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Based on interviews and record reviews, the facility was not in compliance with the Emergency Medical Treatment and Labor Act (EMTALA) by failing to provide prompt screening and determination of a medical emergency as evidenced by the following:

A. The facility failed to provide a Medical Screening Exam. See tag 2406

Based upon record review and interview the facility failed to provide a timely, accurate, and appropriate medical screening to determine whether or not an emergency medical condition exists for Patient (P) #1 (P#1) of 20 (P#1 through P#20) that were sampled. This failed practice has the likelihood to delay treatment and have a negative outcome for patients that are in need of emergent treatment.

Finding are:

A. Record review of "Triage in the Emergency Department" dated 02/08/2021, revealed "Triage is the process of quickly assessing a patient and determine weather the patient is sick or not. Triage begins when a patient enters the Emergency Department. Patients are assigned a Triage Acuity (the level of illness of the patient) by an RN (Registered Nurse) utilizing the ESI (Emergency Severity Index, a scoring process to assign a level of need a patient requires based upon signs and symptoms) scoring tool following an initial assessment (Physical assessment of the patient to identify any signs and/or symptoms of illness a patient may have)."

B. Record review of P#1's medical chart (from the facility's emergency department) dated 08/11/2021, revealed the following:

1. Patient arrived to the emergency department at 9:30 pm on 08/11/2021.
2. Noted patient called three times and no answer (Called to be triaged), no documentation of the times of each of the three calls.
3. Documented at 10:44 pm "ED disposition (Discharge status of the Patient) set to LWBS (Left without being seen) before triage."
4. No documentation of any communication with the Nephrologist on call RN or communication with F#2.
5. No documentation of P#1 informing the facility's staff that P#1 was leaving the emergency department to go to another facility.

D. On 09/01/2021 at 12:55 pm during interview with family member (F) #1 stated the following:

P#1 is a family member that is blind and has a Peritoneal Catheter (A special tube that is inserted into the abdomen to assist in removing waste products from the body). On 08/11/2021 P#1 went to the facility's emergency department at about 10:00 pm because P#1 had abdominal pain, a sign of peritonitis (Infection in the abdomen). When P#1 arrived to the emergency department P#1's family member (F#1) was with him and was not allowed into the waiting room with P#1 (F#1 had the option to wait outside or in her vehicle). When F#1 asked what if P#1 needed assistance who would assist him the staff stated that they would assist him. After about two hours P#1 and F#1 left the emergency department and drove to Santa Fe to a different facility emergency department were P#1 was admitted for peritonitis.

E. On 09/01/2021 at 1:23 pm during interview, family member (F) #2 stated the following:

She and F#1 took P#1 to the facility's emergency department on 08/11/2021 at around 10:00 pm. P#1 is a patient that is blind and has a Peritoneal Catheter and was having abdomen pain on the night of 08/11/2021. F#2 stated that she called P#1's Nephrologist's (Doctor that specialist in kidney care) on call service and the on call RN told her to take P#1 to the facility's emergency department. After arriving at the facility's emergency department F#2 was not allowed into the waiting area with P#1 (F#2 had the option to wait outside or in her vehicle). F#1 asked if someone was going to assist him if he needs help, the staff stated that they would assist P#1. After waiting for about two hours and no triage was done on P#1, F#2 asked to speak with the charge nurse. When F#2 spoke with the charge nurse she stated that it would be 16 hours before they could see P#1. F#2 and F#1 decided to leave the facility and drive to Santa Fe (an hour drive) to another facility's emergency department. When P#1 arrived at the emergency department in Santa Fe P#1 was taken to a room and was diagnosed with peritonitis. P#1 was hospitalized for 4 days at the Santa Fe facility.

F. On 09/01/2021 at 3:00 pm during interview with S#5 (ED RN) and S#6 (ED Manager) stated that they do not recall any issues with a patient not being triaged on 08/11/2021 during the night shift.

G. On 09/02/2021 at 11:00 am during interview with S#3 (ED Director) stated that there was no documentation on the complaint log of a complaint by a patient, a patient's family or staff on 08/11/2021 in regards to a patient not triaged by staff.

H. Record review of "Clinical Notes Report" from the Nephrologist on call logs for P#1 dated 08/11/2021 at 9:00 pm, revealed "After hours call from patient visiting family reposted nausea and abdominal pain. Patient to go to ER (Emergency Room)."

I. Record review of "Clinical Notes Report" from the Nephrologist on call logs for P#1 dated 08/11/2021 at 11:00 pm, revealed "After hours call from patient's (P#1) wife to say that ER is full. Spoke with ED (Emergency Department) charge nurse (Stated by the on call RN) to say that the cell count for patient (P#1) should be good until 12:30 am, she said they will not be able to take patient for another 16 hours. Patient and family decided to drive to Santa Fe. On call doctor notified."

J. Record review of "Clinical Notes Report" from the Nephrologist on call logs for P#1 dated 08/12/2021 at 3:36 am, revealed "Call from Patient's (P#1) wife saying patient does have pertonitis.

K. Record review of "Clinical Notes Report" from the Nephrologist on call logs for P#1 dated 08/16/2021 at 5:53 pm, revealed "Patient discharged from hospital today and advised to come into clinic to receive a dose of antibiotics."