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Based on observation, interview, and document review the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to post EMTALA signs in areas likely to be noticed by all individuals that visit the emergency department (ED), see A 2402; the failure to maintain a central log documenting individuals seeking care in the ED, see A 2405; and the failure to ensure a medical screening exam was provided to an individual seeking care in the ED, see A 2406.

Based on observation and interview the facility failed to post EMTALA signs in areas likely to be noticed by all individuals that visit the emergency department (ED) resulting in the potential for all emergency patients to be uninformed of their rights. Findings include:

On 10/25/2017 at 0845 entrance to the facility occurred through the designated Emergency Room Department entrance. Survey of the waiting room area revealed the absence of EMTALA signs notifying patients of EMTALA law. On 10/25/2017 at 0930 during a tour with staff D and staff B an inquiry was made as to where EMTALA law postings could be located in the ED. Staff D responded that EMTALA law signage was posted in the triage area. Staff D was then queried if EMTALA law signage was posted in the entrance area of the patient waiting area of the ED. Staff D stated the only area that she has ever been aware of EMTALA signage being posted was in the triage area. Further tour of the ED department was conducted. Entrance through the ambulance bay entry did not have EMTALA law signage posted. On 10/25/2017 at 0940 staff D was asked if EMTALA law signage had ever been posted in the ambulance bay entryway. Staff D responded "no. Not that I know of."

Based on interview and document review, the facility failed to maintain a central log for all persons seeking treatment in the Emergency Department resulting in the the potential for failure to track care provided to all individuals seeking emergency services. Findings include:

On 10/25/17 at 1045 during an interview with Emergency Department (ED) Medical Director (Staff F) she stated "We know you are here about the incident we reported. We can show you what we have done to prevent it from happening again." On 10/25/17 at 1055 an interview with ED Medical Director Staff F, ED Staff Nurse (Staff K), Quality Improvement Coordinator (Staff D), Director of Corporate Compliance (Staff B) and the Manager of Regulatory Compliance (Staff C) revealed on 9/18/17 a minor presented to the ED seeking treatment for alleged abuse and was not triaged or treated.

On 10/25/17 at 1122 review of the ED log dated July 2017-October 2017 was conducted. Attempts to identify the patient of concern (#22) of intake MI90845 were unsuccessful as no patient of the stated age, sex, or chief complaint was logged for the date of the alleged incident (9/18/17). A patient name was not provided in the intake information.

On 10/25/17 at 1150 staff K was queried if ED log dated July 2017-October 2017 was complete. Staff K stated yes. Staff K was queried as to if patient #22 was missing from the ED log. Staff K stated "Correct. She (#22) was never registered. The registration clerk kept her name and date of birth but didn't put her in the system. She (#22) should have been entered and triaged and a MSE (medical screening exam) done."

Based on interview and document review the facility failed to ensure a medical screening exam was performed for all individuals seeking treatment in the emergency department for one of twenty-two (#22) patients reviewed for a medical screening exam from a total sample of twenty-two, resulting in the potential for poor patient outcomes. Findings include:

On 10/25/17 at 1045 during an interview with Emergency Department (ED) Medical Director (Staff F) she stated "We know you are here about the incident we reported. We can show you what we have done to prevent it from happening again." On 10/25/17 at 1055 an interview with ED Medical Director Staff F, ED Staff Nurse (Staff K), Quality Improvement Coordinator (Staff D), Director of Corporate Compliance (Staff B) and the Manager of Regulatory Compliance (Staff C) revealed on 9/18/17 a minor presented to the ED seeking treatment for alleged abuse and was not triaged or treated.

On 10/25/17 at 1122 review of the ED log dated July 2017-October 2017 was conducted. Attempts to identify the patient of concern (#22) of intake MI90845 were unsuccessful as no patient of the stated age, sex, or chief complaint was logged for the date of the alleged incident (9/18/17). A patient name was not provided in the intake information.

On 10/25/17 at 1150 Staff K was queried if ED log dated July 2017-October 2017 was complete. Staff K stated yes. Staff K was queried as to if patient #22 was missing from the ED log. Staff K stated "Correct. She (#22) was never registered. The registration clerk kept her name and date of birth but didn't put her in the system. She (#22) should have been entered and triaged and a MSE (medical screening exam) done."

On 10/25/17 at 1152 Staff B stated "We know she (#22) should have been seen by a doctor."

On 10/25/17 at 1330 staff D provided the name and date of birth for patient #22 and entered her information into the search box function of the facility's electronic medical record system (EMR). Review of the facility's EMR revealed the most recent record for patient #22 was from an encounter in 2009.