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Based on document review and interview, it was determined the Critical Access Hospital (CAH) failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The CAH failed to ensure all patients presenting to the Emergency Department, received a Medical Screening Examination (MSE). See deficiency at A - 2406.

Based on document review and interview it was determined that for 2 of 20 patients (Pt #1 and Pt #2) that presented to the Critical Access Hospital's (CAH) Emergency Department (ED), the CAH failed to ensure names of the two patients were listed on the Emergency Department Central Log.

Findings include:

1. The Critical Access Hospital's policy titled, "Screening, Stabilization and Transfer of Individuals with Emergency Medical Conditions," (revised 2018) required, "D. Record Keeping. The Hospital...must maintain...iii. Central Log...a. The Central Log must list every individual who comes to the emergency department and shall indicate whether the individual refused treatment or transfer, was refused treatment..."

2. The Emergency Department Logs dated 5/16/18, 7/8/18, and 7/9/18 were reviewed on 7/11/2018, and the logs failed to include the names of Pt #1 and Pt #2.

3. The clinical record from the recipient Hospital (Hospital B) of Pt #1 was reviewed on 7/11/2018, at 1:30 PM. Pt #1 was 61 year old male, who presented to Hospital B's ED on 5/16/18 for acute alcohol intoxication.

4. The clinical record from the recipient Hospital (Hospital B) of Pt #2 was reviewed on 7/11/2018, at 1:45 PM. Pt #2 was a 17 year old female, who presented to Hospital B's ED on 7/9/2018, with a complaint of sexual assault.

5. On 7/11/2018 at approximately 3:54 PM, an interview was conducted with the Emergency Department Registered Nurse (ED-RN E #2). E #2 stated, "I do recall this patient. He was brought here by Whiteside Police on May 16, 2018. The patient came here with a written order from the physician at the Whiteside jail, stating patient needed to be admitted for Metabolic (processes by which cells produce the substances and energy needed to sustain life) observation. This looked like an order for a direct admit, so I told them I had to call the doctor to find out if we were able to do this. I called the doctor on call (MD #1) and I read him word for word what was written on this order. MD #1 said that we did not do this here, and asked me to give them resource information on where to go. I told the patient and officer that I would be able to provide them with a list of hospitals that they can go to. They (patients)are put down in the log if they are seen here. I did not enter the patients' names into the ED Log because they did not cross the ED threshold."

6. On 7/11/2018 at approximately 3:54 PM, an interview was conducted with the Critical Access Hospital Emergency Department Registered Nurse (ED-RN E #2). E #2 stated, "I was working on July 9, 2018 and I do recall the patient (Pt #2) coming here with a motherly type figure and a male figure, like a brotherly type. The mother said that her daughter had been raped. I explained to her that I was not aware that our facility was equipped to handle this type of case. I told them that I didn't think our providers were able to provide this type of service. She did not appear to be in distress. They were standing in the hallway by the sliding doors. I turned to look at computer for our policy and when I turned back to them, they were gone. I did not notify the physician on call, since they left. If the patient had stayed and the doctor on call advised me to admit the patient, I would have put her in a room and set her up for treatment. I was never trained for sexual assault and I have been here for two years. I don't believe that we even have rape kits available here."

7. On 7/12/18 at approximately 9:13 AM, an interview was conducted with the Chief Executive Officer (E #4). E #4 stated, "Any person that presents on our property should be registered and screened to assess their needs. Even if they do not give a name and decide to leave, they should write in log male (so the patient can be captured on the log)..."

Based on document review and interview it was determined that for 2 of 20 patients (Pt #1 and Pt #2) that presented to the Critical Access Hospital's (CAH) Emergency Department, the CAH failed to ensure all patients received a Medical Screening Examination (MSE).

Findings include:

1. The clinical record from the recipient Hospital (Hospital B) of Pt #1 was reviewed on 7/11/2018, at 1:30 PM. Pt #1 was 61 year old male, who presented to Hospital B's ED on 5/16/18 for acute alcohol intoxication. The clinical record included a document dated 5/16/2018 at 7:53 PM titled, "Emergency Documentation" and included, "...Presents with nausea and abdominal cramping...a 60-year old male was brought in by local police after being processed into the county jail ...he presented with nausea, abdominal bloating and was very shaky, tremulous and sweaty." The ED (Hospital B) documentation indicated, "(Pt #1) was triaged as Acuity Level 2 (acuity of patient's health care problems; 2-Emergent; High risk of deterioration or signs of a time-critical problem)."

2. The clinical record from the recipient Hospital (Hospital B) of Pt #2 was reviewed on 7/11/2018, at 1:45 PM. Pt #2 was a 17 year old female, who presented to Hospital B's ED on 7/9/2018, with a complaint of sexual assault. The clinical record included a document, dated 7/9/2018 at 4:58 AM titled, "Emergency Documentation" and included, "...Arrival mode: Private vehicle, walking...Pelvic exam performed...The patient (Pt #2) presents following alleged sexual assault. The onset was 5 hours ago...17 year old female who states that she was sexually assaulted...ED Tracking Group Recommended ESI (Emergency Severity Index-a five level emergency department triage stratification, from 1 being most urgent to 5 the least urgent) Level 2..."

3. On 7/11/2018 at approximately 3:54 PM, an interview was conducted with the Critical Access Hospital Emergency Department Registered Nurse (ED-RN E #2). E #2 stated, "I was working on July 9, 2018 and I do recall the patient (Pt #1) coming here with a motherly type figure and a male figure, like a brotherly type. The mother said that her daughter had been raped. I explained to her that I was not aware that our facility was equipped to handle this type of case. I told them that I didn't think our providers were able to provide this type of service. She did not appear to be in distress, they were standing in the hallway by the sliding doors. I turned to look at computer for our policy and when I turned back to them, they were gone. I did not notify the physician on call, since they left. If the patient had stayed and the doctor on call advised me to admit the patient, I would have put her in a room and set her up for treatment. I was never trained for sexual assault and I have been here for two years. I don't believe that we even have rape kits available here."

4. On 7/11/2018 at approximately 3:54 PM, an interview was conducted with the Emergency Department Registered Nurse (ED-RN E #2). E #2 stated, "I do recall this patient. He was brought here by Whiteside Police on May 16, 2018. The patient came here with a written order from the physician at the Whiteside jail, stating patient needed to be admitted for Metabolic (processes by which cells produce the substances and energy needed to sustain life) observation. This looked like an order for a direct admit, so I told them I had to call the doctor to find out if we were able to do this. I called the doctor on call (MD #1) and I read him word for word what was written on this order. MD #1 said that we did not do this here and asked me to give them resource information on where to go. I told the patient and officer that I would be able to provide them with a list of hospitals that they can go to."

5. On 7/12/18 at approximately 9:13 AM, an interview was conducted with the Chief Executive Officer (E #4). E #4 stated, "Any person that presents on our property should be registered and screened to assess their needs. We do have a rape policy and a protocol for these situations. The patient (Pt #2) should have been admitted and screened."