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Based on observation and interview, the facility failed to conspicuously post a sign specifying the right to examination and treatment for emergency medical condition and women in labor and/or indicating the facility's participation in the Medicaid program.

The findings included:

Observation with the Emergency Room Manager on September 30, 2011, at 10:30 a.m., revealed no signs regarding a Medical Screening Exam (MSE) or the facility's participation in the Medicaid program posted on the patient entry doors, no sign on the wall to the right of the patient entry doors, or in the registration area. Continued observation revealed no sign posted to the left of the registration area, and a glass enclosed case on the wall facing the registration area (to a patient's back during registration), and approximately thirty feet to the left of the patient entry doors. Observation of the signs in the glass enclosed case on September 30, 2011, revealed no conspicuous sign regarding a MSE and/or participation in the Medicaid program; the ER Manager identified the sign when observation failed to reveal the required sign and required inquiry as to the presence of a sign. Continued observation revealed the sign was posted in the glass enclosed case and fourteen other signs, including three signs larger than the required sign, surrounded it.

Interview with the Emergency Room Manager on September 30, 2011, at approximately 10:35 a.m., in the Emergency Room lobby, confirmed the facility failed to conspicuously post the required sign regarding a MSE and/or the facility's participation in the Medicaid program.

Review of Emergency Room (ER) logs, review of facility policy, and interview, revealed the facility failed to maintain a central log with disposition for ten patients (#3, #4, #14, #18, #19, #20, #21, #22, and #23) of thirty-one sampled patients.

The findings included:

Review of an ER log dated August 1, 2011, revealed the disposition of patient #14 was not identified. Review of an ER log dated August 12, 2011, revealed the disposition of patient #18 was not identified. Review of an ER log dated August 13, 2011, revealed the disposition of patients #19-23 was not identified. Review of an ER log dated September 28, 2011, revealed the disposition of patient #5 was not identified. Review of an ER log dated September 29, 2011, revealed the disposition of patients #3 and #4 was not identified.

Review of facility policy number: PC.ED. 5.02 revealed, "...Review dated:...10/10...Purpose: To provide direction to staff regarding EMTALA (Emergency Medical Treatment and Active Labor Act) guidelines...Emergency Medical Care Log...The emergency medical care log is a record maintained of individuals who come to the Emergency Department seeking emergency care...log will be kept for five years and will contain the following patient information:...Disposition categorized as: treated and released, admitted, stabilized and transferred, refusal of treatment, or expired..."

Interview with the facility's Risk Manager on September 30, 2011, at 2:15 p.m., in a conference room, confirmed the facility failed to include the disposition of Patients #3-5, Patient #14, and Patients #18-23 on the facility's central Emergency Room Log.