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Based on staff interview, medical record review, and facility policy and procedure review, the facility failed to comply with 489.20(l) by not providing appropriate medical screening exams on three (3) out of 20 patient charts reviewed: Patients #9, #13 and #20.

Findings Include:

Cross Refer to A-2406 for the facility's failure to provide a thorough medical screening examination.

During Exit Conference on 11/15/2022 at 3:30 p.m. with the Chief Executive Officer, Compliance Officer/Risk Manager/Patient Advocate, and Director of Quality, survey findings were discussed. No further documentation was submitted for review.

Based on staff interview, medical record review, facility standard work document, education materials and memo, and Emergency Department (ED) scorecard, and facility policy and procedure review, the hospital failed to comply with 489.24(a)(1)(i) by the failure to provide a thorough medical screening examination by an individual(s) who is determined qualified by hospital bylaws or rules and regulations on three (3) out of 20 patient charts reviewed: Patients #9, #13 and #20.

Findings Include:

An interview on 11/07/2022 at 1:15 p.m. with Compliance Officer, Risk Manager, and Patient Advocate, confirmed the Emergency Department (ED) does a full medical screen exam (MSE) for geriatric-psychiatric patients but for patients just wanting to have a psychiatric evaluation, they are sent to the Psychiatric Unit for assessment.

An interview on 11/09/2022 at 9:30 a.m. with Director of Quality, revealed the facility's correct process for psychiatric evaluation patients who come through the Emergency Department is to preregister on the ED log and be seen by the triage nurse and if the patient is seeking behavioral health and is not mentally or chemically impaired then the Psychiatric Unit upstairs is called for a bed, if bed available then the patient is deregistered as an emergency room patient and patient sent upstairs to Psychiatric Unit for assessment. She further confirms if no bed available then the patient is processed through the ED and provided MSE and disposition as appropriate. Confirmed statement at 4:20 p.m. 11/09/2022.

An interview with the Director of Quality on 11/09/2022 at 4:00 p.m. revealed she would expect a patient to have a Medical Screening Exam completed within 30 minutes after triage.

An interview with the Emergency Department Director (EDD) on 11/09/2022 at 4:20 p.m. revealed she would expect a patient to have a Medical Screening Exam within 30 minutes after a triage. EDD reported that she monitors the length of time from arrival until the patient sees the provider and the goal is 30 minutes.

A review of the medical record for Patient #9 was not conducted due to the facility's inability to provide the medical record after multiple requests. Patient #9 was listed on the ED Log without a disposition at discharge on 08/06/2022. No documented evidence of a triage assessment or a Medical Screening examination (MSE).

Review of medical record, "Triage Assessment," for Patient #13 revealed the patient presented to the ED on 06/14/2022 at 12:48 a.m. with complaints of reddened scrotum and swollen lips. Patient triage time was completed at 12:57 a.m. with an acuity level 3. Patient's vital signs completed at 12:57 a.m. Patient left without being seen at 2:48 a.m. without receiving a Medical Screening Exam. The discharge information for Patient #13 documented counseling was not provided on risks of leaving without being seen.

Review of medical record for Patient #20 revealed the patient presented to the ED on 09/21/2022 at 10:09 p.m. with complaints of feeling depressed lately. Medical record review revealed that the patient did not have a triage or Medical Screening Exam completed. Medical record review revealed that the patient was sent to the behavioral care unit for a pre-screen by the Registered Nurse (RN). Medical record review revealed that the RN phoned the Psychiatrist on call, Physician #1, with her pre-screen results. Medical record review revealed that the Psychiatrist, Physician #1, determined that the patient was not appropriate for inpatient treatment via phone and did not complete a medical screening.

Review of the facility's "TRIAGE/MEDICAL SCREENING POLICY," policy number ED 578, original date 09/1997, last revision 12/2021, approved by executive committee states, " ...All patients presenting to the Emergency Department shall be evaluated by a Registered Nurse to determine the nature of the presenting complaint(s), condition, and priority for receiving a medical screening evaluation, and shall be designated a triage priority and monitored with that priority category during the Emergency Department admission ...1. The duty of the Triage Nurse shall be to conduct an initial evaluation of all presenting patients with the assistance of tech as needed. 2. The initial evaluation shall include: a. Brief history b. Determination of complaint(s) c. Vital Signs ...d. A physical assessment or examination of the patient as necessary to determine the nature and severity of the patient's condition ...f. The Triage Nurse shall be responsible for the assignment of patients, in order of severity, a triage category for medical screening examination by the Licensed Independent Practitioner (LIP) on duty ...F. The duty to provide a medical screening examination and stabilizing treatment is not limited by the Triage category assigned. All patients, regardless of Triage category, are required to be provided a medical screening examination and stabilizing treatment ...".

Review of the facility's "Emergency Medical Treatment and Labor Act (EMTALA) Policy", (No Reviewed/Revised date) revealed, " ...Magnolia Regional Health Center will provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists ....Magnolia's obligations to perform a medical screening examination shall be triggered when: ...(ii) an individual arrives on the hospital's property and a request is made for examination or treatment for an emergency medical condition ...Only qualified medical personnel may provide medical screening examinations ...The Hospital will provide all necessary medical screening examinations and necessary stabilizing treatment to any individual regardless of diagnosis ...".

Review of the facility's "Standard Work Document," (No Reviewed/Revised date), revealed, " ...Adult patients who come to the ER for a psychiatric complaint 1. Patient will be triaged and will not be registered in the ER ...if no beds are available Behavioral Health (BH) nurse will be asked to assess patient in the ER ... 2. Triage will call Behavioral Health to make sure a bed is available ...if the patient appears stable and no signs of alcohol intoxication ... Adult patients are not required to have an ER workup unless they appear medically compromised or intoxicated ... 3. Security will accompany patient to BH ... 4. BH nurse will do a CR pre-admission assessment ... 5. BH physician will be called, and patient will be admitted or referred ...".

Review of the facility's "EMTALA Education Material," (no date), revealed, "....The facility must provide a medical screening examination (by a physician preferable), beyond triage, to all patients regardless of acuity who present in the hospital emergency department as necessary to complete the medical screening examination ...".

Review of the facility's "Educational Memo" related to EMTALA, (Dated June 21, 2021) revealed ..." The Act requires Medicare-participating hospitals that offer emergency services to provide a medical screening when a request is made for examination or treatment for an emergency medical condition ...".

A review of the facility's "Emergency Department Provider Scorecard," from October 2021 through September 2022, revealed the facility only met the goal of the patient having a Medical Screening Exam in less than 30 minutes in the month of May 2022.

During exit conference on 11/15/2022 at 3:30 p.m. with the Chief Executive officer, Compliance Officer/Risk Manager/Patient Advocate, and Director of Quality, survey findings were discussed. No further documentation was submitted for review.