HospitalInspections.org

.
Based on interview, record review and review of hospital policies and procedures, the hospital failed to develop and implement policies and procedures for evaluation, treatment and appropriate transfer or discharge of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death.

Findings included:

1. The hospital failed to provide medical screening examinations and stabilizing treatment for 3 of 23 patients (Patient #2, Patient #10, Patient #20) presenting to the emergency department (ED).

Cross Reference Tag A-2407
.

.
Based on interview, document review, and review of hospital policies and procedures, the hospital failed to provide medical screening examinations and stabilizing treatment for patients presenting to the emergency department (ED) for 3 of 23 (Patient #2, Patient #10, Patient #20) records reviewed.

Failure to provide medical screening examinations and stabilizing treatment for patients presenting to the ED for care risks patients not receiving care resulting in illness, injury, or death.

Findings included:

1. Review of the hospital's policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," number 11228, revised 06/18/24, showed that the hospital provides a medical screening examination (MSE) to determine whether an emergency medical condition (EMC) exists to anyone who presents to the ED.

Review of the hospital's policy titled, "Process When Patients Leave Without Being Seen," number 20579, revised 11/28/23, showed that if an individual chose to withdraw their request for examination or treatment, the triage nurse or provider should offer the individual further medical examination and inform the patient the benefits of exam and the risks of leaving prior to examination. Clinical staff should take all reasonable steps to secure the individual's written informed consent which indicated that they refused examination and treatment.

2. Review of the hospital's document titled, "Medical Staff Rules and Regulations," revised 2024, showed the following:

a. Every patient who comes to the hospital, on whose behalf a request is made for examination or treatment for a medical condition, will be provided with a medical screening examination.

b. If a patient is offered a medical screening exam, but refuses, they will be asked to sign form(s) acknowledging that they have refused the MSE. The refusal will be documented.

3. Investigator #1 and Investigator #2 reviewed a sample of medical records. The review showed the following:

Patient #10

a. On 02/07/25 at 1:47 PM, Patient #10 registered for care in the ED with a request for amphetamines. The patient notified a registration staff member that he was going to leave because his urine drug screen was going to be positive. Documentation of registration staff notifying clinical staff, clinical staff reviewing risks of leaving with patient, and a signed refusal of care could not be found.

Patient #2

b. On 02/27/25 at 2:26 PM, Patient #2, a 34-year-old female with a history of intellectual disability and selective mutism, arrived in the ED accompanied by her mother. The mother requested that Patient #2 be seen for throat pain and inability to eat. The patient was registered for care, and the nurse (Staff #14) brought the patient to triage. During the triage process, the mom requested a referral to a gastro-intestinal (GI) specialist. Staff #14 stated that the ED did not give outpatient referrals to GI specialists. The patient's mom responded by saying that she would drive Patient #2 to another town and get her own referral. Patient #2 then gave Staff #14 a hug and left the ED with her mom. Documentation of clinical staff reviewing the risks of leaving with patient and a signed refusal of care could not be found.

Outside medical record review showed that Patient #2 was triaged at another hospital less than 4 hours later. The patient agreed to be evaluated and was admitted for malnutrition.

Patient #20

c. On 04/23/25 at 4:55 PM, Patient #20 registered for care in the ED with the chief complaint of back pain. The patient was triaged and then asked to wait in the waiting room. The patient refused to wait, despite her family's encouragement, and the family used a wheelchair to wheel the patient out. Documentation of registration staff notifying clinical staff, clinical staff reviewing risks of leaving with patient, and a signed refusal of care could not be found. Patient #20 returned to the ED the following day with the complaint of increased back pain. The patient agreed to care and was diagnosed with a cardiac event and transferred to a higher level of care.

4. On 06/04/25 at 12:30 PM, Investigator #1 interviewed the Quality Management, Risk, and Regulatory Compliance Officer (Staff #3). Staff #3 stated that signed documentation of Patient #2 refusing care or refusing to sign documentation could not be found for the visit that occurred on 02/27/25. Staff #3 stated that there wouldn't be an against medical advice (AMA) form for patients who chose to leave before being seen because AMA was only after they've been seen by a provider. Staff #3 stated that they don't have a refusal form for before a MSE because patients have the right to choose not to be seen.

5. On 05/28/25 at 11:00 AM, Investigator #1 and Investigator #2 interviewed the Assistant Chief Nursing Officer (CNO) (Staff #1). Staff #1 confirmed that Patient #2, Patient #10, and Patient #20 chose to leave the hospital without completing their MSE process.
.