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Based on document reviews and interviews, the facility failed to provide a medical screening examination within the capability of the hospital's Emergency Department ("ED") for a patient who came to the ED seeking care in one (1) of twenty (20) ED patient records reviewed (Patient #1).

Finding:

The hospital's "Management of Patients Presenting with Potential Emergency Medical Conditions in Compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) and Maine's Hospital Licensing Rules" last revised 11/2022, states in part, "If a person, including a minor, comes or presents to a MGMC ED ("ED") (i.e. at either the ACH, or the TCH) and (i) the person requests examination or treatment for a medical condition...qualified ED clinical staff (as defined in Section III(A)(2) below) shall provide an appropriate medical screening examination within the capability of the ED, including ancillary services routinely available to the ED, to determine whether an emergency medical condition exists...".

42 CFR §489.24(a)(1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) "comes to the emergency department," as defined in paragraph (b) of this section, the hospital must-(i) Provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations..."

On 12/12/2022 at 9:52 AM, the Division of Licensing and Certification received a self-reported alleged EMTALA violation.

On 12/13/2022 at 2:00 PM, an on-site investigation was initiated.

On 12/14/2022 at 8:30 AM, Patient #1's medical record was reviewed. This revealed the following information:
- On 12/11/2022 at 10:01 AM, Patient #1 arrived at the ED;
- Patient #1 was triaged by the Registered Nurse ("RN") at 10:08 AM;
- Patient #1 was then sent back to the waiting room until he/she could be seen by a Provider;
- At approximately 10:15 AM, Patient #1 had a verbal altercation with another patient while in the waiting room;
- The RN came out to the waiting room and asked Patient #1 to leave the ED due to his unwillingness to calm down; and
- At approximately 10:25 AM, Patient #1 was escorted out of the ED, without receiving a medical screening examination, by the RN and the Security Officer.

On 12/13/2022 at 12:30 PM, a telephone interview was conducted with the RN related to Patient #1's visit to the ED on 12/11/2022. She stated the following:
- I was the RN who triaged Patient #1;
- I had a good view of the waiting area and saw a mother with a child enter the ED;
- I suddenly heard Patient #1 screaming at the child and went to the waiting room to intervene;
- Patient #1 was so angry, hostile and verbally aggressive that I asked him to leave; and
- No, Patient #1 was not seen by a Provider.

On 12/14/2022 at 11:00 AM, a telephone interview was conducted with the Security Officer related to Patient #1's visit to the ED on 12/11/2022. He stated the following:
- Out of nowhere, I heard Patient #1 yelling at a child, while in the waiting room;
- Patient #1 was also in a verbal altercation with the child's mother;
- The RN explained to Patient #1 that if he/she would continue yelling, swearing and being hostile, that he would have to leave the ED; and
- Patient #1 then continued being verbally aggressive and I told him/her it is time to leave and escorted Patient #1 out of the ED.

On 12/14/2022 at 1:32 PM, the Administrative Director/Chief Compliance Officer confirmed that Patient #1 was not provided with a medical screening examination, as outlined in their policy.