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Based on document review and staff interview, it was determined the Hospital failed to ensure all patients are logged in the Emergency Department central log and failed to provide a Medical Screening Exam to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24.

Findings include:

1. The hospital failed to document all patients on the ED central log. See deficiency at A-2405

2. The hospital failed to ensure patients who did come to the Emergency Department were provided an appropriate medical screening examination within the capability of the hospital's emergency department. See deficiency at A-2406

Based on a request for documents and staff interview, it was determined for 1 of 20 patients (Pt #1) presenting to the emergency department (ED) the hospital failed to ensure the patient was documented in the ED central log. This has the potential to affect all patients receiving care in an ED that treats approximately 85 patients a day.

Finding include:

1. On 10/31/22 at 9:30 am, a request was made to the vice president/chief of quality control (E#1) for documentation indicating Pt #1 presented to the ED via EMS (Abbott) on 9/21/22 at approximately 6:30 am. Other documents and policies were also requested. At 11:00 am another request was made for documentation indicating Pt #1 was logged in. There was no evidence that the patient was ever registered or placed on the ED tracking log, even though it was reported by E#1, Pt#1 was brought by EMS yet remained in the ambulance.

2. An interview was conducted with ED charge nurse (E#10) on 11/1/22 at 8:15 am. E#10 was asked if she was aware of anyone who registered and logged Pt #1 into the ED central log. E#10 recalled the registration clerk did go to the ambulance but is unaware of what if any information was obtained. E#10 reported there is no entry of Pt #1 in the ED log. E#10 reported the registration clerk is no longer here as he moved from the area.

Based on document review and staff interview, it was determined for 1 of 20 (Pt #1) patients who presented to the Emergency Department (ED), the hospital failed to provide an appropriate medical screening to determine within reasonable clinical confidence whether an emergency medical condition existed. This has the potential to affect all patients receiving care in an ED that treats approximately 85 patients a day.

Finding include:

1. A request for documentation of a medical screening for Pt #1 was made on 10/31/22 during the entrance conference. No documentation was provided indicating a medical screening was completed for Pt #1.

2. An interview with ED physician involved in incident with Pt #1 (E#9) was conducted by phone on 10/31/22 at 3:14 pm. E#9 stated, "The whole thing was odd. The nurse manager picked up the line and I got information from her. The nurse relayed Pt #1 was in car accident the afternoon of the previous day and remained in the car. Pt #1 with contusion to head, deformity of arm. Paramedic relayed the patient was alert and oriented. My perspective -this could be a trauma as I thought of head injury." E#9 reported the medic was confrontational and rude to the nurse, so E#9 took the call and asked some questions. I told the medic I felt the patient should be taken to Carbondale trauma. E#9 reported the medic "didn't think it was serious" but E#9 "was unclear what they were going to do-as far as bringing the patient here." E#9 reported the EMS showed up and medic came into hospital without the patient. E#9 or other staff did not ask where Pt #1 was or request to bring the patient into the hospital for examination. E#9 felt he could not talk with the medic and left the area to take care of other patients, expecting the patient to be brought into the ED. When E#9 came back to the nurse station within minutes the nurse said, "They (EMS) are pulling away." Pt #1 was not brought into the hospital. E#9 stated, "When I left the discussion I thought the patient was being brought into a room. I didn't refuse care, tell them to leave or go to Carbondale. I was prepared to provide care to the patient."

3. On 11/2/22 at 9:15 am, an interview was conducted with the Vice President/Chief Quality Control (E#1). This surveyor reviewed the information received during the survey regarding the incident with Pt #1. E#1 confirmed the incident including Pt #1 was brought to the hospital, remained in the ambulance while the medic entered to talk with staff, but Pt #1 was not brought into the ED. The medic left the hospital with the patient and a medical screening was not provided. The situation prompted E#1 to self-report the incident. E#1 confirmed Pt #1 presented to the ED per EMS but was not documented in the ED log.