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Based on observation, interview, and record review, the facility (Hospital A) failed to ensure compliance with requirements under the Emergency Medical Treatment and Labor Act (EMTALA) when Patient 1 did not receive a Medical Screening Exam (MSE-an assessment by a medical provider to determine whether an individual has an emergency medical condition). (Refer to tag A2406)

Based on observation, interview, and record review, the facility (Hospital A) failed to ensure a medical screening examination (MSE- an assessment by a medical provider to determine whether an individual has emergency medical condition) was provided for one of 23 sampled patients (Patient 1) who was brought to the facility's Emergency Department (ED) by Emergency Medical Services (EMS) transport on 4/20/2021 at 12:48 AM after a traffic collision. This failure resulted in delayed medical treatment for Patient 1 when EMS transported Patient 1 to another facility (Hospital B) for emergency medical treatment. This failure had the potential to result in adverse health outcomes to include death for the facility's patients seeking emergency medical treatment.

Findings:

During a review of Patient 1's EMS "Run Sheet," dated 4/19/21 at 11:46 PM, indicated, Patient 1 arrived to the facility on 4/20/21 at 12:48 AM.

During a review of the electronic ED Visit Log, dated 4/19/2021 and 4/20/2021, failed to show documented evidence that Patient 1 was seen in the facility's ED.

During a concurrent interview and observation of the ED with the Chief Nurse Officer (CNO) and Clinical Manager 1 (CM 1) on 4/29/2021 at 8:50 AM, CM 1 stated when a patient comes to the ED a MSE must be completed by physicians or mid-level practitioners.

During a concurrent interview and record review with the CNO, on 4/30/21 at 9:45 AM, the CNO was unable to locate Patient 1 on the ED Visit Log. The CNO stated she was aware of the reported EMTALA violation after Patient 1 did not receive a MSE on 4/20/2021.

During an interview with ED Medical Doctor 2 (MD 2), on 4/29/2021 at 9:15 AM, MD 2 stated once a patient "Hits the door, we are obligated to stabilize and treat the patient..."

During an interview with MD 1 on 4/30/2021 at 10:30 AM, MD 1 stated ED staff nurses, notified him on 4/20/21, that Patient 1 was being transported by EMS after a traffic collision. MD 1 stated based on the verbal report, Patient 1 should have been transported to a trauma center. MD 1 stated the paramedics arrived in the Ambulance Bay (on hospital premises), and he went outside to meet with them. MD 1 stated he informed EMS staff that Patient 1 met trauma criteria, and Patient 1 should have been transported to a trauma hospital. Furthermore, MD 1 stated Patient 1 was on the gurney outside the ambulance while he was questioning the paramedics. MD 1 stated he observed Patient 1 for "A minute or two" and Patient 1 was verbalizing in Spanish and spontaneously opening his eyes. MD 1 stated the paramedics decided to call someone and then left with the patient. MD 1 stated he did not have a chance to conduct Patient 1's MSE.

A review of the hospital's policy and procedure titled, "EMTALA; Compliance with" dated reviewed 03/2018, indicated, "It is the policy of the Hospital to comply with the EMTALA obligations" mandated by Federal and applicable state laws governing the provision of emergency services and care. The policy indicated EMTALA is applicable to any individual who comes to the emergency department and to any physician who is responsible for the examination, treatment, or transfer of an individual to whom EMTALA applies. The policy further indicates a medical screening examination will be offered to any individual who comes to the emergency department.

A review of the Department of Health Services, County of Los Angeles, Reference number 506, Subject: "Trauma Triage" dated 7/1/2020 showed the purpose was to establish criteria and standards which ensure that patients requiring the care of a trauma center are appropriately triaged and transported. This Reference was located posted on a cabinet in the ED, and ED staff stated it was used to estimate trauma criteria. The Reference indicated under "Trauma Guidelines," the mechanism of injury and patient history are the most effective methods of selecting critically injured patients before unstable vital signs develop. "Paramedics and base hospital personnel should consider mechanism of injury and patient history when determining patient destination. At the discretion of the base hospital, transportation to a trauma center is advisable for..." included one criteria among many, listed as "Vehicle telemetry data consistent with high risk of injury."