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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 for examination and treatment. (Patient #1).

Finding include:

Hospital policy titled "Emergency Medical Treatment and Active Labor Act (EMTALA) Policy" revealed: "...B. Medical Screening. When an individual comes to the emergency department (ED) requesting medical treatment, an appropriate MSE, within the capabilities of the ED, shall be provided to determine whether an emergency medical condition (EMC) exists...III. STABLIZING TREATMENT: If it is determined through an MSE that an EMC exists or that a women is in labor, ED personnel shall: (1) provide such further medical examination and treatment as may be required to stabilize the medical condition or provide treatment to the woman in labor, within the capabilities of the staff and facilities available at the hospital or (2) transfer the individual to another appropriate facility that can meet the patient's needs, in accordance with the transfer procedures contained in this policy ...B. Transfer Procedures ...1. Stabilizing Medical Treatment ...The hospital shall provide stabilizing medical treatment within its capacity to minimize the risks of transfer to the individual's health ...."

Hospital policy titled "Plan for the Provision of Patient Care" revealed: " ...EMERGENCY DEPARTMENT Scope of Services ...Stabilization of any actual, perceived or potential: sudden or urgent; physical or psychological problems that are episodic or acute, including illness, injury or childbirth. These problems may require minimal care or advance life support measure, or any variant of stabilization for presenting medical condition ...."

Patient #1's Emergency Documentation from Hospital #2 dated 10/29/2022 revealed: " ...ESI: 3 ...X-ray of the [redacted] showed minimal to mild [redacted]. Will place in [redacted] with [redacted] ...."


Review of the Hospital ED log for October, 2022 reveal that Patient #1 was listed on the log. After further review, it was not documented that Patient #1 was triaged, given an ESI or seen by a QMP. Patient #1's final disposition was listed as left before triage.

EMS narrative dated 10/29/2022, revealed: " ...Upon arrival in OVH (Oro Valley Hospital) ED, attempted to turn patient care over to ED charge nurse [Erin], as RN was taking patient information, ED MD on duty approached and said he was not accepting the patient and that [she] was to be "transferred to another hospital because we have no general surgery, no cardiac, no stroke, no ortho so we can't take the patient ..." Patient asked, "can't you just take an x-ray" to which MD replied, "we can't" MD directed crew to [NWMC] ...Removed patient from OVH ED and began transporting to [NWMC] ...."

Provider #6 Narrative Statement dated 11/02/2022, revealed: " ...EMS pre-arrival: we were informed that [AMR] was bringing a patient with concern for wrist fracture. At the time of EMS arrival, I was present with the charge nurse desk to listen to the report and perform my medical screening exam. Charge nurse [Erin] was taking report. EMS crew reported that the patient had concern of bilateral wrist fractures and multiple rib fractures. Given that history I was concerned that the EMS crew was unaware that Oro Valley Hospital was not a trauma facility (as the case sounded very concerning for a significant trauma) and that we currently had no emergency OR capabilities ...The EMS crew was explicitly told we were not refusing this patient and I would talk with the patient and do my assessment to determine the best way to proceed ...The medic stated that [AMR] policy is once the patient is on the hospital grounds they can not take them to another facility. I attempted to educate them that I could do a medical screening exam and then transfer them (if medically appropriate and if an appropriate receiving facility could be identified) as that should help reduce delays in care ...The medic again stated their policy was that they could not take the patient to a different facility once they had entered the hospital facility. At this point I contacted their operation manager ...When I went to find the medic and the patient I was informed by the charge nurse [Erin] that [AMR] was irritated with us and they loaded the patient back into the ambulance and were leaving to another facility ...."

Employee #10 confirmed during an interview on 04/12/2023 that the operating room (OR) at OVH was closed due to the central sterilization being closed because of flooding. Employee #10 stated that EMS was not informed that the OR was closed. Employee #10 stated that Provider #6's contract with the facility was terminated.

Employee #15 confirmed during an interview on 04/13/2023 that they were the charge nurse at the time of the event. Employee #15 stated that EMS was coming towards [her] to give report before Provider #6 stopped EMS. Employee #15 stated that Provider #6 and EMS had a conversation that Employee #6 was not able to hear. Employee #6 stated that when they went to gather more information from EMS, they were unable to because the ambulance had left OVH property.

Employee #15 further confirmed that Patient #1 was in the facility and was reloaded into the ambulance for transport to another facility.

Employee #8 confirmed during an interview on 04/13/2023 that Provider #6 was not referred to the Arizona State Medical Board. Employee #8 stated that Provider #6's employment agency would need to report them to the Arizona State Medical Board.

Employee #4 and Employee #6 confirmed during an interview on 04/12/2023 that Patient #1 should not have been turned away from the ED by Provider #6.

CONCLUSION:

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 for examination and treatment. (Patient #1)