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Based on review of document review, observation and interview the hospital failed to comply with 489.24 (A 2406) by failure to ensure there were no deterrents from seeking a medical screening exam in the Emergency Department. The cumulative effect of this systemic practice resulted in the hospital's inability to ensure that all patients arriving at the emergency department would receive a medical screening exam. The average monthly census of the Emergency Department is 4202 patients.

Based on review of documentation, observation and interview the hospital failed to ensure one (Patient #21) of 21 medical records reviewed were not unduly discouraged from receiving a medical screening exam. The average monthly census of the Emergency Department is 4202 patients.

Findings include:

The hospital's EMTALA policy (LD-39) was reviewed on 02/26/18. The policy stated the hospital will examine and provide stabilizing treatment or facilitate an appropriate transfer for individuals seeking emergency care in accordance with this Policy and Procedure, regardless of the person's ability to pay, race, color, national origin, or otherwise. A physician or other person determined in the Medical Staff Bylaws or Rules and Regulations to be qualified, must perform a medical screening examination. The hospital may collect routine registration information so long as it does not delay the exam. The exam must be sufficient to determine with reasonable medical confidence whether the patient has an emergency medical condition.

The Emergency Department was toured on 02/26/18 at 10:34 AM. A Flu restrictions sign was observed at the entrance door before the security counter. The sign read "To protect you and our patients we are restricting visitors to minimize the spread of viruses and infection. No visitors under the age of 14 until flu season ends."

The hospital's Internal Investigation report involving Patient #21 was reviewed on 02/27/18 at approximately 9:00 AM. The report stated on 01/15/18, Staff B received an email about an alleged EMTALA violation. The violation was turned in by Hospital B and provided by a female patient who claims that she was denied care and turned away from the Emergency Department by a police officer on 01/10/18. Shortly after receiving the email Staff B began to review camera footage from the Emergency Department lobby and found footage matching the description of the complaint. The report stated on 01/10/18 at 4:55 PM, two adult females with a female child entered the Emergency Department doors and were greeted by the officer working at the metal detector, Staff C. From the video footage, it appears that Staff C is talking with the females and after about a minute all three are seen walking out of the lobby and leave the property. With the seriousness of the complaint, Staff B initiated an internal investigation.

The hospital's Patient Safety Event Meeting minutes from 01/31/18 at 10:00 AM involving Patient #21 were reviewed on 02/27/18 at approximately 9:00 AM. The minutes stated:

1. "The patient arrived to the emergency department with her teenage daughter and young son. Due to the flu restriction, Staff C asked the patient if her daughter would be able to watch the young son while the patient was seen. The daughter responded no and the patient left."

2. "Video footage is available and had been reviewed- Staff C asked her if she was here to be seen. Staff C pointed to the policy regarding the visiting restrictions due to the flu and asked if the teenage daughter could watch the young child while the patient was seen. An exchange can be viewed between the patient and daughter. You are able to see the patient throw up her arms, verbal comment made, and they leave. Allegedly the patient then called Hospital B to see if she could be treated there with the children present and was told they could be. The patient then went there for treatment."

A letter from Hospital B, dated 01/12/18 was reviewed on 02/27/18 at approximately 9:00 AM. The letter stated "On the evening of 01/10/18, a 32 year old female telephoned and then presented to Hospital B emergency department accompanied by her two children, ages 12 and six. Per the information received from the nursing department supervisor, the patient called first to see if she could be seen because she was turned away at Hospital A. Per her statement, she was unable to get past the security guards with her two children. She reported that the security guards told her that she couldn't enter the emergency department with the children due to the increased number of flu presentations to the hospital."