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Based on observation and interview, the hospital failed to conspicuously post signage specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor (EMTALA). The hospital had no EMTALA signage posted near the entrance or registration desk in the emergency room (ER), or at the entrance to the ER from the main hospital. Additionally, although there is a significant population of patients who speak Karen in the community, there is no EMTALA signage available in that language. This deficient practice had the potential to affect any patients presenting to the emergency room.

Findings include:

During a tour of the hospital on on 7/1/19 at 11:00 a.m., observations revealed there were no EMTALA signs at the ER walk-in entrance, the registration desk, or the ER entrance from the main hospital entrance. The only EMTALA signage observed was in the waiting area and ambulance entrance. The signs were in English and Spanish only.

During interview with Registered Nurse (RN)-H on 7/1/19 at 2:15 p.m., RN-H stated there is a significant portion of the patient population in the area that speaks Spanish, Karen and Kareni. RN-H verified the EMTALA signs posted do not include all of those languages.

The hospital's 12/29/17 policy, Emergency Medical Treatment and Labor Act (EMTALA) included: Under the Policy section: 5. Mayo Clinic Healthsystem-AL/AU (Albert Lea/Austin) will post signage in the emergency department that states the rights of individuals to obtain a medical screening examination and stabilizing treatment for emergency medical conditions.

Based on interview and document review, the hospital failed to ensure 2 of 26 patients reviewed (P3 and P26) who presented to the emergency department (ED) had an appropriate medical screening examination conducted. P3 and P26 presented at the ED entrance but were redirected by hospital staff to go to the Same Day Clinic (SDC) for care instead.

Findings Include:

Medical record review revealed P3 was seen at the hospital's Same Day Clinic (SDC) on 4/2/19. The record indicated P3 was 8 years old and had been brought into the hospital's emergency room by her mother for evaluation due to an arm injury. The SDC notes, dated 4/2/19 revealed P3 was seen at the SDC then sent back to the ED from the SDC for treatment of a displaced fracture of her left radius.

During a post survey interview on 7/15/19 at 9:00 a.m., P3's mother stated she brought P3 into the emergency room with the intent of being seen in the ED. The mother reported when she went up to register P3, the ED staff asked her if she wanted P3 seen in the ED. The mother said she'd responded she was not sure. The ED staff told P3's mother to take P3 to the SDC and then come back to the ED if she required that level of care. P3's mother could not recall specifically who directed her to the SDC, but stated she recalled staff directed her and it had definitely not been her decision to go to the SDC.

Medical record review revealed P26 walked in through the emergency entrance on 4/6/19 with complaints of severe back pain. However, the record indicated P26 was seen and treated for pain in the SDC, then discharged to home.

A review of a patient complaint dated 4/6/19, revealed P26 had complained to hospital staff that when he presented to the ED registration desk on 4/6/19, he was not offered the choice of being seen in the ED verses the SDC. P26 reported the ED registration staff told him based on his complaint of back pain, he could just go to the SDC. Hospital staff taking the complaint asked the patient specifically if he was able to talk to a nurse in blue scrubs at the ED and P26 had stated "no." Further, the complaint indicated P26 reported he had severe back pain and required a wheelchair instead of being able to ambulate. The patient reported he wanted to be seen in the ED so he could get help faster instead of having to wait at the SDC.

During an interview with Licensed Practical Nurse (LPN)-K on 7/1/19 at 3:15 p.m., LPN-K stated she was aware there were concerns about patients being sent up to the SDC when they initially presented at the ED. In addition, LPN-K stated at least 1 time she thought there was a language barrier and the patient may not have realized s/he was being sent from the ED to the SDC. However, when questioned, LPN-K could not recall the name of the patient or the date this occurred.

During an interview with Registration Staff (RS)-T on 7/2/19 at 11:15 a.m., she stated when patients present to the ED registration, staff are required to ask them if they wish to be seen in the ED. RS-T stated, "Sometimes that is difficult because not all patients speak English." In addition, RS-T stated if patients say they are not sure where they want to be seen, she hands them a pamphlet that provides information about the types of problems the ED usually treats and the types of problems the SDC usually treats. RS-T stated, "The problem is there is a significant population of patients who present to the ED who speak Karen and Karenni, and the hospital has nothing in those languages to inform patients about care provided."

During an interview on 7/2/19 at 9:30 a.m., Nurse Practitioner (NP)-M stated she has had patients tell her they were sent from the ED to be seen in SDC because they were not sick enough for the ED. NP-M stated she thinks it may be registration staff are sending patient's to SDC instead of the ED but was not sure.

During an interview on 7/2/19 at 9:50 a.m., NP-N stated she had heard SDC patients state the ED staff had sent them to the SDC instead of being seen in the ED. NP-N stated P3's parent told her, while P3 was being seen in the SDC, that she initially took P3 to the ED intending to be seen in the ED, but the ED sent her to the SDC instead.

The hospital's 12/29/17 policy EMTALA, included under the Policy section: 1. Mayo Clinic Health System-AL/AU (Albert Lea/Austin) will provide every patient who comes to the emergency department (ED) with an appropriate medical screening examination to determine whether the patient has an emergency medical condition...2. The medical screening examination will be performed by a qualified medical provider.