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Based on observations, interviews, policy and document review, the hospital failed to provide medical screening examinations (MSE) for two out of 20 sampled patients (Patient 1 and Patient 2) brought to its dedicated emergency department (DED) by ambulance after a motorcycle accident.

These failures may have led to a delay in stabilizing treatment and appropriate transfer.

Findings:

The base (hospital) radio conversation between MD 1 and Paramedic 1, the evening of 1/12/18, was recorded. The surveyor listened to the audio recording with the Emergency Department Director on 7/29/21 at 8:30 a.m. The recorded conversation, dated "1/12/2018 1908", went as follows: MD 1: "Yea, I'm here." Paramedic 1: "Hi [MD 1]. I'm at your back door. I also got a 63 year old male..." MD 1: "Yea, let me hold you. Where are you now?" Paramedic 1: "At your back door." MD 1: "You have to take him to trauma center. I am not accepting the patients." Paramedic 1: "Either one of them?" MD 1: "Neither one of them." Paramedic 1: "OK." MD 1: "Thank you."

The 1/12/18 Ambulance Service electronic Patient Care Records (ePCR), or Run Reports, for Patients 1 and 2 were reviewed. Patient 1's Run Report indicated a "General Comment" documented at 7:04 p.m. It read, "Call(ed) [hospital] with patient report, [MD 1] refused patients, diverted at 1908." Patient 2's Run Report indicated a "General Comment" documented at 7:04 p.m. It read, "Called [hospital] with patient report, [MD 1] refused patients, diverted to [trauma center] at 1908."

The "Prehospital Radio Log" indicated Registered Nurse 1 (RN 1), on 1/12/18 at 7:03 p.m., was notified by "Medic 22 (ambulance)" about the arrival of "2 patients, motorcycle accident." MD 1's name was also identified on the Prehospital Radio Log.

The EMTALA Central Log entries from 1/12/18 were reviewed. Neither Patient 1 nor Patient 2 were listed on the log. In a concurrent interview on 7/29/21 at 8:30 a.m., the Emergency Department Director (EDD) acknowledged neither patient was added to the EMTALA Central Log on 1/12/18 when they arrived to the ED via ambulance.

During concurrent interview and record review on 7/29/21 at 12:05 p.m., the facility was unable to provide documented evidence Patient 1 or Patient 2 were triaged and/or screened for an emergent medical condition upon arrival to the ED the evening of 1/12/18.

During an interview with RN 1 on 7/28/21 at 11 a.m., RN 1 stated she was working the evening of 1/12/18 and was present when the ambulance arrived with Patients 1 and 2. RN 1 stated she saw MD 1 speak to Paramedic 1 and Emergency Medical Technician 1 (EMT 1) near the ambulance bay entrance. RN 1 explained, initially MD 1 told the ambulance staff to take both patients to a trauma center hospital. RN 1 stated, MD 1 then "changed his mind" and told Paramedic 1 and EMT 1 to bring both patients into the ED for examination. RN 1 believed "it was [EMT 1]" who angrily responded, "No, we're leaving," and slammed the back door of the ambulance. EMT 1 and Paramedic 1 left the hospital property and Patients 1 and 2 remained in the ambulance. RN 1 admitted she did not know if MD 1 performed an MSE on either patient.

In an interview on 7/29/21 at 8:20 a.m., EDD stated the ED staff and physician were aware the ambulance was outside; "The problem was no MSE was performed by the provider."

During an interview on 7/29/21 at 8:45 a.m., EDD was asked if MD 1 documented that the patients left the hospital property before an MSE was performed. EDD acknowledged he did not and commented, "Where would he?"

During a telephone interview with MD 1 on 8/2/21 at 1:40 p.m., he stated he could not remember anything about the incident or alleged EMTALA violation.

On 7/29/21 at 10:18 a.m. in the ED, MD 2 was observed using the base phone to communicate with a paramedic on an incoming ambulance. After concluding the phone call, MD 2 stated, once a patient is brought to the ED by ambulance, "we own them and must provide care."

According to the [hospital] "Department Description-Emergency Department" (in effect May 2011), the Emergency Department is an eight-bed unit providing basic emergency services. All patients presenting for care are medically screened and treated within the scope of services available at [the hospital]. Transfers and referrals to other facilities are utilized for services not available...A physician with specialty training or significant experience in Emergency Medicine is available 24 hours a day."

According to the Patient Care Services policy and procedure (in effect 11/28/17) titled, "EMTALA (Emergency Medical Treatment and Active Labor Act): Application and Implementation", "It is the policy of [the hospital] to comply with the EMTALA obligations...EMTALA is applicable to any individual who comes to a dedicated emergency department seeking or in need of examination or treatment for a medical condition, even if the treatment is not for an emergency condition...EMTALA applies to all individuals on the hospital property who experience what may be an emergency medical condition. [The phrase "comes to the Emergency Department" also means an individual in a non-hospital owned ground or air ambulance that is on hospital property for the purpose of presenting the individual at the hospital DED for examination or treatment for medical condition.] A medical screening examination must be offered to any individual presenting to the DED for examination or treatment of a medical condition. The examination must be provided within the capabilities of the hospital, including the availability of on-call physicians. The examination must be performed by physicians or other qualified personnel..."

According to the 2018 Medical Staff Rules and Regulations for the Department of Medicine, "Any patient presenting to the Emergency Department will have a medical screening examination performed by qualified personnel who have been granted privileges for triage of Emergency Department patients."