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Based on document review and interview, it was determined that the Hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The Hospital failed to provide an appropriate medical screening examination (MSE), as required, while the patient was in the emergency room. (A-2406)

Based on document review and interview, it was determined that for 1 of 20 (Pt. #20) patients reviewed for emergency medical services, the Hospital failed to provide an appropriate medical screening examination (MSE) to determine whether or not an emergency medical condition existed prior to transferring to another Hospital, as required, while the patient was in the emergency room.

Findings include:

1. The Hospital's policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)" (revised 5/2022) was reviewed and required, "1. Emergency Services conducts an appropriate level of care assessment on clients presenting for evaluation. 2. The Director of Nursing (or an available nurse) will assess in evaluating a client if during an assessment of an individual's medical history and/or psychiatric status an emergency condition is revealed... 4. The facility will provide treatment consistent with the level of emergency presented by the person and within the capabilities and capacity of this facility."

2. The "Hospital's Rules and Regulations" (revised 7/2021) was reviewed and required, "Psychiatric/medical screening and stabilizing treatment will be conducted on all patients presenting themselves on the Hospital premises. Screening will be for both psychiatric and medical stability to accomplish admission and/or appropriate transfer for care. The medical staff authorizes the registered nurse to perform the medical screen on patients... Preadmission... A qualified Mental Health Professional (QMHP) for behavioral health screening must meet one of the following criteria: 1. registered nurse, clinical nurse specialist, or clinical nurse practitioner... licensed clinical worker."

3. The clinical record for Pt. #20 was reviewed on 01/04/2022. Pt. #20 was brought to the emergency services department on 09/25/2022 at 7:55 PM. The clinical record included the following:
-Emergency Services Assessment (page 1 of 11 completed) on 9/25/2022 at 8:20 PM, vital signs: blood pressure - 130/76; temperature - 98.1; pulse - 80; respirations - 18; pain - none. (page 11 of 11) Pt (patient) presents intoxicated. Assessment was unable to be completed d/t (due to) pt being intoxicated and needed medical clearance. Pt was transferred (name of outside hospital) via ambulance... 911 called, CFD (Chicago Fire Department) facilitated transfer. (signed by E #8/Licensed Social Worker). Patient was not seen by a Physician.
The clinical record indicated that a medical screening examination was not completed, as required, to determine if an emergency medical condition existed prior to transfer.

4. On 01/04/2023 at approximately 11:35 PM, an interview was conducted with the Medical Director (MD #1). MD #1 stated that all patients that present to the emergency services department are assessed by the clinicians. If a patient does not appear appropriate for admission for example if they are intoxicated or under the influence of drugs, the clinician should consult the on-call physician or Director of nursing to determine if they should be transferred. This facility is not equipped to admit patients that are not medically cleared.

5. On 01/04/2023 at approximately 1:00 PM, an interview was conducted with an Emergency Services Counselor (E #6). E #6 stated that if a patient presents to the emergency department and they do not appear medically stable such as abnormal vital signs or signs of being intoxicated, E #6 would consult with the on-call physician or medical staff to determine if an emergency medical condition exists. E #6 stated that intake clinicians do not make the final determination if a patient requires to be transferred to another hospital.

6. On 01/05/2023 at approximately 2:20 PM, an interview was conducted with the Assistant Director of Nursing (E #7). E #7 stated that the patient (Pt. #20) was sent out to another hospital for medical clearance because the patient was too intoxicated. The patient's vital signs were checked and were stable, no medical history was obtained due to the patient was too intoxicated. The Hospital contacted the Chicago Fire Department to transport the patient. E #7 did not contact the on call physician to consult.