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Based on interview and record review, the facility failed to provide an appropriate medical screening examination within the capability of the of the hospital's emergency department for 1 (Patient #21) of 21 patients sampled. Refer to findings in Tag 2406.

Based on interview and record review, the facility failed to maintain an accurate central log for 1 (Patient #21) of 21 patients sampled. Patient #21 presented in the emergency department (ED) requesting assistance through the Baker Act. The Florida Mental Health Act (known as the Baker Act) provides legal procedures for mental health examination and treatment based on the behavioral criteria that the person may be harmful to himself or others. This patient was not registered on the central log.

The findings included:

1. A hospital self-report on 9/9/14 indicated Patient #21presented to the ED on 8/23/14 requesting to be "Baker Acted." Hospital staff thought she was requesting psychiatric services. They recommended that she go to a sister hospital with a psychiatric unit.

2. In an interview on 9/15/14 at 1:05 p.m., Employee H stated, " I did hear about a nurse turning away a patient. Or sending them to another facility for treatment. This occurred on day shift."

3. In an interview on 9/16/14 at 1:00 p.m., Employee I said that he had spoken to Risk Management about a female patient that had come in to the ED asking to be Baker Acted. He said that he called back to the charge nurse to get the medical code to put in the computer so that he could pull her arm band and get her admitted for a medical screening exam. He said in the meantime Triage Nurse Staff J, took the patient into the triage room. Employee I said the patient came out of the triage room and left the ER.

4. In an interview on 9/16/14 at 1:25 p.m., the Clinical Coordinator said that she recalled an event that happened on August 23rd where a patient was turned away. She said that it was her understanding Employee I spoke to Employee J. Employee J then spoke to the charge nurse. The charge nurse told Employee J to check the patient in so that she may receive a medical screening exam. Employee J did not check the patient in.

5. Review of the central log for 8/24/14 revealed Patient #21 was not registered on the central log.

Based on interview and record review, the facility failed to provide an appropriate medical screening examination within the capability of the of the hospital's emergency department for 1 (Patient #21) of 21 patients sampled. Patient #21 presented in the emergency room (ER) requesting assistance through the Baker Act. The Florida Mental Health Act (known as the Baker Act) provides legal procedures for mental health examination and treatment based on the behavioral criteria that the person may be harmful to himself or others. This patient was not afforded a medical screening examination.

The findings included:

1. A hospital self-report on 9/9/14 indicated Patient #21 presented to the ED on 8/23/14 requesting to be "Baker Acted." Hospital staff thought she was requesting psychiatric services. They recommended that she go to a sister hospital with a psychiatric unit. The patient was later admitted to the sister facility.

2. In an interview on 9/15/14 at 1:05 p.m., Employee H stated, "I did hear about a nurse turning away a patient. Or sending them to another facility for treatment. This occurred on day shift."

3. In an interview on 9/16/14 at 1:00 p.m., Employee I said that he had spoken to Risk Management about a female patient that had come in to the ER asking to be Baker Acted. He said that he called back to the charge nurse to get the medical code to put in the computer so that he could pull her arm band and get her admitted for a medical screening exam. He said in the meantime Triage Nurse Staff J, took the patient (#21) into the triage room. Employee I said the patient came out of the triage room and left the ER. There was no documented evidence to indicate that on 8/23/14 Patient #21 received a medical screening examination.

4. In an interview on 9/16/14 at 1:25 p.m., the Clinical Coordinator said that she recalled an event that happened on August 23rd where a patient was turned away. She said that it was her understanding Employee I spoke to Employee J. Employee J then spoke to the charge nurse. The charge nurse told Employee J to check the patient in so that she may receive a medical screening exam. Employee J did not check the patient in.

5. Review of the facility's Policy and Procedure (# AD316, revised 6/09) Emergency Medical Treatment and Active Labor Act (EMTALA) directs that, "Any individual who comes to [facility name], and on whose behalf a request is made for an examination or treatment for an [emergency medical condition], shall receive a medical screening examination by a qualified medical person to determine if the individual has an emergency medical condition..." The facility failed to ensure their policy and procedure was followed as evidenced by failing to ensure an appropriate medical screening examination was provided for Patient #21 on 8/24/14.