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Based on policy and procedure review, medical record review and staff and physician interviews the hospital failed to ensure a timely medical screening examination (MSE) was provided within the capability of the hospital's Dedicated Emergency Department (DED) including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition existed and failed to explain risk and benefits for 1 of 3 sampled LWBS (left without being seen) patients (Patient #2).

The findings include:

The hospital failed to ensure a timely medical screening examination (MSE) was provided within the capability of the hospital's Dedicated Emergency Department (DED) including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition existed and failed to explain risk and benefits for 1 of 3 sampled LWBS (left without being seen) patients (Patient #2).

~cross refer to 489.24(a), Medical Screening Exam - Tag A2406.

Based on policy and procedure review, medical record review and staff and physician interviews the hospital failed to ensure a timely medical screening examination (MSE) was provided within the capability of the hospital's Dedicated Emergency Department (DED) including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition existed and failed to explain risk and benefits for 1 of 3 sampled LWBS (left without being seen) patients (Patient #2).

The findings included:

Review of the policy and procedure titled "EMTALA Policy" reviewed 03/01/2021 revealed "Purpose: To maintain compliance with EMTALA requirements for all clinical areas. Policy:...All patients presenting to the Emergency Department and within 250 feet of (Named) Regional Medical Center will be offered a Medical Screening exam upon request...Medical Screening Exams and Stabilization: Any individual who presents to (Named) Emergency Department for care will receive an appropriate Medical Screening Exam within the capabilities of the facility...Refusal to consent to treatment: Written refusal-If an individual refuses to consent to examination or treatment, after being informed of the risks and benefits and the hospital's obligations under EMTALA, reasonable attempts will be made by hospital personnel to obtain a written refusal to consent to treatment or examination using the Against Medical Advice form..."

Review revealed Patient #2 presented to Hospital A Dedicated Emergency Department (DED) on 12/05/2021 at 1212 for Kidney Stone problems. Patient #2 was discharged home at 1624.

Review revealed Patient #2 presented back to Hospital A DED on 12/13/2021 at 1652 for a yeast infection. Review of LPN (licensed practical nurse) #1's ED note dated 12/13/2021 at 1821 revealed "Pt (patient) refuses anything being done she refuses vital signs states she had been to see her doctor today and sent to ER for a yeast infection. Pt ambulatory to vehicle in no distress." Review of the record revealed Patient #2 left prior to being triaged or seen by a provider.

Review revealed Patient #2 presented to Hospital B DED on 12/14/2021 at 1008 for abdominal pain, back pain, vaginal discharge, and hematuria times two weeks.

Interview on 02/02/2022 at 0901 with NP (nurse practitioner) #2 revealed he was the NP on duty on 12/13/2021 when Patient #2 presented to the DED. Interview revealed Patient #2 left before being triaged or seen by him. NP #2 stated he was very familiar with Patient #2. NP #2 stated "we are her (Patient #2) primary, she comes here for everything." NP #2 stated it was unlikely that if Patient #2 had seen her PCP that day for a yeast infection, the PCP would have told her to come to the DED for evaluation. NP #2 stated Patient #2 had an extensive history of kidney stones and UTIs.

Interview on 02/02/2022 at 0926 with LPN #1 revealed she was the LPN on duty on 12/13/2021 when Patient #2 presented to the DED. LPN #1 stated she took Patient #2 to a room in the ED to get her vital signs and chief complaint. Patient #2 told LPN #1 she had seen her PCP earlier in the day for a yeast infection and was advised by her PCP to go to the ED for evaluation. LPN #1 asked Patient #2 if her PCP prescribed her medications for the yeast infection and if she had gone to the pharmacy to pick up the medications which Patient #2 responded with no, she had not picked up the medication. LPN #1 advised Patient #2 "they" (the ED provider) "probably" would not do anything different for her. LPN #1 stated Patient #2 stated "ok", and she was not going to stay. Patient #2 refused to be triaged or vital signs obtained at that point and left without being triaged or seen by a provider.

Interview on 02/02/2022 at 1554 with RN #3 revealed he was the RN on duty on 12/13/2021 when Patient #2 presented to the DED for a yeast infection. Interview revealed RN #3 did not recall that day specifically nor any details about that visit.

The patient had no vital signs despite being in the emergency department for one-and-a-half hours. The patient's chief complaint was never recorded. The patient was never seen by a qualified medical professional. The patient was not stabilized prior to discharge. There is no indication that the patient was informed of the risks and benefits of her decision to leave.