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Based on review of facility documents, staff interview (EMP), and observation, it was determined the facility failed to ensure a patient that presented to the Emergency Department greeter registration desk with a family member requesting to petition an involuntary commitment was placed on the central log upon presentation.

Findings include:

Review on February 6, 2023, of facility policy, "EMTALA," reviewed January 2020, revealed "Purpose: The purpose of this policy is to ensure that the emergency medical treatment and patient transfer policy is based on federal law relating to the emergency medical treatment and medically appropriate transfer of individuals between hospitals. ...All individuals presenting on hospital property requesting emergency medical services, individuals presenting to a Dedicated Emergency Department requesting medical services, and patients arriving/presenting via ambulance requesting medical services shall receive an appropriate Medical Screening Examination and Stabilization services as required by the Emergency Medical Treatment and Labor Act ("EMTALA"), 42 U.S.C. Section 1395 and all Federal Regulations and interpretive guidelines promulgated there under ....Definitions: ...Central Log means a log the Hospital maintains of all individuals who present to the Hospital seeking emergency medical assistance and the disposition of such individuals, whether the person refused treatment, was transferred, was admitted and treated, was Stabilized and Transferred, or discharged. The purpose of the Central Log is to track the care provided to each individual who comes to the Hospital seeking care for an Emergency Medical Condition. ..."

Review on February 6, 2023, of security camera footage (no audio for the footage) revealed a minivan pull up to the ambulatory patient entrance of the Emergency Department (ED). A person exited the driver's side of the vehicle and entered the hospital and approached the ED greeter registration desk on January 6, 2023, at 0750. At 0752, the person is seen talking with the ED greeter at the desk and pointed outside toward the exit. At 0753, a person is seen outside standing near the rear of the van. At 0754, a person, whom EMP1 identified as MR1's family member, and a second person, whom EMP1 identified as MR1,exit the van, enter the hospital and approach the ED greeter registration desk and were talking with EMP2. At 0801, MR1 ambulated away from the desk and sat in the ED waiting area. The family member exited the facility and was seen outside on his/her personal cellphone. At 0809, the local police arrived and were talking with the family member outside near the van. At 0810, both the police and the family member approach the ED greeter registration desk and could be seen talking with EMP2. At 0813, the family member and police could be seen talking with MR1 in the waiting area. At 0816, the police, the family member, and MR1 exit the ambulatory entrance to the ED and go back outside. At 0823, the van pulls out of the entrance of the hospital and the police leave in their vehicle.

Interview on February 6, 2023, at approximately 1130, confirmed the above findings. EMP1 revealed s/he had been made aware of the event by a mental health county delegate who called to inform the facility of the incident. A facility investigation was started at that time. EMP1 revealed MR1 was brought to the facility by a family member who wanted to petition for a 302 involuntary commitment. The family member approached the ED greeter registration area and spoke with EMP2 who told the family member that a 302 could not be filed on someone that was present. EMP1 revealed EMP2 was a newer employee who had transferred from a sister facility, which was a behavioral health facility, that had recently closed. EMP1 revealed EMP2 confirmed the patient denied being suicidal when s/he spoke with him/her. The patient then went and sat in the waiting area. EMP1 revealed MR1's family member did call the local police who showed up at the facility. EMP2 told the local police the same thing, that a 302 could not be completed if the patient was present. EMP1 revealed MR1's family member then took him/her to another local hospital.

Review on February 6, 2023, of the Emergency Department central log revealed MR1 was placed on the Emergency Department central log on January 13, 2023, at 0852.

Interview on February 6, 2023, with EMP1 confirmed MR1 was placed on the ED log after the facility was made aware of the event on February 13, 2023.

Based on review of facility documents, staff interview (EMP), and observation, it was determined the facility failed to ensure a patient that presented to the Emergency Room greeter registration desk with a family member requesting to petition an involuntary commitment had an Emergency Medical Screening Examination in the Emergency Department (ED) for one of one observation.

Findings include:

Review on February 6, 2023, of facility policy, "EMTALA," reviewed January 2020, revealed " Purpose: The purpose of this policy is to ensure that the emergency medical treatment and patient transfer policy is based on federal law relating to the emergency medical treatment and medically appropriate transfer of individuals between hospitals. ...All individuals presenting on hospital property requesting emergency medical services, individuals presenting to a Dedicated Emergency Department requesting medical services, and patients arriving/presenting via ambulance requesting medical services shall receive an appropriate Medical Screening Examination and Stabilization services as required by the Emergency Medical Treatment and Labor Act ("EMTALA"), 42 U.S.C. Section 1395 and all Federal Regulations and interpretive guidelines promulgated there under. Definitions: ...Comes to the Emergency Department with respect to an individual requesting examination and treatment means the individual is on the Hospital Property (including parking lot, campus, ambulance bay, and other departments of the Hospital) or an off campus department of the Hospital which meets the definition of a "Dedicated Emergency Department." Dedicated Emergency Department means a department or a facility of a Hospital that is located on the main Hospital campus or off campus, and meets at least one of the following: 1. The department or facility is licensed by the state as an emergency room or department; ...Emergency Medical Treatment and Labor Act ("EMTALA") refers to Section 1866 and 1867 of the Social Security Act, 42 U.S.C Section 1395dd, which obligates the Hospital to provide medical screening, treatment and transfer of individuals with Emergency Medical Conditions or women in labor. It is also referred to as the "anti-dumping" statute and COBRA. Emergency Medical Condition means: 1. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: a. Placing the health of the individual ...in serious jeopardy; b. Serious impairment to bodily functions; or c. Serious dysfunction of any bodily organ or part: ...Hospital Property or Premises includes the entire main Hospital campus, including the parking lot, sidewalk and driveway. ...Medical Screening Examination is the process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an Emergency Medical Condition exists or a woman is in labor. Such screening must be done within the Hospital's capabilities and available personnel, including on-call physicians. Triage is not equivalent to a medical screening examination. ...I. Medical Screening/Stabilization A. General Requirements In general, when an individual comes, by himself or herself, with another person, or by EMS to the Dedicated Emergency Department of the Hospital and a request is made on the individual's behalf for a medical examination or treatment, the Hospital will provide an appropriate Medical Screening Examination within the capability of the Hospital (including ancillary services routinely available in the Dedicated Emergency Department and emergency services offered at outpatient departments or facilities) to determine whether an Emergency Medical condition exists, or with respect to a pregnant woman having contractions, whether the woman is in active labor; and if necessary, the Hospital will execute an Appropriate Transfer according to the guidelines of EMTALA and this policy. These same requirements apply if a person comes to other areas on Hospital property and a prudent layperson believes the individual is in need of an emergency examination or treatment. ...C. Medical Screening Examination Requirements 1. The hospital will perform the Medical Screening Examination to determine if an Emergency Medical Condition exists. 2. The Hospital will provide a Medical Screening Examination to any individual regardless of diagnosis, financial status, race, color, national origin, handicap, ability to pay, or other protected category. 3. Triage is not equivalent to a Medical Screening Examination. Triage merely determines the "order" in which patients will be seen, not the presence of [SIC] absence of an Emergency Medical Condition. 4. The Medical Screening Examination will include both a generalized assessment and a focused assessment based on the patient's chief complaint, with the intent to determine the presence or absence of an Emergency Medical Condition. 5. The Medical Screening Examination will be the same Medical Screening Examination that the Hospital would perform on any individual coming to the Hospital's Dedicated Emergency Department with those signs and symptoms, regardless of the individual's ability to pay for medical care. If the Medical Screening Examination is appropriate, and does not reveal an Emergency Medical Condition, the Hospital has no further obligations under EMTALA or this policy. 6. Depending on the patient's presenting symptoms, the Medical Screening Examination may include a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures such as, but not limited to, lumbar punctures, clinical laboratory tests, CT scans and other diagnostic tests and procedures. 8. [SIC] All medical screenings do not have to be equally extensive. 9. Hospital personnel may leave the Hospital to examine and/or treat an individual in need of emergency services in the immediate vicinity of the Hospital. 10. Every individual who comes to the Hospital's Dedicated Emergency Department and requests a medical examination or treatment will be provided a Medical Screening Examination. The Medical Screening Examination will not be delayed to inquire about the individual's method of payment or insurance status. 11. The Medical Screening Examination for a patient with a psychiatric/mental health complaint requires a medical assessment and a mental health assessment. The Medical Screening Examination should rule out organic, toxic, or traumatic causes for any unusual behavior. 12. Patients presenting with symptoms of substance abuse, including the use of alcohol and street drugs, are entitled to a medical screening examination to determine whether they have an emergency medical condition.13. The Medical Screening Examination will be the same appropriate screening the Hospital would perform on any individual coming to the Hospital's Dedicated Emergency Department with those signs and symptoms, regardless of the individual's ability to pay. 15. [SIC] The Hospital will not request prior insurance authorization before the patient has received a Medical Screening Examination to determine the presence or absence of an Emergency Medical Condition or before an existing Emergency Medical Condition has been stabilized. ... "

Review on February 6, 2023, of security camera footage (no audio for the footage) revealed a minivan pull up to the ambulatory patient entrance of the Emergency Department (ED). A person exited the driver's side of the vehicle and entered the hospital and approached the ED greeter registration desk on January 6, 2023, at 0750. At 0752, the person is seen talking with the ED greeter at the desk and pointed outside toward the exit. At 0753, a person is seen outside standing near the rear of the van. At 0754, the person, whom EMP1 identified as MR1's family member, and a second person exited the van, whom EMP1 identified as MR1, enter the hospital and approach the ED greeter registration desk and were talking with EMP2. At 0801, MR1 ambulated away from the desk and sat in the ED waiting area. The family member exited the facility and was seen outside on his/her personal cellphone. At 0809, the local police arrived, and were talking with the family member outside near the van. At 0810, both police and the family member approach the ED greeter registration desk and could be seen talking with EMP2. At 0813, the family member and police could be seen talking with MR1 in the waiting area. At 0816, the police, the family member, and MR1 exit the ambulatory entrance to the ED and go back outside. At 0823, the van pulls out of the entrance of the hospital and the police leave in their vehicle.

Interview on February 6, 2023, at approximately 1130, confirmed the above findings. EMP1 revealed s/he had been made aware of the event by a mental health county delegate who called to inform the facility of the incident. A facility investigation was started at that time. EMP1 revealed MR1 was brought to the facility by a family member who wanted to petition for a 302 involuntary commitment. The family member approached the ED greeter registration area and spoke with EMP2 who told the family member that a 302 could not be filed on someone that was present. EMP1 revealed EMP2 was a newer employee who had transferred from a sister facility, which was a behavioral health facility, that had recently closed. EMP1 revealed EMP2 confirmed the patient denied being suicidal when s/he spoke with him/her. The patient then went and sat in the waiting area. EMP1 revealed MR1's family member did call the local police who showed up at the facility. EMP2 told the local police the same thing, that a 302 could not be completed if the patient was present. EMP1 revealed MR1's family member then took him/her to another local hospital.

Continued interview with EMP1 on February 6, 2023, confirmed MR1 did not have an Emergency Medical Screening completed in the Emergency Department.