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Based on document review and interview, the facility failed to capture 1 (patient #1) of 11 patients reviewed on the Emergency Room Log. Patient #1 presented to the Emergency Room (ER) via ambulance at facility #1. Based on interview of ambulance crew, patient and patient family was told by the ER Physician that facility #1 did not have an Intensive Care Unit (ICU) and the patient needed to be transported to a facility with an ICU. The patient was transported to (facility #2) by the ambulance. The facility #1 did not document that patient #1 was in the Emergency Room.

A review of the document from the ambulance service titled Patient Care Report dated 06/16/2018 revealed in the Narrative: "Arrived onsite to find an 80 year old white male with patent airway, alert, in chair on bi-pap, at home. Wife states pt. has been short of breath (SOB) all day and how has O2 (oxygen) on 9L/min and his saturations are in the 80's. Pt. states SOB for a couples of days. Denies chest pain but says his SOB is worse than normal. Moving patient to stretcher delayed while Fire Department requested for help. Pt's wife requested (facility #1) and I advised her that they don't have ICU and she knew that but said all his doctors were there and that's where she wanted him taken. She said last time they went there that if he needed admittance they can send him downtown.
On arrival at facility #1, the ER Dr. refused this patient so we transported patient to (facility #2) and report was given."

A review of facility #1's Emergency Room Log revealed patient #1's name had not been recorded on the log.

An interview with staff #4 confirmed patient #1 had been brought to facility #1's ER and had not been recorded in the Emergency Room Log.

An interview with staff #6 confirmed patient #1 had been brought to facility #1's ER and had not been recorded in the Emergency Room Log.

An interview with staff #7 confirmed patient #1 had been brought to facility #1's ER and had not been recorded in the Emergency Room Log.

A review of a written statement from staff #10 confirmed a patient presented to facility #1's ER by ambulance and the patient was not added to the patient tracker or registered in the system.

Based on document review and interview, the facility failed to provide a Medical Screening Examination to 1 (patient #1) of 11 patients reviewed. Patient #1 presented to the Emergency Room (ER) via ambulance at facility #1. Based on interview of ambulance crew, patient and patient family was told by the ER Physician that facility #1 did not have an Intensive Care Unit (ICU) and the patient needed to transported to a facility with an ICU. The patient was transported to (facility #2) by the ambulance. The facility #1 had no documentation that patient #1 was in the Emergency Room. No emergency room record was available for review.

A review of the document titled Bylaws of the Medical Staff and Ruled and Regulations revealed on page 119, Assessment of Emergency Patients, 76. ... All patients seeking treatment in the Emergency Department shall undergo medical screening by a physician or by an appropriately privileged designee.

A review of a policy titled Medical Screening Examinations revealed ...Individuals who present to the Emergency Care Center (ECC) shall receive a medical screening examination and stabilizing treatment appropriate to their medical condition ...

A review of a written statement from staff #13 revealed, "Today around 1730 we were dispatched to sob call. On arrival found pt. Well known to ems for breathing problems. Pt. on bipap and wife couldn't get sats up. When I asked her which hospital they used, she said facility #1. I advised her that they don't have ICU if he needed to be admitted and she said she knew that, but his Dr's were there, and if he needed admittance they could ship him downtown. I said why don't you just let us take him to (facility #2), and she said they would probably send him home anyway. When we got to facility #1 and were standing in front of the nurse's station. The DR. came out and in front of everyone started questioning me about why I didn't do a better job informing the pts. family about them not having an ICU. As I was trying to explain it to him the wife walked up and he said to her that apparently I didn't do a very good job of informing her of their capabilities and her husband obviously needed to be intubated and admitted to ICU, and they don't do that there, and they would have to send him downtown for that. At that point I said are you refusing this patient to the Dr. and the Dr. ignored me and said to the wife I hope I have explained it better than EMS did. She then said to me, let's just take him to (facility #2). So we loaded him up and transported to (facility #2).

Our complete time at facility #1 was 1833 and at (facility #2) was 1856.

At no time did he come out from around nurses station and even attempt to assess pt. to try to determine his condition or needs. If he was that critical which I don't think he was. He just refused definitive care.(sic)"

A review of a written statement from staff #10 revealed, "I was asked about an occurrence on 6/16/18 regarding a patient being brought in by ambulance who wasn't registered. The only case I can somewhat remember is regarding a patient that was brought in, but he was never 'dropped', so we did not get his information/register him. I was working in the back that day. The EMS radioed ahead and stated the PT was short of breath and low 02 levels. They radioed the sats/numbers, but I didn't understand much of it. Physician #9 recognized the PT was going to need ICU/IMC almost immediately and questioned why the PT was being transported here. When the EMS arrived with the PT, they were brought to the hallway in front of the nurse's station and Physician #9 questioned the EMS driver. The PT wife stated they wanted to come here because the PT's doctors were here, but was unaware we didn't have the ICU anymore (apparently he had been admitted to our ICU before with similar problems). Physician #9 explained to her that in her husband's condition, he would need to be transferred to downtown right away, so that if he stayed here, he would have to be evaluated and then another EMS would be called to later transport him again, which in the long run would delay his care. After that the wife agreed and said they wanted to go ahead and go straight to downtown. I am not sure if they went to UT main or (facility #2)" ...

An interview with staff #4 confirmed patient #1 had been brought to facility #1's ER and had not been recorded in the Emergency Room Log.

An interview with staff #6 confirmed patient #1 had been brought to facility #1's ER and had not been recorded in the Emergency Room Log.

An interview with staff #7 confirmed patient #1 had been brought to facility #1's ER and had not been recorded in the Emergency Room Log.

A phone interview with ER physician #9 confirmed patient #1 had presented in facility #1's ER and the physician had spoken with EMS and the wife of the patient and told them the patient needed to be transported to a facility with an ICU. Physician #9 confirmed an MSE had not been performed on the patient and no medical record was generated.