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Based on a review of facility documentation and medical records (MR), and staff interviews (EMP), it was determined that the facility failed to provide an appropriate Medical Screening Examination within the capability of the hospital's emergency department for one of 21 medical records reviewed (MR1).

Findings include:

Review of facility documentation "Medical Staff Bylaws, Policies, And Rules And Regulations Of Washington Health System Greene" dated March 12, 2019, revealed "9.2 Medical Screening Examinations: (a) Medical screening examinations, within the capability of the Hospital, will be performed on all individuals who come to the Hospital requesting examination or treatment to determine the presence of an emergency medical condition."

Review of facility policy and procedure "Emergency Medical Screening, Treatment & Transfer Policy (EMTALA)" last revised April 2, 2019, revealed "I. Presenting For Care And Medical Screening Examination A. Any individual who comes to the Health System Emergency Department requesting examination or treatment shall be provided with an appropriate medical screening examination (MSE) B. An individual will also be considered to have come to the Health System Emergency Department if the individual is on health system property (including its parking lot, driveway, or sidewalk) and is requesting care for what may be an emergency condition or someone has requested care on his or her behalf. Health System property is the Health System's campus, defined as an area that is 250 yards around the health System building."

Review of facility documentation revealed that MR1 presented to the hospital ' s ambulance bay escorted by several police cars. The patient was brought to the emergency department due to a display of violent behaviors and a 302 involuntary hospital admission. Patient did not have any medical concerns. Administrative Nursing Supervisor EMP11 told the police officers to take the patient to [another local hospital] that was better staffed and equipped to manage patients with behavioral health issues. The patient was transferred without having an appropriate medical screening examination.

Review of MR1 revealed "ED Provider Note 04/23/2020 21:08 ... Receiving Provider Note ... [The patient] ... did not have a medical screening exam prior to transfer."

During an interview on July 21, 2020 at 8:05 AM, EMP1, EMP2, and EMP3 confirmed that the facility failed to provide an appropriate medical screening examination.