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Based on document review and interview, it was determined that in 1 of 22 medical records (MR) reviewed of patients who presented to the hospital requesting medical services, the facility failed to ensure compliance with 429.24 in that the facility failed to enter patient on central log and failed to provide a medical screening exam.

Findings included:

1. See findings cited at 42 CFR 489.20 (r) (3)

Based on document review and interview, the facility failed to ensure patients were entered on central log for 1 of 22 patients (patient #1).

Findings included:

1. Facility Policy titled Emergency Medical Treatment and Active Labor Act (EMTALA), #3415409, last reviewed 4/2017, indicated: Application of EMTALA -EMTALA is triggered when:
a. An individual presents to the dedicated department (ED/OB) requesting an examination or treatment of a medical condition.
Procedure:
b. Log in patients and perform medical screening exam to determine whether emergency medical condition exists.

2. Review of ED/OB registration documents (patient #1 did not have a MR), on 5/23/2018 at 1510 hours, patient #1 presented and patient indicated "I think my water broke".

3. Review of ED log from 12/01/2017 through 5/30/2018, lacked documentation that patient was entered on log.

Based on document review and interview, the facility failed to ensure that it's written policies and procedures governing immediate assessment of all patients presenting to the facility and documentation of patient visits to the Emergency Department (ED) were followed for 1 of 22 patients (patient #1).

Findings included:

1. Facility Policy titled Emergency Medical Treatment and Active Labor Act (EMTALA), #3415409, last reviewed 4/2017, indicated: Application of EMTALA -EMTALA is triggered when:
a. An individual presents to the dedicated department (ED/OB) requesting an examination or treatment of a medical condition.
b. A hospitals EMTALA obligation is fulfilled when after a medical screening examination; the physician or Qualified Medical Personnel determines the patient does not have an emergency medical condition; or if the emergency medical condition exists, the patient may be transferred to another facility only if: the condition requires treatment that Facility #1 cannot provide and the transfer benefits outweigh the risks of transfer; or the patient requests transfer to another facility, after being informed of the risks and benefits of transfer specific to the medical condition.
Procedure:
c. Log in patients and perform medical screening exam to determine whether emergency medical condition exists.

2. Patient #1 did not have a MR of any type that could be found in the EMR system at this facility. According to ED/OB registration documents, on 5/23/2018 at 1510 hours, patient #1 presented and patient indicated "I think my water broke". Patient signed consent titled 1. Information, records, treatment, financial responsibility on 5/23/2018 at 1510 hours. Patient #1 also signed consent for the care of baby after delivery. Patient #1 was not triaged and did not receive a medical screening examination and was advised by an OB RN (after talking to OB physician) to go to facility #2, over 30 miles away.

3. According to Management Investigation, written by staff #10, on 5/24/2018 at 1508 hours, narrative included: According to staff #12, Patient Admissions Specialist, these are the events that she was able to provide regarding the patient. "As I was finishing up registration, staff #16 came down from OB and asked patient a few questions. Staff #16 then came around the corner so she could call physician #3, Obstetrician, and discuss the situation with him/her. Staff #16 went back to the patient and told her that it would be in patient's best interest to go to doctor/hospital that has seen her during this pregnancy since we have no medical history on her and did not feel like she was contracting or any other symptoms that would indicate labor, other than water breaking. Staff #16 asked me if I had it all entered and I said everything was in but I just not saved it yet. Since the patient left I canceled everything and discarded her paperwork. The staff did not record the patient's information on the ED Patient Log as she was being seen by OB. I was able to retrieve the patient's consent forms with a date and time and the partially completed check-in sheet."