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A. Based on record review and staff interview, it was determined the Hospital failed to ensure compliance with A2407.

Findings include:

1. The Hospital failed to ensure the medical record contained the patients written refusal, or documented steps taken to secure patients written refusal of examination and/or treatment, including risks and benefits of examination and or treatment.

A. Based on record review and staff interview, it was determined in 1of 1 (Pt. #1) patients that left without being seen, the Hospital failed to ensure the medical record contained the patients written refusal, or documented steps taken to secure patients written refusal of examination and/or treatment, including risks and benefits of examination and or treatment.

Findings include:

1. The medical record of Pt. #1 was reviewed on survey date 9/14/11. Pt. #1 presented to the Emergency Department (ED) on 9/4/11 with complaint "discharge cramping, 10 wks preg. (pregnant)." Clinical Chart form documentation indicates " Patient and/or family announced that they are leaving. They were advised to stay, advised to return if worse. Notes: Patient stated that her OB doctor told her to come to Marion to be seen ... "Pt stated that I don't have anyone to keep my kid" ... "I want an ultrasound and someone to monitor me." This nurse encouraged patient to see OB doctor as he requested. Pt left to go to Marion to see OB." There was no documentation to indicate steps taken to secure Pt. #1's written refusal of examination and/or treatment, including the risks and benefits.

2. During an interview with E#1 on 9/14/11 at 2:55 pm, it was reported that E#1 went to the waiting room to get Pt. #1 for triage and escorted her to the triage room located across from the registration area. In the interview, E#1 reported this was approximately 5-10 minutes after Pt. #1 registered. E #1 reported Pt. #1 told E #1 that she called her doctor in Marion after having "pink tinged discharge and cramping the day before." Pt. #1 told E #1 that she did not go to Marion because she did not have anyone to watch her child and she began to feel better after lying down. E#1 reported while getting the Blood Pressure cuff in place on Pt#1 ' s arm, Pt.#1 said "I want to be monitored and an ultrasound." In the interview E#1 reported she explained that the hospital does not have monitoring equipment but could call for an ultrasound if the doctor decided that it is needed. E #1 reported at this time Pt. #1 got up and beginning walking out of the triage room. E #1 reported she heard Pt. #1 saying to her significant other (SO), "Let's go, they're not going to see me. E #1 reported she did not ask Pt#1 to sign a form indicating she was leaving against medical advice (AMA).

3. During an interview with the ED Director on 9/14/11 at 3:30 PM, the above findings were confirmed.