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Based on policy review, medical record review and interviews the hospital failed to ensure that an adequate medical screening examination and stabilizing treatment was provided for a patient who presented to the hospital's Dedicated Emergency Department (DED) for evaluation on 09/25/2021.

The findings include:

The hospital failed to ensure that an adequate medical screening examination was provided for a patient (Patient #28) who presented to the hospital's DED for psychiatric evaluation on 09/25/2021.

~cross refer to 489.24(a), Medical Screening Exam - Tag A2406.

Based on policy review, medical record review and interviews the hospital failed to ensure that an adequate medical screening examination was provided for a patient (Patient #28) who presented to the hospital's Dedicated Emergency Department (DED) for psychiatric evaluation on 09/25/2021.

The findings included:

Review of facility policy "Initial Screening Assessment" effective April 14, 2020 revealed "...Procedure ...Patients presenting to the "Campus B" for evaluation of a medical condition will have a Medical Screening Exam (MSE) performed by a qualified medical person (physician, physician assistant, or nurse practitioner) ... If an emergency medical condition is present, then stabilizing treatment and/or transfer will be provided ... 7. Patient's presenting to "Campus B" as a walk-in assessment will have a medical screening exam by a qualified medical person..."

Closed medical record review of Patient #28 revealed a 27-year-old male who presents to Hospital A's Campus B on 09/25/2021 at 1915. Review revealed "he was brought to "named hospital" by his mother and brother due to refusing to take his medication and experiencing increased AH (auditory hallucinations). Pt's (patient's) mother shares she took pt. to the "named Urgent Care" earlier today and that, after patient was brought back into the exam room to be assessed, pt. became agitated and got VH (visual hallucinations) and got up close and in the face of the nurse. According to pt.'s mother, security handcuffed pt. and the police were called, and they removed him from the premises and took him outside of the building, still in handcuffs. She shares she was advised to take pt to either Hospital A's Campus C or Hospital A's Campus B and to have pt. IVCed (involuntarily committed). Having been to Hospital A's Campus B in the past, pt.'s mother brought pt. to Campus B ... Pt was unable to answer the questions posed by clinician, including his birthday, so pt.'s mother answered them for him ... Pt's orientation was UTA (unable to assess). His memory was UTA. Pt was uncooperative, though overall pleasant and giddy, with the exception he lunged at staff, throughout the assessment process. Pt's insight, judgement, and impulse control are poor ... Addendum: It was determined pt. required medical clearance, so pt. was sent to Campus C, pt. left the premises, so clinician filed IVC paperwork and pt. was picked up at his home and brought back to Campus C. Disposition: Named Psychiatric Nurse Practitioner, reviewed pt.'s chart and information and determined pt. met inpatient criteria..."

Telephone interview on 09/29/2021 at 1710 with CC (Crisis Counselor) #12 revealed she recalled Patient #28 on 09/25/2021. Interview revealed she performs a psychiatric assessment on all walk-ins who present to the hospital. Interview revealed the hospital no longer has a QMP (qualified medical provider) onsite to perform medical screening exams. Interview revealed MSE's were performed via Telehealth. Interview confirmed Patient #28 was not seen by a QMP due to not on site and Patient #28 could not cooperate with a Telehealth assessment.

Telephone Interview on 09/29/2021 at 1305 with NP (Nurse Practitioner) #10 revealed she recalled having a conversation with CC #12 about Patient #28. Interview revealed she used to work at Campus B but since Hospital A's behavioral health urgent care opened all the QMPs were moved to that location and MSE's for Campus B were performed via Telehealth. Interview confirmed she did not examine Patient #28. Interview confirmed a MSE was not completed before sending Patient #28 to Campus C for medical clearance.

Interview on 09/29/2021 at 1400 with Medical Doctor (MD) #10 revealed she was the Psychiatric Medical Director. Interview revealed all patients presenting to Campus B are supposed to have a MSE completed. Interview revealed the QMP's were now staffed at the hospitals urgent care and they have hired staff to fill open positions. Interview revealed all walk-ins presenting to Campus B are to have a MSE conducted via Telehealth.

In summary, the patient was not appropriately managed as he was able to leave the premises during his screening. He did not receive an appropriate continuous medical screening examination, as he was able to elope. He was not stabilized prior to his disposition.