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Based on review of hospital policies and procedures and interviews, the hospital, as the provider, failed to enforce policies and procedures to comply with the requirements of 42 CFR 489.24. The hospital did not follow its policy and procedure concerning the medical screening requirement for one of twenty-one (Patient A) where a request for a medical screen evaluation (MSE) and stabilizing treatment was made on behalf of the patient and whose records were reviewed.

Findings:

1. Southwestern Medical Center's (SWMC) policy and procedure, entitled "Quality-EMTALA", revised 7/12/12 stipulated, "...Any hospital with an emergency department will provide to any individual who 'comes to the emergency department' an appropriate MSE within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an EMC exists, regardless of the individual's ability to pay when a request is made by or on behalf of the individual for medical care, or a prudent layperson would observe such care is needed, whether the individual is in the hospital's DED or elsewhere on the hospital's campus..."

2. During an interview March 25, 2014, the hospital's CQO (Chief Quality Officer) informed the surveyors the hospital is required to provide a MSE to anyone that presents to the emergency department and/or on the hospital property. The hospital did not follow its policy. On 03/13/2014, Patient #A arrived on hospital ground by ambulance. The patient did not receive a medical screening examination to determine whether an emergency medical condition existed.

Based on review of the hospital's emergency room (ER) log, policies and procedures, and interviews with hospital staff, the hospital failed to maintain a central log entry for each individual who presents seeking treatment and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged. In six of six months (September 2013 through March 2014) the emergency services log entries for patients was not complete.

Findings:

Southwestern Medical Center's (SWMC) policy and procedure, entitled "Quality-EMTALA", revised 7/13/12 stipulated, " Central Log is a log that a hospital is required to maintain on each individual who "comes to the emergency department" seeking assistance that documents whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged."

1. The ER log did not contain an entry for Patient A's 03/13/14 visit.

2. On 03/25/14, administrative staff told the surveyors that on 03/13/14 the ambulance service had entered the hospital grounds and was approached by an ER nurse who informed the driver the hospital was on critical care divert. Patient A's 03/13/14 visit was not recorded in the ER log.

3. The ER logs from 09/01/13 through 03/22/14 were reviewed. According to statistics submitted by the facility, the logs under review contained 10,799 entries for the time period. Sixty-five (65) of the entires did not contain dispositions for the patients. This was confirmed by the hospitals Chief Quality Officer during chart review.
a. September 2013: seven (7) patients did not have a disposition documented.
b. October 2013: sixteen (16) patients did not have a disposition documented.
c. November 2013: fourteen (14) patients did not have a disposition documented.
d. December 2013: five (5) patients did not have a disposition documented.
e. January 2014: thirteen (13) patients did not have a disposition documented.
f. February 2014: five (5) patients did not have a disposition documented.
g. March 1 - 22, 2014: five (5) patients did not have a disposition documented.

4. The log did not always have the correct patient disposition. This occurred in four of twenty medical records.
a. Record #5 had transfer to a critical access hospital for patient disposition, but review revealed the patient was transferred to a tertiary hospital in another city.
b. Record #9 had transfer to other facility for patient disposition, but review revealed the patient was admitted to the hospital.
c. Records #14 and 19 had home for patient disposition, but review revealed both patients were admitted.

5. The above information was presented in the exit interview with the administrative staff.

Based on review of hospital documents, the emergency room (ER) department central log, policies and procedures and medical records and interviews with hospital staff, the hospital failed to provide a medical screening examination by a qualified medical person in order to determine whether an emergency medical condition existed to one of twenty-one patients (Patient #A) who presented to the hospital requesting examination for a perceived emergency medical condition and whose medical records were reviewed.

Findings:

1. Patient #A presented to the hospital via ground ambulance on 03/13/14 at approximately 2005. Upon entering the emergency room (ER) bay the ambulance driver was approached by a ER nurse. The ER nurse informed the driver the hospital was on critical care divert. The patient was taken away by ambulance without receiving a medical screening examination by a qualified medical person at the hospital.

2. Review of the ambulance report for Patient #A, documented, "...Pt initial destination was chosen by the pt (patient) due to his cardiologist being at Southwest hospital. Dispatch called to verify hospital off divert status, confirmed. Upon arrival at hospital, staff in driveway informed they were on critical care divert. Staff member (sic) met ambulance outside of ER in bay informing us they were not accepting the pt due to critical care divert...."

3. The ambulance transported Patient #A to another local hospital.

4. On the morning of 03/25/14, the Chief Quality Officer (CQO) stated she was aware of the incident and had self reported the above incident to the Oklahoma State Department of Health (OSDH).