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Based on interview and record review the facility failed to ensure a Medical Screening Exam (MSE) was performed on one of 20 sampled patients (Patient 1), who presented to the hospital. This failure resulted in Patient 1 being turned away, transported to another hospital, and at risk for harm.

Findings:

During a review of Patient 1's "[Local Ambulance company] Incident Status: Draft," date of service 1/30/2025 at 02:39 (2:39 a.m.), indicated, "Rescue one was dispatchment for a seizure. EMS (emergency medical services) was already on scene of the call. The Patient [Patient 1] was just transported to Emergency room by this crew. The patient [Patient 1] was turned away from the emergency room and told to call 911 (emergency services) for tran (sic) Patient [Patient 1] was assisted onto the ambulance gurney and transported to [Hospital 2] (sic) was contacted enroute. Patient [Patient 1] was registered and taken to his assigned bed upon arrival to Hospital 2. Handoff report was given to the nurse receiving care of the patient [Patient 1] . . . Incident: [Hospital 1] Destination [Hospital 2] . . . At Patient: [Arrived Hospital 1] 01/30/2025 00:03:14 (12:03 a.m.) Depart [Hospital 1]: 01/30/2025 00:28 (12:28 a.m.) Arrived Dest [destination Hospital 2]: 01/30/2025 01:29 (1:29 a.m.) . . . "

During a record review of Patient 1's "Physician Face Sheet," for Hospital 2, dated 1/2025, indicated, "Admit Date time 01/30/2025 (1:39 a.m.).

During an interview on 2/13/25 at 1:22 p.m. with Emergency Medical Technician (EMT) 1, EMT 1 stated, the date of the event was on 1/30/2025 at 3:24 a.m., with Patient 1. EMT 1 and crew were dispatched to Patient 1's home for 911 call. Patient 1 was transported to Hospital 1. EMT 1 stated, "We showed up at Hospital 1 and the nurse and the doctor stated they would not be seeing the patient (Patient 1)." Medical Doctor (MD) informed him [Patient 1] needed to call 911 and leave the hospital [Hospital 1] again. EMT 1 stated, "We were inside the ER (emergency room), the patient was taken off the EMS gurney and placed on a hospital gurney. The Doctor (MD) and Registered Nurse (RN) 3 were present. EMT 1 stated, "That's when MD said informing the patient [Patient 1] he would need to contact 911 himself to be transported to another hospital." EMT 1 stated, "The patient did what the doctor [MD] said informing the patient [Patient 1] he would need to travel "X" many yards off the hospital [Hospital 1] property."

During an interview on 2/18/25 at 11:12 a.m. with EMT 2, EMT 2 stated, they were trying to exit the emergency room after dropping off a patient. The crew [EMT 1] had come in with him [Patient 1] on the gurney. RN 3 and MD were in the triage entrance (ambulance entrance into emergency room) with EMT 1. RN 3 stopped them [EMT 1] and asked why the patient [Patient 1] was not taken to Bakersfield. EMT 1 informed RN 3 the patient [Patient 1] had requested (sic). RN 3 directed EMT 1 to place Patient 1 in room one A. MD stated, "They were not going to check Patient 1 into the ED (Emergency Department), Patient 1 was supposed to go to Bakersfield because they had previously taken care of everything for him [Patient 1] that day." EMT 2 stated, we could not leave the hospital because of the incident going on in front of us. EM T 2 stated Patient 1 remained on the ambulance gurney. MD informed Patient 1 that when he [Patient 1] calls 911, to request one of three hospitals. EMT 2 stated she saw MD hand Patient 1 a sticky note with Hospital 2, Hospital 3, and Hospital 4 names written down. EMT 2 returned to the ambulance, and Patient 1 was walking out of the ED ambulatory entrance. EMT 2 stated, 10 to 15 minutes later she heard the call 10:15 (code to transport patient) to hospital.

During a review of the facility documentation titled "Physician Schedule," dated January 2025, indicated, "Thursday 30th [2025] ER pm [MD]. MD scheduled to work on 1/30/25 in the emergency room at Hospital 1.

During an interview on 2/19/25 at 12:22 p.m. with MD, MD stated, "He (Patient 1) came in on 1/30/25 for possible Seizure and was discharged. Patient 1 returned later. MD stated Patient 1 might have been given a list of all hospital he could go if he wanted to.


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During an interview on 2/19/25 at 11:29 a.m. with Registered Nurse (RN) 1, RN 1 stated she heard about a patient being turned away twice. RN 1 stated she was told that Medical Doctor (MD) stopped the patient at the ER (emergency room) door, and told the patient to call 911 to go to Bakersfield. RN 1 stated she was told the patient was one of the hospitals "frequent flyers."

During an interview on 2/19/25 at 11:50 a.m. with RN 2, RN 2 stated "At times the assessment is done before triage, and the patient is told to go to Bakersfield." RN 2 stated "MD is good for sending people away at the door." RN 2 stated he (MD) will make staff call EMS (Emergency Medical Services) to tell them not to come.

During a review of the facility's policy and procedure (P&P) titled, Emergency Medical Treatment and Active Labor (EMTALA)," dated 11/2/16, indicated, "The admitting clerk will notify the appropriate triage nurse of all complaints and document. . . 2. Ambulance patient arrivals: a. Patients will be assessed by an ER/triage nurse and placed in an appropriate treatment area. The triage category will be assigned. B. The admitting clerk will come to the bedside and complete the demographic information excluding insurance information. 3. A patient's insurance information will be requested with the MSE (Medical Screening Examination) is completed and order is flagged authorizing the information. B. Triage: 1. The admitting clerk will be notified of the location of all patients after the triage is completed. C. Medical Screening Exam: The hospital will provide a Medical Screening Exam (MSE) for every person who some to the Emergency Department and requests medical treatment. Within the capability of the Emergency Department, the screening examination will determine whether or not an Emergency Medical Condition (EMC) exists."

Based on interview and record review the facility failed to ensure three of three staff (Registered Nurse (RN) 3, RN 4, and Respiratory Therapist [RT]) and Emergency Department Physicians were provided Emergency Medical Treatment and Labor Act (EMTALA - emergency room regulations) training. This failure resulted in staff not being provided EMTALA training.

Findings:

During a concurrent interview and record review 2/18/25 at 3:38 p.m. with, Health Information Management (HIM) 1, HIM 1 provided the Education transcripts for RN 3. No EMTALA education training documentation was found in the training to indicated RN 3 had been provided training.

During a concurrent interview and record review 2/18/25 at 3:40 p.m. with HIM 1, HIM 1 provided the Education transcripts for RN 4. No EMTALA education training documentation was found in the training to indicated RN 4 had been provided training.

During a concurrent interview and record review 2/18/25 at 3:42 p.m. with HIM 1, HIM 1 provided the Education transcripts for RT. No EMTALA education training documentation was found in the training to indicated RT had been provided training to indicated staff had been provided training.

During an interview on 2/19/2025 at 11:59 a.m. with Chief Nursing Officer (CNO), CNO stated, "EMTALA [training] has not been required, but were going to start."



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During an interview on 2/19/25 at 12:07 p.m. with Learning Management System (LMS), LMS stated the ED (Emergency Department) Physicians have not had EMTALA training. "We don't have record of any EMTALA training for our Physicians."

Based on interview and record review, the hospital failed to ensure the Physician Certification Statement for Ambulance Services (PCSAS) was completed for one of three sampled patients (Patient 14) was completed. This failure had the potential to result in inaccurate information.

Findings:

During a concurrent interview and record review on 2/19/25 at 9:00 a.m. with Health Information Management Manager (HIMM), Patient 14's Electronic Medical Record (EMR) for date of service 10/4/24 was reviewed. The EMR indicated Patient 14 was transferred to another hospital on 10/4/24. The PCSAS was not completely filled out, and was missing the following information on the form:
Section I - Receiving Physician NPI (National Provider Identifier)

Section II - #2 Describe the Medical Condition. . . (section was blank), #4 Can this patient safely be transported. . . Yes or No (not marked)

The page with heading "Please fill in all appropriate information and check off each section before transferring patient." was missing the following information:
Is PCS filled in accurately and signed by an authorized individual? Y or N (not marked)
Form completed by: (section was blank)

During an interview on 2/19/25 at 9:02 a.m. with HIMM, HIMM stated "We have the provider hospital, but we don't have the number." HIMM confirmed the PCSAS form was incomplete.

A Policy and Procedure for Physician Certification was requested, and not provided.