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Based on review of 1 of 21 patients who were logged into the Hospital's Emergency Department (ED) Records, review of documentation and interviews, it was determined that the Hospital failed to provide a medical screening examination to Patient #21 on 8/4/13.

Findings include:

The local police department record, dated 8/4/13, indicated that at 11:37 P.M. a call was placed for a medical rescue for Patient (Pt.) #21 and Emergency Medical Service (EMS) was dispatched.

The EMS ambulance trip sheet, dated 8/5/13, (still 8/4/13) indicated at 11:57 P.M. Pt. #21 arrived at the Hospital's ED.

The Hospital Central Log, dated 8/4/13 indicated at 11:57 P.M. Pt. #21 presented to the ED.

The Surveyor interviewed the Risk Manager at 7:30 A.M. on 8/13/13. The Risk Manager said there was no patient record for Pt. #21's visit on 8/4/13.

The Surveyor interviewed the Charge Nurse at 12:30 P.M. on 8/13/13. The Charge Nurse said that Pt. #21 was brought into the ED by the city's Fire Department EMS. The Charge Nurse said it was a busy night and 2 other ambulances came to the ED just about the same time Pt. #21 came in. The Charge Nurse said the EMS staff brought Pt.#21 into the ED and reported that he/she may have a head bleed and would need a head CT scan. The Charge Nurse said knowing that she had recently been told by the CT technologist that the CT scanner was down (not working correctly), so she told the EMS staff he'll/she'll have to go to Hospital #2. The Charge Nurse said she left that area to attend to a patient with chest pain and was planning to come back to Pt. #21. The Charge Nurse said she also knew in her mind that the city's fire department EMS personnel don't transport patients between hospitals.

The Surveyor interviewed the ED Attending Physician on 8/14/13 at 2:00 P.M. The ED Attending Physician said the ED was very busy the night Pt. #21 came into the ED. The ED Physician said he was told that the CT scanner was not working because the readings were not available. The ED Physician said he was walking by the EMS staff and the Charge Nurse and heard the discussion. The ED Physician said he told the EMS staff not to take Pt. #21 off the stretcher and that Pt #21 will need to be sent to Hospital #2. The ED Physician said he did not perform an EMS and did not see Pt. #21 leave the ED.

The Charge Nurse said she came back a few minutes later to the area where Pt. #21 was and immediately realized he/she left the Hospital without a medical screening examination and without being properly transferred. The Charge Nurse said she immediately called the Nursing Supervisor.

The Surveyor interviewed the CT Technologist on 8/14/13. The CT technologist said on 8/4/13 at approximately 9:30 she noticed that CT images sent to be read were not read, so she sent them again. The CT Technologist said she called the ED Charge Nurse to report the problem with the imaging and the delay in the CT result reports.

The Hospital was in compliance with EMTALA Regulations at the time of the on-site visit. The Hospital completed a root cause analysis and an internal investigation regarding the suspected Emergency Medical Treatment and Labor Act (EMTALA) violation. The Hospital identified opportunities for improvement and all staff were re-trained in all EMTALA policies and procedures.

Based on review of 1 of 21 patients who were logged into the Hospital's Emergency Department (ED) Records, review of documentation and interviews, it was determined that the Hospital failed to provide a medical screening examination to Patient #21 on 8/4/13.

Findings include:

The local police department record, dated 8/4/13, indicated that at 11:37 P.M. a call was placed for a medical rescue for Patient (Pt.) #21 and Emergency Medical Service (EMS) was dispatched.

The EMS ambulance trip sheet, dated 8/5/13, (still 8/4/13) indicated at 11:57 P.M. Pt. #21 arrived at the Hospital's ED.

The Hospital Central Log, dated 8/4/13 indicated at 11:57 P.M. Pt. #21 presented to the ED.

The Surveyor interviewed the Risk Manager at 7:30 A.M. on 8/13/13. The Risk Manager said there was no patient record for Pt. #21's visit on 8/4/13.

The Surveyor interviewed the Charge Nurse at 12:30 P.M. on 8/13/13. The Charge Nurse said that Pt. #21 was brought into the ED by the city's Fire Department EMS. The Charge Nurse said it was a busy night and 2 other ambulances came to the ED just about the same time Pt. #21 came in. The Charge Nurse said the EMS staff brought Pt.#21 into the ED and reported that he/she may have a head bleed and would need a head CT scan. The Charge Nurse said knowing that she had recently been told by the CT technologist that the CT scanner was down (not working correctly), so she told the EMS staff he'll/she'll have to go to Hospital #2. The Charge Nurse said she left that area to attend to a patient with chest pain and was planning to come back to Pt. #21. The Charge Nurse said she also knew in her mind that the city's fire department EMS personnel don't transport patients between hospitals.

The Surveyor interviewed the ED Attending Physician on 8/14/13 at 2:00 P.M. The ED Attending Physician said the ED was very busy the night Pt. #21 came into the ED. The ED Physician said he was told that the CT scanner was not working because the readings were not available. The ED Physician said he was walking by the EMS staff and the Charge Nurse and heard the discussion. The ED Physician said he told the EMS staff not to take Pt. #21 off the stretcher and that Pt #21 will need to be sent to Hospital #2. The ED Physician said he did not perform an EMS and did not see Pt. #21 leave the ED.

The Charge Nurse said she came back a few minutes later to the area where Pt. #21 was and immediately realized he/she left the Hospital without a medical screening examination and without being properly transferred. The Charge Nurse said she immediately called the Nursing Supervisor.

The Surveyor interviewed the CT Technologist on 8/14/13. The CT technologist said on 8/4/13 at approximately 9:30 she noticed that CT images sent to be read were not read, so she sent them again. The CT Technologist said she called the ED Charge Nurse to report the problem with the imaging and the delay in the CT result reports.

The Hospital was in compliance with EMTALA Regulations at the time of the on-site visit. The Hospital completed a root cause analysis and an internal investigation regarding the suspected Emergency Medical Treatment and Labor Act (EMTALA) violation. The Hospital identified opportunities for improvement and all staff were re-trained in all EMTALA policies and procedures.