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Based on review of patient records, hospital policies and procedures and staff interview, the hospital failed to comply with all requirements of 489.24.

Refer to citation and example at:

A 2406 (489.24(a)) Medical Screening Exam) - Hospital staff in the Emergency Department failed to provide a medical screening exam to a patient who arrived by ambulance on hospital grounds on November 16, 2017. The hospital was on diversion status at the time. The ambulance was not owned by the hospital.

Based on a self-disclosure report submitted by the hospital to the Regional Office of the Center for Medicare Services (CMS) on 11/30/17, review of hospital policy and procedure, and staff interview, Emergency Department (ED) hospital staff failed to provide a medical screening exam to rule out an emergency medical condition for a patient who had arrived on hospital grounds for 1 of 25 records reviewed of patients presenting to the Emergency Department (Patient #1). The ambulance was not owned by the hospital.

Failure to provide a medical screening exam risked patient health and safety, and was a violation of the federal "anti-dumping" regulations.

Findings include:

Patient #1: Per review of the hospital's self-disclosure report, the Emergency Department was at or exceeded capacity (96 patients in the ED, all beds full, and 40 patients in the waiting room) and went on diversionary status on 11/16/17 at approximately 3:46 P.M. for approximately 61 minutes. During this time, Patient #1 arrived by ambulance and was on hospital grounds outside the Emergency Department. A paramedic came into the ED and inquired with the Charge Nurse about the status of the diversion. The ED Charge Nurse advised the paramedic the diversionary status was still in effect because there were no beds available. The report documented the paramedic then left the ED and took the patient to the next nearest hospital ED, which was approximately 2 miles away. The patient's name was not known, but was believed to be a psychiatric patient.

Per the report, the paramedic did not indicate the patient needed stabilizing care or had an apparent emergency medical condition, but was checking on the hospital's diversionary status. The ambulance was not owned by the hospital.

Record review of hospital policy titled, "Diversion of Patients" last dated 03/29/16, showed that no patient who arrives at the medical center is diverted regardless of ED diversion status prior to receiving a medical screening exam. The exam must be provided under EMTALA, and the patient transferred as appropriate.

Interview with the Quality Assurance/Performance Improvement Manager on 12/18/17 verified the facts of the hospital's self-disclosure and actions to immediately re-educate staff and monitor compliance with hospital policy and regulatory requirements.

The hospital failed to provide an appropriate medical screening exam to rule out an emergency medical condition as required.