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Based on medical record review, document review, policy review, and interview, emergency department (ED)registration staff did not follow facility Emergency Medical Treatment & Labor Act (EMTALA) policy, which discouraged Patient #1 from receiving evaluation and treatment.

Findings Include:

Review on 09/07/22 of the ED medical record dated 07/08/22 revealed at 12:24 AM, Patient #1 arrived at ED and was triaged with a chief complaint of sexual assault. At 02:05 AM, nursing note by Staff (D), ED registered nurse (RN) indicates that at 01:33 AM, Patient #1 was no longer in the room waiting for SANE nurse. Per staff, Patient #1 had been gone for approximately 15 minutes. The waiting room and area outside of emergency room were checked, but Patient #1 was not found.

Review on 09/07/22 of email dated 07/18/22 at 07:25 AM from Staff (J), Patient Access Services Representative to Staff (K), Director of Patient Access Services revealed Patient #1 was a victim of an assault. During the registration process to verify demographic information, Patient #1 stated she didn't have any insurance. Staff (J) offered Patient #1 an insurance application packet, which she refused, stating she made to much money for Medicaid. Staff (J) informed Patient #1 a $300.00 copay would be billed to her. Patient #1 got very upset. Staff (J) went and asked Staff (L), Senior Patient Access Services Representative about the billing for self -pay patients who are victims, asking if she would come speak to Patient #1 directly. Staff (L) and Staff (J) walked back to Patient #1's room and informed her that not having insurance would be a $300.00 copay billed to her. Patient #1 was not satisfied with that answer stating that it will go to collections, she wasn't paying it, and that she was leaving.

Review on 09/07/22 of policy "EMTALA and Medical Screening" last approved 01/2022 revealed ECMC will provide a medical screening exam and necessary stabilizing treatment to any individual regardless of payment source or ability. Routine registration should take place to facilitate the patient flow through the department. The guidelines to observe while registering the patient are to not say or imply anything to the patient that might discourage them from seeking the medical screen.

Interview on 09/06/22 at 10:40 AM with Staff (K), Director of Patient Access Services verified these findings and stated that both patient access representatives should not have talked about payment with Patient #1.