refuses to just move on. We just make accommodations if they refuse to wear a face mask."

H. Review of Patient 21's Hospital B medical record for the 11/16/21 ED visit revealed, Patient 21 arrived at 11:37 AM and was dismissed at 1:53 PM. The physician History of Present Illness revealed, a "patient with pain in the left hand and a deformity to the left little finger." The physical exam identified "A deformity to the left fifth digit and generalized tenderness to palpation of the lateral left hand." An X-Ray of the left hand was completed which identified a "closed fifth proximal phalanx fracture with prominent angulation. [A break in the bone closest to the hand of the pinky finger with an abnormal angle]" Patient 21's finger was anesthetized and the doctor straighten the fractured finger. The finger/hand was placed in a splint and Patient 21 was to follow up with a hand surgeon the next day, she was provided pain medication and dismissed at 1:53 PM.