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Based on record review and interview, the hospital failed to ensure compliance with the requirements of CFR 489.24 as evidenced by:

1) Failing to provide a medical screening exam on all patients that presented to the emergency department with an emergency complaint for 1 (#1) of 20 patients sampled. This deficient practice is evidenced by Patient #1 not receiving a medical screening exam after presenting to the ED with a chief complaint of suicidal ideations. (See findings under tag C-2406)

2) Failing to ensure a central log was maintained on each individual who comes to the ED seeking assistance and whether he/she refused treatment, was refused treatment, or whether he or she was transferred, admitted, treated, stabilized and transferred, or discharged. This deficient practice was evidenced by failure to have Patient #1, who presented for ED services on 07/23/19, included in the ED log for 1 (#1) of 20 sampled patient records reviewed. (See findings under tag C-2405)

3) Failing to ensure a sign was posted in a conspicuous place in the emergency department (ED) or in any place or places likely to be noticed by all individuals entering the ED specifying the rights of individuals under section 1867 of the EMTALA with respect to examination and treatment for emergency medical conditions and women in labor and to post conspicuously information indicating whether or not the hospital participated in the Medicaid program. (See findings under tag C-2402)

Based on observation and interview, the hospital failed to ensure a sign was posted in a conspicuous place in the emergency department (ED) or in any place or places likely to be noticed by all individuals entering the ED specifying the rights of individuals under section 1867 of the EMTALA with respect to examination and treatment for emergency medical conditions and women in labor and to post conspicuously information indicating whether or not the hospital participated in the Medicaid program.

Findings:

Observation on 08/13/19 at 9:35 a.m. in the waiting area of the ED revealed no observation of signs posted specifying the rights of individuals under section 1867 of the EMTALA as stated above. At that time, an interview with S1CNO confirmed that the ED was under construction and signs had not been placed in the new ED waiting area specifying the rights of individuals related to the EMTALA.

Based on record review and interview, the hospital failed to ensure a central log was maintained on each individual who comes to the ED seeking assistance and whether he/she refused treatment, was refused treatment, or whether he or she was transferred, admitted, treated, stabilized and transferred, or discharged. This deficient practice was evidenced by failure to have Patient #1, who presented for ED services on 07/23/19, included in the ED log for 1 (#1) of 20 sampled patient records reviewed.

Findings:

Review of the ED patient log for 07/23/19 revealed no documented evidence that Patient #1's name was included on the log.

On 08/13/19 at 10:30 a.m., the hospital's video recordings were reviewed with S1CNO. Observation of the recording revealed that on 07/23/19 at 11:15 p.m., Patient #1 and a companion arrived at the ED admissions desk. The companion was observed talking to the admissions clerk. Further observations at 11:17 p.m. revealed that S2Security Officer arrived at the admission desk and walked Patient #1 to the ED waiting area and handcuffed the patient. At 11:20 p.m., Patient #1 was observed to exit the hospital with S2Security Guard.

On 8/13/19 at 1:20 p.m., telephone interview with S3Admissions Clerk revealed that on the night of 7/23/19, Patient #1 came to the admissions desk and stated that he was suicidal. S3Admissions Clerk stated that she called for security to come to admissions and S2Security Officer arrived to talk to the patient and led him to the ED waiting area. S3Admissions Clerk stated that she was in the process of getting the patient's name and date of birth when the security guard walked up, but she did not complete the patient's registration. S3Admissions Clerk confirmed that Patient #1 was never included on the ED patient log.

On 08/13/19 at 1:30 p.m., S1CNO confirmed that all patients who present to the ED for treatment must be placed on the ED log. Further interview with S1CNO confirmed that Patient #1 was not included on the ED log dated 07/23/19.

Based on record review and interviews the hospital failed to provide a medical screening exam on all patients that presented to the emergency department with an emergency complaint for 1 (#1) of 20 patients sampled. This deficient practice is evidenced by Patient #1 not receiving a medical screening exam after presenting to the ED with a chief complaint of suicidal ideations.

Findings:

Review of the hospital policy titled "Patient presenting to the ER in regards to EMTALA/state nursing law" revealed in part: complete the emergency room triage process, all patients presenting to the ER must be seen and medically assessed by a physician.

On 08/13/19 at 10:30 a.m., the hospital's video recordings were reviewed with S1CNO. Observation of the recording revealed that on 07/23/19 at 11:15 p.m., Patient #1 and a companion arrived at the ED admissions desk in the lobby of the hospital. The companion was observed talking to the admissions clerk. Further observations at 11:17 p.m. revealed that S2Security Officer arrived at the admission desk and walked Patient #1 to the ED waiting area and handcuffed the patient. At 11:20 p.m., Patient #1 was observed to exit the hospital with S2Security Guard. Further observations of video recordings on the outside of the hospital revealed at 11:45 p.m., S2Security Guard drove off the hospital premisis with Patient #1 in the back seat of the police car.

Review of the hospital's ED log dated 07/23/19 revealed no documented evidence that Patient #1 was included on the log.

On 08/13/19 at 12:33 p.m., interview with S2Security Officer revealed he was a full-time Sherriff Deputy and also worked part-time as a Security Officer at the hospital. He stated that on the night of 07/23/19, he was working as a Security Officer at the hospital and was called to the admissions desk due to a suicidal patient (Patient #1) presenting for treatment. S2Security Officer stated that Patient #1 kept saying he wanted to die any way possible and he reverted back to his police training, handcuffed the patient, and transferred him to another hospital that provided psychiatric services, utilizing RPC (Request for Protective Custody). S2Security Officer confirmed that Patient #1 was not examined by a physician prior to his transfer and stated, "In hindsight, I should have let them (the medical staff) examine him." When asked if S2Security Officer had received any orientation training prior to working for the hospital, he stated that he did not because he was in court the day of orientation.

On 8/13/19 at 12:55 p.m., an interview with S4COO revealed that she was the supervisor for the Security Department of the hospital. When asked if she was aware of the incident involving Patient #1 on 07/23/19, she stated that S2Security Officer's supervisor (S5Security Supervisor), who is also a local Sherriff Deputy and part-time Security Officer at the hospital, called her the night of 07/23/19 after the incident occurred. She further stated that S5Security Supervisor stated that S2Security Officer came in contact with Patient #1 in the hospital parking lot and transferred him to another hospital due to suicidal ideations. She stated that since the patient was not in the hospital building, she did not think anything was done incorrectly. She verified she was not aware that a patient presenting with an emergency condition to a staff member of the hospital in the parking lot of the hospital would fall under EMTALA obligations. She also verified she only discovered during the interview with the surveyors that the patient presented to the admission desk within the hospital. At this time, S4COO reviewed S2Security Officer's personnel file and confirmed there was no documented evidence of any hospital orientation or training.

On 08/13/19 at 1:10 p.m., interview with S6Physician revealed that he was the Medical Director of the ED. When asked if he was aware of the incident involving Patient #1 on 07/23/19, he stated no. After repeating what was explained about the encounter involving Patient #1 by S2Security Officer and what was observed on the video recording, S6Physician confirmed that Patient #1 should have received a medical screening exam prior to being transferred by S2Security Officer. S6Physician further stated that all patients who present to the ED for treatment should be screened by a physician.

On 08/13/19 at 1:30 p.m., interview with S1CNO confirmed that Patient #1 did not receive a medical screening exam after presenting to the ED on 07/23/19. S1CNO further confirmed that the hospital EMTALA policy was not followed.