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Based on interview and document review it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the absence of a log documenting all patients seeking medical treatment and the failure to perform a medical screening exam for 1 (#21) of 21 patients seeking treatment in the Emergency Department. See tags A-2405 and A-2406.

Based on interview and document review, the facility failed to maintain a central log for all persons seeking treatment in the Emergency Department resulting in the the potential for failure to track care provided to all individuals seeking emergency services. Findings include:

On 03/03/2020 at 1400, the computer generated list for the 38 patients that were registered as seen in the Emergency Department (ED) on 10/18/2019 was provided for review. The list was in order of times that the patients were registered. The patient of concern for complaint MI00109446 was not listed.

On 03/03/2020 at 1100 During an interview with staff D the receptionist, she stated "I remember this patient, She wanted to talk to a nurse about a medication, I did not register her. I took her question to the back and asked Nurse H to talk to the patient. Staff H told me to tell her go talk to a Pharmacist." Staff D explained that she told that to the patient and she left very angry. Staff D stated "We do not have a log of all the patients who come to the ED, when we register them in the computer that is our record of their visit." Staff D could not produce any documentation of the patient of concerns visit.

On 03/03/2020 at 1430 staff H was interviewed. Staff H stated "I do not remember this patient and I do not remember telling the receptionist to send the patient to a pharmacist."

On 03/03/2020 at 1330 staff I the Medical Director of the ED was interviewed. Staff I stated, "I was not aware that we sent anyone away to talk to a pharmacist." He also stated, "It is our policy to provide a medical screening examination to any person that arrives on hospital property in need of emergency services."

On 03/03/2020 at 1200 a Policy was requested from staff A the ED Director related to the use of the computer registration to be used as the centralized Emergency Log, a policy could not be provided.

Based on interview and record review the facility failed to ensure a Medical Screening Exam was performed for one of 21 patients (#21) requesting services of the Emergency Department resulting in patient #21 never receiving
a medical screening exam for her presenting problem of incomplete Miscarriage with excessive Vaginal bleeding after being prescribed CYTOTEC who then presented to two other Emergency departments at two different Hospitals before she received a Medical Screening Exam and treatment. Findings include:

On 03/03/2020 at 1100 During an interview with staff D the receptionist, she stated "I remember this patient, She wanted to talk to a nurse about a medication, I did not register her. I took her question to the back and asked Nurse H to talk to the patient. Staff H told me to tell her go talk to a Pharmacist." Staff D explained that she told that to the patient and she left very angry.

On 03/03/2020 at 1430 staff H was interviewed. Staff H stated "I do not remember this patient and I do not remember telling the receptionist to send the patient to a pharmacist."

On 03/03/2020 at 1330 staff I the Medical Director of the ED was interviewed. Staff I stated "It was hospital policy to provide a medical screening examination to any person in need of emergency services that arrived on hospital property." He also stated "I was not aware that we sent anyone away to talk to a pharmacist."

On 03/03/2020 at 1400 the Policy titled "EMTALA-Medical Screening and Treatment of Emergency Medical Conditions" #5022887 dated effective 08/31/2018 was reviewed. Under the section PURPOSE: it stated, "To ensure that individuals coming to an affiliated Hospitals Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination as required by the Emergency Medical Treatment and Labor Act (EMTALA) 42 U.S.C. Section 1395 and all Federal regulations and interpretive guidelines promulgated thereunder, and, if an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment within the Hospital's capabilities and/or are transferred if appropriate, all without regard to the patient's insurance coverage or ability to pay."