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Based on observation, interview, and document review, the hospital failed to implement its policies and procedures for the evaluation and treatment of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA).

Failure to ensure patients receive a comprehensive 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:

The hospital failed to reasess a patient when the patient had changes in their vital signs prior to discharge from the emergency department (ED).

Cross-reference: Tag A-2406

Based on interview and review of documents, the hospital failed to implement its policies and procedures to provide a medical screening exam for a patient that came to the emergency department (ED) seeking emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA) for 1 of 25 patient records reviewed (Patient #1).

Failure to provide a medical screening exam for patients before they leave the ED puts patients at risk for harm from a medical or psychological emergency that is not screened and treated.

Findings included:

1. Document review of the hospital's policy titled "EMTALA"effective 05/31/18, showed that all patients in the ED were to receive a medical screening exam (MSE) by a physician. The MSE was not considered complete until a physician had examined the patient.

2. On 07/24/19 at 8:00 AM, the investigator interviewed a contact (Contact #1) for Patient #1. The contact stated they brought the patient to the ED for a skin condition. The patient was asked to leave after becoming agitated in the ED. The patient was not seen by the physician for a MSE.

3. On 07/24/19 at 8:20 AM, the investigator interviewed Patient #1. Patient #1 stated they had come to the ED for a skin rash. While in the ED the patient stated it was discovered they had an elevated blood pressure (BP). The patient stated they had become upset waiting to see the physician and security was called to escort him out of the ED. No nurse or physician tried to talk to him when he was upset. The patient did not receive a MSE.

4. Document review of Patient's #1's medical record showed that the patient came to the ED on 05/29/19 for a skin rash. The patient's vital signs upon presentation to the ED were BP 193/109 and pulse of 121. The patient was put in an exam room. While waiting for the physician to perform a MSE the patient became upset. The patient began using profanity and walking up and down the hall in the ED. Security was called to escort the patient out of the ED. The patient did not get a MSE from a physician.

5. On 07/23/19 at 11:00 AM, the investigator interviewed the ED manager (Staff #7). Staff #7 stated that all patients that presented to the ED were to get a medical screening exam.

6. On 07/23/19 at 11:30 AM, the investigator interviewed the ED director (Staff #8). Staff #8 stated that all patients presenting to the ED needed a MSE to determine there was no urgent medical condition.