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Based on record reviews and interviews the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider's agreement which requires that hospitals comply with the EMTALA requirements as defined in 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by failing to perform a medical screening examination on 1 of 40 patients (Patient #1) who had arrived via EMS with a probable right femur fracture, abrasions/cuts, and right side pain following a Motor Vehicle Crash (MVC), where the patient was unrestrained, hit her head on the windshield causing a starburst crack to the windshield, and admitted to consuming alcohol; but did not receive a medical screening examination and was taken to a local trauma center by the same EMS provider who had brought her to the ED. (See findings cited at A 2406)

Based upon record reviews and interviews, the hospital failed to ensure all patients who presented to the hospital's emergency department (ED) received a screening medical examination to see if an emergency condition existed as evidenced by 1 of 40 patients (Patient #1) who had arrived via EMS with a probable right femur fracture, abrasions/cuts, and right side pain following a Motor Vehicle Crash (MVC), where the patient was unrestrained, hit her head on the windshield causing a starburst crack to the windshield, and admitted to consuming alcohol; but did not receive a medical screening examination and was taken to a local trauma center by the same EMS provider who had brought her to the ED. Findings:

Review of hospital medical records (patient #s 2-40) revealed they all presented to the ED with complaints of trauma from MVCs and falls. 39 of 40 patients (#s2-40) received screening medical examinations; except for Patient #1.

Review of the EMS patient record revealed the following: Call received at 8:55pm; dispatched at 8:55pm; en route at 8:56pm; on scene at 9:06pm; depart scene at 9:25pm; arrived destination at 10:07pm-destination Hospital A.

Interview, 10/15/2014 at 11:10am with S15 Advanced EMT stated he was working as a fireman the night of 09/30/2014 and was first on the scene of Patient #1 ' s accident. He stated it was a one car MVC; and the patient had hit a tree and was found in the drivers ' seat. S15 Advanced EMT stated as he got to Patient #1 ' s car he could see that she had hit the windshield with some force. Asked why or how he knew this and S15 Advanced EMT replied, " Because there was some of her hair embedded in the starburst crack on the windshield " . S15 Advanced EMT stated the patient was unrestrained, no seat belt, and she admitted to drinking alcohol and was complaining her right side was hurting. He further stated that the patient was aware of her name but did not know the day, date, or year. She had a possible fractured leg (right) and hip injury, multiple scratches/bruising and had a knot on her head presumably where she had hit the windshield.

S15 Advanced EMT stated he placed her on a backboard and placed a C-collar on her neck. Then he assisted placing her in the ambulance and obtained her vital signs. At this time S15 Advanced EMT stated he and the other fireman responders left the scene when the patient was secured in the ambulance (Medic #3) with Paramedics.

S13 Paramedic-EMT had documented Patient #1 had requested to be taken to WKS (Willis Knighton Medical Center-South Campus). Upon notification, WKS ED informed S13 Paramedic-EMT that with the type of injuries reported (fractured femur) the patient would need to be transferred to WKP (Willis Knighton Medical Center-Pierremont Campus) because WKS did not have orthopedics.

Continued review of the EMS patient record revealed S13 Paramedic-EMT and S12 Paramedic-EMT (Driver) of Medic #3 ambulance decided to divert from WKS and went to WKP. S13 Paramedic-EMT telephoned and gave report to the ED at WKP.

S4 ED Physician, upon receiving information on Patient #1, informed S8 RN ED Charge Nurse to contact the EMS ambulance transporting the patient and have them divert to the local Trauma Center (Hospital A). When questioned, 10/15/2014 at 7:25am, as to why he would have the EMS provider divert to the trauma center without seeing/examining the patient, S4 ED Physician stated, "based upon my years of experience as an ER physician, when someone reports that a patient was in a MVC and unrestrained, hit their head on the windshield with a resultant starburst crack, that indicated most probably a severe head/neck trauma and the best thing for the patient would be to be taken directly to the trauma center".

Review of the hospital's EMTALA policies/procedures (Approved 11/2013) revealed: "MEDICAL SCREENING EXAMS 1 ...will receive a medical screening exam, within that facilities capabilities, by a qualified medical person to determine if an emergency medical condition exists ...2 ...The purpose of the exam is to determine whether the person is suffering from an emergency medical condition or is in active labor ...regardless of the individual ' s ability to pay ...3. The term ' emergency medical condition ' means a medical condition manifesting itself by acute symptoms of sufficient severity ...that the absence of immediate medical attention could reasonably be expected to result in: 1. placing the patient ' s health in serious jeopardy 2. serious impairment to bodily functions 3. serious dysfunction of any bodily organ or part ... "

Interviews, 10/14/2014 at 4:10pm and 4:25pm with S6 RN ED and S7 RN ED, revealed they had attempted to contact the EMS provider and have them take the patient to the trauma center--Hospital A, but were unable to contact them. S6 RN ED stated he called the EMS dispatcher and she told them she would continue to try and contact the EMS crew and have them call the ED. The dispatcher contacted the EMS crew as they were driving into the ED driveway.

S4 ED Physician, S6 RN ED and S7 RN ED were out in the driveway and told the Paramedics to take the patient to Hospital A. S12 Paramedic-EMT/driver of the ambulance stated (per S4 ED Physician) that the patient had a fractured femur and was stable. S4 ED Physician stated the patient was a trauma patient and should be taken to Hospital A.

Based on the hospital's policies/procedures regarding EMTALA, S4 ED Physician should have conducted a medical screening examination.

Interviews, 10/14/2014 at 2:00PM, with S14 Compliance Officer, S3 RN Director of ED Services, and S2 Director of Nursing confirmed S4 ED Physician should have conducted a medical screening examination.

Interview, 10/15/2014 at 7:25AM, with S4 ED Physician confirmed he should have performed a medical screening examination. S4 ED Physician stated as the ambulance was driving away, he thought about it, but still insisted he was only considering the best interests of the patient and that the trauma center was the best place for her.