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Based on clinical record review, policy review and staff interview it was determined the facility failed to comply with the requirement to conduct a Medical Screening Examination and a delay in examination and treatment for 1 (#1) of 20 records reviewed.

Patient #1 presented to the Emergency Department (ED) on 4/19/13 at 12:50 a.m. Review of the ED patient information document revealed the reason for the visit was that the patient had anxiety medication and antibiotics last night and that night had a bottle of a highly alcoholic, low-price fortified wine.

Review of the triage record dated 4/19/13 at 12:56 a.m. revealed a chief complaint of vomiting. The past medical history included anxiety. Further review of the documentation revealed there was no triage assessment and/or vital signs completed on the patient.

The patient was very insistent on being seen, banging on the registrar's window and the triage nurse's door. The triage nurse called the police department. The patient left when the police arrived.

A review of a copy of the patient's credit card receipt in the record revealed the patient had paid $200 on 4/19/13 at 1:03 a.m. to the ED registrar, approximately fifteen minutes after arrival and prior to triage

Based on clinical record review, policy review and staff interview it was determined the facility failed to provide a medical screening examination that was within the capability and capacity of the Emergency Department for 1 (#1) of 20 sampled patients presenting to the Emergency Department to determine if an emergency medical condition existed.

Findings include:

A review of the facility's policy "Triage Policy" #ER 101, reviewed 4/12, section II, revealed triage data will be obtained at the bedside, if a bed is available, as soon as the patient arrives. This subjective and objective information will be utilized to accurately sort patients according to their acuity and resource needs.

A review of the facility's policy "Assessment and Reassessment" policy #200, approved 11/8/12, page 6, revealed for the Emergency Department, "patients receive primary assessment survey upon arrival to the hospital and triaged as soon as possible by a registered nurse ".

A review of the facility's policy, "EMTALA- Medical Screening" policy #RM 1211, approved 4/2/12, page 10, section D revealed (1) hospitals are obligated to perform the Medical Screening Examination to determine if an emergency medical condition exists. It is not appropriate to merely "log in" a patient and not provide a medical Screening examination.

Patient #1 presented to the Emergency Department (ED) on 4/19/13 at 12:50 a.m. Review of the ED patient information document revealed the reason for the visit was that the patient had anxiety medication and antibiotics last night and that night had a bottle of a highly alcoholic, low-price fortified wine.

Review of the triage record dated 4/19/13 at 12:56 a.m. revealed a chief complaint of vomiting. The past medical history included anxiety. Further review of the documentation revealed there was no triage assessment and/or vital signs completed on the patient.

An interview was conducted on 5/3/13 at 2:40 p.m. with the registrar involved with patient #1. The registrar stated the patient was very insistent and aggressive, banging on her window and the triage nurse's door. She said she was very afraid of him and told the nurse about him. The triage nurse called the police department, the patient left when the police arrived. The facility failed to ensure that their Triage policy and procedure was followed on April 19, 2013 for patient #1 as evidenced by failing to sort out this patient ' s needs to determine his acuity and resource needs when he presented to the emergency department with complaints of possible drug overdose after taking many medications and drinking alcohol.

Based on clinical record review, policy review, credit card receipt, and staff interview it was determined the facility delayed providing an appropriate medical screening examination for 1 (#1) of 20 sample patients by accepting the patients co-pay before being assessed for an emergency medical condition.

Findings include:

Patient #1 presented to the Emergency Department (ED) on 4/19/13 at 12:50 a.m. Review of the reason for the visit was that the patient had taken the anti-anxiety medication, Lexapro and an antibiotic last night and that night he had a bottle of a highly alcoholic, low-price fortified wine. The form is provided to registration after the patient fills it out.

Review of the triage record dated 4/19/13 at 12:56 a.m. revealed the chief complaint was vomiting. The past medical history included anxiety. Further review of the documentation revealed there was no triage assessment or vital signs completed on the patient.

A review of a copy of the patient's credit card receipt in the record revealed the patient had paid $200 on 4/19/13 at 1:03 a.m. to the ED registrar.

An interview was conducted on 5/3/13 at 2:40 p.m. with the registrar involved with the patient. The patient gave the registrar his credit card for a $200 payment. She had told him that it was not protocol but he insisted she take it anyway. After she received the payment, the patient was insisted on being seen. The registrar informed the triage nurse who called the police department. When the police arrived, the patient left before being seen by the triage nurse or his vital signs taken.

A review of the facility's policy, "EMTALA-Medical Screening" policy #RM 1211, approved 4/2/12, page 11, section E, (1) there shall be no delay in providing a medical screening examination or stabilizing treatment for an emergency medical condition in order to inquire about a patient's method of payment or insurance status. (3) Individuals who inquire about financial responsibility for emergency care should receive a response by a staff member who is well trained to provide information regarding potential financial liability. Patients should be encouraged to delay such discussions until after the completion of the medical screening examination and any necessary stabilizing treatment.

The facility failed to ensure that their policy and procedure was followed on 4/19/2013 related to accepting a method of payment before a medical screening examination was completed on Patient #1.