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Based on review of medical records, video surveillance review, policy and procedure review, and staff interviews, it was determined, the facility failed to ensure that an appropriate medical screening examination was provided as required, that was 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 existed after a request was made on an individual's behalf for an examination and treatment for one (#6) of 21 sampled patients. Refer to findings in Tag A- 2406

Based on policy review, medical record review, video surveillance review, Facility transfer logs and interviews, it was determined, the facility failed to substantiate the provision of emergency services for 1 of 21 sampled patients (Patient #6) as evidenced by lack of an appropriate transfer. The facility failed to provide medical treatment within its capacity to minimize the risks to the individual's health (prior to discharge), failed to contact the receiving facility to verify if it had available space and qualified personnel for the treatment of the individual; failed to obtain acceptance of the transfer and failed to ensure the transfer was effected through qualified personnel and transportation equipment, as required. Refer to findings in Tag A-2409.

Based on video surveillance review, Kiosk data review, Emergency Department central log review, policy review and staff interviews, it was determined, the facility failed to ensure the central log included all individuals who presented to the emergency department seeking treatment. This failure affected 1 of 21 sample patients (Patient #6).


The findings included:


Review of the facility video surveillance conducted on 01/29/19 at 1:45 PM revealed Patient #6, a 22 month old, was brought into the emergency room lobby being carried by an adult on 01/21/19 at 2:57 AM. The adult had words with the security guard, who then went in the back area and returned with a staff member. The staff member briefly looked at Patient #6. The adult had words with the staff member, walked towards the registration kiosk and began typing on the screen while holding a conversation with the staff member. The video indicates at 2:59 AM, the adult and Patient #6 left the emergency room and the staff returned to the emergency room treatment area.

Review of the facility central logs conducted on 01/29/19 failed to provide evidence that Patient #6 was entered into the system when presented to the emergency department on 01/21/19 seeking medical care.

Interview with the Director of Emergency Services conducted on 1/30/2019 at 11:00 a.m., revealed that the facility has a Kiosk used for patient registration, they can either scan their driver's license or manually put in name, date of birth and reason for visit ...The kiosk is a separate computer system when the staff pulls a name from the kiosk to the electronic medical record, the patient is then registered in the Central Log. Only the Charge Nurse and the triage nurse are allowed to remove names from the kiosk registry.


Multiple attempts were made to contact the security guard on duty on 1/21/2019 were made throughout the complaint survey. Interview with the Director of Security on 1/30/2019 at 12:32 p.m., revealed that he was able to contact the security guard on duty on 1/21/2019, and he has no recollection of the events on 1/21/2019.


Review of the facility registration Kiosk data for 01/21/19 documents a registration entry was initiated at 2:58 AM, the entry was removed due to incomplete data, no name or information was available. This record does not indicate refusal of care.


Facility policy, titled "EMTALA-Central Log", dated 06/2018 documents "The hospital shall maintain a central log containing information on each individual who requests emergency services or care or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment, whether he or she left before a medical screening examination could be performed, whether he or she refused treatment, whether he or she was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged." The facility failed to ensure that their policy and procedure were followed as evidenced by failing to ensure that on 1/21/2019 Patient #6 was entered into the facility's ED log.

Based on review of medical records, video surveillance review, policy and procedure review, and staff interviews, it was determined, the facility failed to ensure that an appropriate medical screening examination was provided as required, that was 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 existed after a request was made on an individual's behalf for an examination and treatment for one (#6) of 21 sampled patients.


The findings included:


Review of the facility video surveillance conducted on 01/29/19 at 1:45 PM revealed Patient #6 was brought into the emergency room lobby being carried by an adult on 01/21/19 at 2:57 AM. The adult had words with the security guard, who then went in the back area and returned with a staff member. The staff member briefly looked at Patient #6. The adult had words with the staff member, walked towards the registration kiosk and began typing on the screen while holding a conversation with the staff member. The video indicates at 2:59 AM, the adult and Patient #6 left the emergency room and the staff member returned to the emergency room treatment area.

Review of the clinical records obtained from Facility B, an acute care facility, revealed Patient #6 presented to the facility's ED, with his parent, on 01/21/19 at 3:10 AM with complaints of fever and shaking. The medical record revealed the patient's Vital signs on presentation to the ED were listed as: Blood Pressure: 138/65; Temperature: 102.1 (HI-high) degrees (normal temperature children 97.9-99.0); Heart rate: 150; Respirations: 40; Pulse Oximetry: 97% on Room Air. The ED physician documented in the medical record that Patient #6's father had presented to JFK Medical Center, North Campus prior to arriving at Facility B for the same complaints of shaking and fever and was told to come to Facility B. The physical examination was conducted by the ED physician and laboratory tests for RSV-PCR (Respiratory Syncytial Virus- a very contagious viral respiratory infection) the results were negative; and Influenza A PCR & B PCR were not detected. The patient was diagnosed with Acute Upper Respiratory infection, and discharged to home on 1/21/2019 at 3:00 PM.


Interview with The Sepsis Coordinator on 01/29/19 at 12:53 PM, who navigated the electronic record, confirmed there are no records pertaining to Patient #6, there is no evidence a medical screening exam was provided.


An interview with Staff A, a Paramedic, who was identified (in the video surveillance ) as the staff member talking to the adult holding Patient #6 was conducted on 01/29/19 at 2:24 PM via telephone. Staff A had no recollection of the event or neither what conversation transpired during this encounter. After further prompting, he stated as a general statement, if patients ask if we treat children, he replies they will treat and transfer to another hospital as they don't admit pediatric patients.



Interview with the Director of Emergency Services conducted on 1/30/2019 at 11:00 AM reveled the Director had no knowledge of the incident related to patient #6. The facility process is to register, triage and evaluate every patient that comes in the department, and is not sure of what happened, any conversation deviate from their process is unwarranted. The Director confirmed the emergency room staff is trained and qualified to treat the pediatric population.


Interview with the Medical Director of the Emergency Department on 1/30/2019 at 11:45 AM revealed the emergency department evaluates all kinds of patients from pediatric to geriatrics. The physicians and midlevel providers are credentialed and qualified to treat pediatric patients.


Facility policy titled, "EMTALA-Medical Screening Exam and Stabilization Policy", dated 06/17 documents "An EMTALA obligation is triggered when an individual comes to a dedicated emergency department and the individual or a representative acting on the individual behalf requests an examination or treatment for a medical condition.... A hospital must provide an appropriate medical screening exam within the capabilities of the hospital emergency department, including ancillary services routinely available to determine whether or not an emergency medical condition exists; to any individual who requests such examination, an individual who has such a request made on his or her behalf... a medical screening exam shall be provided to determine whether or not the individual is experiencing an emergency medical condition." The facility failed to ensure that their policy and procedure as followed as evidenced by based on clinical medical records reviewed, and interviews the facility failed to provide written evidence that a medical record was maintained related to patient #6. The facility also failed to provide written confirmation that a medical screening examination was provided for patient #6 on 1/21/2019, when a request was made on his behalf for an examination and treatment of a medical condition.

Based on policy review, medical record review, video surveillance review, Transfer logs and interviews, it was determined, the facility failed to substantiate the provision of emergency services for 1 of 21 sampled patients (Patient #6) as evidenced by lack of an appropriate transfer. The facility failed to provide medical treatment within its capacity to minimize the risks to the individual's health (prior to discharge), failed to contact the receiving facility to verify if it had available space and qualified personnel for the treatment of the individual; failed to obtain acceptance of the transfer and failed to ensure the transfer was effected through qualified personnel and transportation equipment, as required.

The findings included:

Review of the facility video surveillance conducted on 01/29/19 at 1:45 PM revealed Patient #6 was brought into the emergency room lobby being carried by an adult on 01/21/19 at 2:57 AM. The adult had words with the security guard, who then went in the back area and returned with a staff member. The staff member briefly looked at Patient #6. The adult had words with the staff member, walked towards the registration kiosk and began typing on the screen while holding a conversation with the staff member. The video indicates at 2:59 AM, the adult and Patient #6 left the emergency room and the staff member returned to the emergency room treatment area.

Review of the clinical records obtained from Facility B, an acute care facility, revealed Patient #6 presented to the facility on 01/21/19 at 3:10 AM with complaints of fever and shaking. The record documents Patient #6's father had presented to JFK Medical Center, North Campus prior to arriving at Facility B for the same complaints of shaking and fever and was told to come to Facility B.

Review of the facility's transfer logs provides no evidence Patient #6 was transferred to Facility B.

Interview with the Charge Nurse dated 1/29/2019 at 10:40 AM, explained the physician would initiate a transfer to another facility and all the arrangements are done by the transfer Center, and the Charge nurse assures all paper work is completed. The CEO explained the transfer center has the on line Manuel which includes geographical locations of receiving hospitals, list of services provided, list of transfer agreements and name and phone numbers of the contact person designated to arrange the transfer.

Interview with The Sepsis Coordinator on 01/29/19 at 12:53 PM, who navigated the electronic record, confirmed there are no records pertaining to Patient #6, there is no evidence a medical screening exam was completed or stabilization treatment was provided or transfer arrangements were conducted.

An interview with Staff A, a Paramedic, who was identified as the staff member talking to the adult holding Patient #6 in the video surveillance, was conducted on 01/29/19 at 2:24 PM via telephone. After further prompting, he stated as a general statement, if patients ask if we treat children, he replies they will treat and transfer to another hospital as they don't admit pediatric patients.

Interview with director of Transfer Center phone on 01/30/2019 at 9:41 AM revealed the emergency room staff calls the call center and is routed to a nurse. The staff collects minimal information including the service requested, then they ensure patient preference if any, research the availability of the sister facilities and is the service is not available, they will check the closest facilities providing that particular service. Once a facility has been identified, they work on patient's acceptance and facilitate physician to physician communication and notify the transferring facility to complete the memorandum of transfer with all the pertinent records.

An interview was conducted with the ED Director on 01/30/2019 at 11 AM, she confirmed that the Emergency room staff are trained and qualified to treat the pediatric population, if a child needs admission, a transfer would be completed.

Facility policy titled, "EMTALA-Transfer Policy", dated 06/2018 documents "To establish guidelines for either accepting an appropriate transfer from another facility or providing an appropriate transfer to another facility of an individual with an emergency medical condition, who request or requires a transfer for further medical care and follow up to a receiving facility as required by EMTALA, 42 USC 1395dd and all federal regulations and Florida Statutes and all related administrative rules.
A transfer will be appropriate if:
The transferring hospital provides medical treatment within its capacity that minimizes the risks to the individual's health and, in case of a woman in labor, the health of an unborn child.
The receiving facility has available space and qualified personnel for the treatment of the individual and has agreed to accept the transfer and to provide appropriate medical treatment.
The transferring hospital send the receiving hospital all medical records
The transfer is effected through qualified personnel and transportation equipment." The facility failed to ensure that an appropriate transfer was provided for patient #6 on 1/21/2019 as evidenced by failing to provide medical treatment that was within its capacity in order to minimize the risks to the individuals (#6) health; and failed to provide evidence of a written physician certification of transfer to another facility explaining the risks and the benefits of the transfer; failed to notify the receiving facility to obtain acceptance of the patient to ensure the facility had available space and qualified personnel for the treatment of patient #6 on 1/21/2019.