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Based on document review, video review and staff interview, it was determined the Critical Access Hospital (CAH) failed to complete the Emergency Department (ED) central log and provide a Medical Screening Exam to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24. This has the potential to affect all patients receiving care in an Emergency Department that treats on average of 10 patients per day.

Findings include:

1. The CAH failed to ensure patients were documented on the ED central log. See deficiency cited at C2405.

2. The CAH failed to ensure a Medical Screening Exam was performed. See deficiency cited at C2406.

Based on document review, observation and staff interview it was determined the Critical Access Hospital (CAH) failed to ensure that every patient who presents to the emergency department (ED) seeking assistance even if refusing treatment, should be recorded on the ED central log. This failure has the potential to effect all patients seeking services at the ED.

Findings include:

1. On 12/16/20 at 9:30 AM, the "Occurrence Report" dated 12/1/20 and completed by the ED Nurse, whom interacted with Pt #1 (E #2) was reviewed. Documentation indicated a patient (Pt #1) presented to the ED on 12/1/20 at 1:00 AM, with chief complaint of hip pain and was 25 weeks gestation. Pt #1 told E#2 that Pt #1 was under the care of an OB doctor. Pt #1 was offered an evaluation and care by E #2. Pt #1 was told by E#2, that they would not be able to do ultrasound here and had no OB department." Pt #1 then decided to go to the hospital where there was OB services. At approximately 1:15 AM, Pt #1 left the hospital by personal vehicle accompanied by a female driver.

2. On 12/16/20 at 9:30 AM, the ED log was reviewed. There was no documentation to indicate Pt #1 was entered on the ED central log.


3. On 12/16/20 at 1:50 PM, an interview was conducted with the Chief Nursing Officer (E#1). E#1 stated, "I was made aware of the situation (with Pt #1) on 12/2/20 at 10:30 AM. E#1 started an investigation and determined an occurrence report had been completed by the RN (E#2) on 12/1/20 at 1:30 AM. E#2 verified that Pt #1 was not entered on the ED Central log.

4. On 12/16/20 at 2:00 PM, a three minute video recording on 12/1/20 was reviewed. The video shows a person (identified by E #1 as Pt #1) coming to ED entrance and another person (identified by E #1 as E #2) meeting Pt #1 at the door. A short conversation occurred. Pt #1 turned and headed away from ED.

5. On 12/16/20 at 2:18 PM, a telephone interview was conducted with E#2. E#2 was asked about the ED presentation of Pt #1. E#2 verbalized that: "the patient (Pt #1) arrived with a female by car with complaints of hip pain and told me the patient was was 25 weeks pregnant. I told the patient that we did not have OB (obstetrics) here, but we could evaluate and do lab work, pelvic exam and IV's (intravenous) if necessary. I asked the patient (Pt #1) if the patient had an OB doctor. The patient (Pt #1) stated, yes at another hospital. I told the patient that they would not be able to do ultrasound here and had no OB department." E#2 stated "I offered multiple times to evaluate Pt #1, but the patient decided to go to other hospital where Pt #1's OB doctor was located. I never denied the patient care."

Based on document review, observation and staff interview, it was determined the CAH failed to ensure an appropriate medical screening exam (MSE) is completed on all individuals presenting to the ED. This failure has the potential to effect all patients needing emergency services. Average daily census-10.

Findings include:

1. On 12/16/20 at 9:30 AM, the "Occurrence Report" dated 12/1/20 and completed by the ED Nurse, whom interacted with Pt #1 (E #2) was reviewed. Documentation indicated a patient (Pt #1) presented to the ED on 12/1/20 at 1:00 AM, with chief complaint of hip pain and was 25 weeks gestation. Pt #1 told E#2 that Pt #1 was under the care of an OB doctor. Pt #1 was offered an evaluation and care by E #2. Pt #1 was told by E#2, that they would not be able to do ultrasound here and had no OB department." Pt #1 then decided to go to the hospital where there was OB services. At approximately 1:15 AM, Pt #1 left the hospital by personal vehicle accompanied by a female driver. Pt #1 received no MSE

2. On 12/16/20 at 1:50 PM, an interview was conducted with the Chief Nursing Officer (E#1). E#1 was made aware of the situation (with Pt #1) on 12/2/20 at 10:30 AM. E#1 started an investigation and determined an occurrence report had been completed by the RN (E#2) on 12/1/20 at 1:30 AM. E#1 verified that Pt #1 did not receive a MSE.

3. On 12/16/20 at 2:00 PM, a three minute video recording on 12/1/20 was reviewed. The video shows a person (identified by E #1 as Pt #1) coming to ED entrance and another person (identified by E #1 as E #2) meeting Pt #1 at the door. A short conversation occurred. Pt #1 turned and headed away from ED.

4. On 12/16/20 at 2:18 PM, a telephone interview was conducted with E#2. E#2 was asked about the ED presentation of Pt #1. E#2 verbalized that: "the patient (Pt #1) arrived with a female by car with complaints of hip pain and told me the patient was was 25 weeks pregnant. I told the patient that we did not have OB (obstetrics) here, but we could evaluate and do lab work, pelvic exam and IV's (intravenous), if necessary. I asked the patient (Pt #1) if the patient had an OB doctor. The patient (Pt #1) stated, yes at another hospital. I told the patient that they would not be able to do ultrasound here and had no OB department." E#2 stated "I offered multiple times to evaluate Pt #1, but the patient decided to go to other hospital where Pt #1's OB doctor was located. I never denied the patient care." E #2 verified that Pt #1 did not received a MSE

5. On 12/17/20 at 9:00 AM, a telephone interview was conducted with the contracted ED physician (E#3) who was on site when the patient presented to the ED. E#3 was asked if aware of Pt #1 coming to the ED on 12/1/20. E#3 did not recall the situation and was not made aware of anything about Pt #1. E#3 verbalized, we normally do an evaluation on everyone who presents to the ED.