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Based on interview and review of Medical Staff Bylaws, the hospital failed to determine which staff members were qualified to conduct a medical screening examination for patients that presented to the Dedicated Emergency Department. This had the potential to affect all patients served.

Findings included:Refer to A2406.

Based on interview and review of Medical Staff Bylaws, the hospital failed to determine which staff members were qualified to conduct a medical screening examination for patients that presented to the Dedicated Emergency Department. This had the potential to affect all patients served.

Findings included:

A review of the hospital's Medical Staff Bylaws, effective January 23, 2019, was reviewed. There was no specific documentation to indicate which members of the medical staff were determined qualified to conduct medical screening exams for patients that presented to the Emergency Department (ED).

In an interview with Employee Identifier (EI) #1, Accreditation and Regulatory Compliance, on June 7, 2022 at 3:28 pm, an opportunity was made for staff to identify for the surveyor in the Medical Staff Bylaws where specific members of the Medical Staff had been determined qualified to conduct medical screening exams.

In a follow up interview with EI #1, on June 8, 2022 at 2:09 pm, it was confirmed the Bylaws refer to a hospital policy, but there was no specific language contained within the Medical Staff Bylaws to specify which member of medical staff was identified to conduct the MSEs as required under the Emergency Medical Treatment and Labor Act (EMTALA).