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Based on record review and interview the hospital failed to conduct a medical screening exam for a patient who arrived at the emergency room via EMS (emergency medical services) while the hospital was on divert status (not accepting patients) for EMS due to emergency room saturation. This deficient practice placed the patient at risk for developing a potentially life threatening condition during transport since a determination of an emergency medical condition was not made. The findings are:

A. Record review of the hospital's investigative summary prepared by the Risk Management Analyst indicated "No Medical Screening Exam was performed and no transfer arrangements were made."

B. Record review of the hospital's Emergency Department Guideline titled Medical Screening Exam, effective date 05/2014 indicated "All persons presenting for care to the Emergency Departments will be admitted to the Emergency Department (ED) and a medical screening exam (MSE) will be completed to determine if an emergency medical condition (EMC) exists."

C. Record review of the hospital policy titled EMTALA effective date 05/2014 section 8.2.1 indicated "...the hospital may deny access if it is in "diversionary status", that is, it does not have the staff or facilities to accept any additional emergency patients. If, however, the ambulance staff disregards the hospital's instructions and transports the individual on to hospital property, the individual is considered to have come to the emergency department."

D. On 07/11/17 at 2:45 pm during interview, the Executive Director of Quality confirmed the information in the hospital's investigation summary (see C above).

Based on record review and interview the hospital failed to provide an appropriate transfer for a patient presenting at the emergency department via EMS (Emergency Medical Services) for treatment. This deficient practice had the potential to further delay treatment for the patient and increase the risk of developing a potentially life threatening emergency medical condition. The findings are:

A. Record review of the hospital's investigative summary prepared by the Risk Management Analyst indicated "No Medical Screening Exam was performed and no transfer arrangements were made."

B. Record review of the hospital policy titled EMTALA effective date 05/2014 section 3.1 indicated
"A patient is stable for transfer from one hospital to a second hospital if the treating provider determines, within reasonable clinical confidence that the patient is expected to leave the hospital and be received at the second facility, with no material deterioration in his/her medical condition; and the treating provider reasonably believes the receiving facility has the capability to manage the patient's medical condition and any reasonably foreseeable complication of that condition. In the case of a patient who is suffering from psychiatric condition(s), the patient is considered stable for transfer when he/she is protected and prevented from injuring himself/herself or others."
Section 3.3 indicated "The treating provider is responsible for evaluating, ordering and arranging all transfers of patients from the emergency departments to other facilities."

C. On 07/11/17 at 2:45 pm during interview, the Executive Director of Quality confirmed the information in the hospital's investigation summary.