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Based on review of hospital policies/procedures, documents, personnel records, and interview with staff, it was determined that the hospital failed to enforce policies/procedures to comply with the requirements of 42 CRF 489.24.

Findings include:

Hospital policy titled "EMTALA-Medical Screening Examination and Stabilization Treatment" revealed: "...When an EMS provider brings an individual to the Hospital with a Dedicated Emergency Department and the Hospital does not have the capacity or capability to provide an immediate medical screening exam and if needed, stabilizing or an appropriate transfer, the Hospital must still assess the individual upon arrival to ensure that the individual is appropriately prioritized based on presenting signs and symptoms. Hospital should assess whether the EMS can appropriately monitor the individual ' s condition...."

1 of 1 patients did not receive an appropriate MSE upon arrival at the facility and there was no record that the patient was assessed and monitored according to the facilities policy.

Based on review of policies and procedures, hospital documents and staff interviews, it was determined that the hospital failed to provide a Medical Screening Examination to a patient who presented to the ED via Emergency Medical Services (EMS) ambulance for examination and treatment (Patient #2).
Findings include:

Patient #2 presented to Banner Baywood Medical Center Emergency Department (ED) on 05/26/2022 at 5:05 pm via Emergency Medical Services (EMS) ambulance from an assisted living facility after sustaining a fall. EMS waited with Patient #2 in the ED corridor for a room to become available for approximately one and a half hours. EMS left Banner Baywood ED and transported Patient #2 to another facility at approximately 6:20 pm.

Hospital policy titled " Emergency Department Patient Care " revealed: "...Triage assessment: Completed by a RN and/or QMP (qualified medical professional). If a paramedic is used to expedite triage to assist with high volume, the RN oversees the ESI scoring, care plan of the patient and utilizes standing orders when needed. An Emergency Severity Index (ESI) score is assigned when the triage assessment is completed. ESI 1= Requires immediate life-saving interventions ...ESI 2= High risk situation or confused, lethargic, disoriented or severe pain distress...ESI 3= two or more resources may be needed ...ESI 4=One or more resource may be needed...ESI 5+ No resources needed ...ED triage documentation may include, but is not limited to: 1. Chief complaint, vital signs, paint ad oxygenation. 2. Mode of arrival and mechanism of injury. 3. Triage assessment and ESI scoring. 4. Infectious disease screening. 5. Suicide screening...Medical Screening Exam: A medical screening exam (MSE) is completed by an Emergency Physician or QMP...When applicable the ED medical provider and/or QMP will complete the MSE in conjunction with an RN or Paramedic as a joint assessment...General Nursing Care: Patients arriving from all portals of entry into the ED will receive a baseline assessment of their chief complaint by a registered nurse, physician or designee...."

Hospital policy titled "EMTALA-Medical Screening Examination and Stabilization Treatment" revealed: "...When an EMS provider brings an individual to the Hospital with a Dedicated Emergency Department and the Hospital does not have the capacity or capability to provide an immediate medical screening exam and if needed, stabilizing or an appropriate transfer, the Hospital must still assess the individual upon arrival to ensure that the individual is appropriately prioritized based on presenting signs and symptoms. Hospital should assess whether the EMS can appropriately monitor the individual ' s condition...."

Hospital policy titled "Left Without Treatment (LWOT)" revealed: "...Patients with Capacity, including Emancipated Minors, who consent to care have the right to leave without treatment prior to a planned release...Whenever possible, the support staff, nursing personnel, and/or the QMP is notified to allow an opportunity for the patient to receive information related to medical risks should they persist in leaving before their MSE and a discharge is completed...If the patient is not seen leaving the facility, the nurse will document LWOT as the disposition in the patient ' s medical record...."

A review of the ED disposition log for 05/26/2022 revealed the patient was registered at 17:05. Further review revealed the patient was documented as an LWOT (Left Without Treatment) at 18:15.

A review of the Prehospital Delayed Offload Escalation Chart revealed: " ...Purpose: To provide an escalation process for our prehospital partners regarding ambulance offload times >45 minutes...45-minute delay- house supervisor, 60-minute delay- ED director...90-minute delay Monday- Friday CNO, after hours contact House supervisor...."

A review of the ED census for the timeframe Patient #2 was in the ED revealed 63 patients were in rooms, with 19 patients being held for transfers to the inpatient units; 4 other EMS patients were waiting for rooms and 14 patients were in the lobby.

Emergency Medical Services (EMS) medical record revealed the Patient #2 was taken by ambulance to Banner Baywood ED on 05/26/2022 arrival 1658, registration 1710. The EMS narrative revealed "...patient was at an assisted living facility and was found sitting in a wheelchair awake and crying. Per staff at the scene at approximately 1600 hours, the patient was found on the carpeted floor near the dining area in a supine position. Patient was evaluated by another EMS crew and cleared to stay at the facility. The facility called EMS back, secondary to a change in the patient's behavior with inconsolable crying. Patient displays a hematoma to the occipital region of head, no other trauma noted. Patient transported to Banner Baywood Medical Center (BBMC) per Medical Power of Attorney (MPOA) request. Patient transported to BBMC, reassess as needed. Waiting on available bed for approximately 1.5 hours with no initial triage assessment. Per Battalion Chief were to depart the property with alternate destination. Transport 1826 from BBMC Arrival 1838 at Banner Goldfield .... "

A review of Patient #2 medical record revealed a prehospital form dated 05/26/2022 at 16:50 with ETA 10 minutes with to room 72 when clean. A face sheet dated 05/26/2022 revealed a registration time of 17:05.