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Based on a review of the clinical record, hospital documentation and interviews for one of twenty-one patients (Patient #1) reviewed who either left the hospital against medical advice (AMA) or transferred to another facility, the hospital failed to ensure the patient received a medical screening examination. The findings include:

Patient #1 was transported to Hospital #1's ED (Emergency Department) on 2/14/18 at 8:19 AM via Emergency Medical Service (EMS) #1 for complaints of shortness of breath (SOB) and chest pain. The ambulance run sheet dated 2/14/18 identified that Patient #1 arrived at Hospital #1's ED via EMS #1 at 8:19 AM. ED Medical Doctor (MD) #1 tried to divert EMS, however, the EMS ambulance had already arrived at ED#1's ambulance entrance. During transport via ambulance to Hospital #1's ED, Patient #1 required supportive respiratory interventions and the administration of sublingual nitroglycerine x2 for respiratory difficulty and complaints of chest pain. Upon arrival to Hospital #1's ED, EMS personnel asked MD #1 to evaluate Patient #1 due to acute electrocardiogram (EKG) changes indicative of a STEMI (ST elevation myocardial infarction). Further review of the ambulance run sheet identified that after MD#1 evaluated Patient #1's EKG at 8:19 AM while patient was still in the ambulance. MD#1 instructed EMS to transport Patient #1 to Hospital #2's ED, indicating any delay in transfer would only delay time sensitive patient care/treatment. EMS personnel (Medic #1) requested a second medic to meet them for assistance. Medic #2 met Medic #1 at 8:27 AM and a third sublingual nitroglycerine was administered to Patient #1 at 8:42 AM. Patient #1 arrived at Hospital #2 at 8:52 AM with a total transfer time of 31 minutes from Hospital #1 to Hospital #2. Patient #1's medical record from Hospital #2 identified that the patient was evaluated at Hospital #2's ED on 2/14/18 with a heart rate of 131, blood pressure 150/90, respiratory rate of 24 and oxygen saturation of 94% on bi-pap. Patient #1 was diagnosed with an acute myocardial infarction, required intubation with mechanical ventilation and was subsequently admitted to the hospital. Patient #1's discharge summary dated 2/23/18 noted final diagnoses of acute pulmonary edema, hypertensive crisis, new paroxysmal atrial fibrillation and coronary artery disease status post stent placements.

Review of the ED record from Hospital #1 dated 2/14/18 failed to identify that an medical screening examination was conducted by the physician. Further review failed to indicate that the ambulance transport documentation for Patient #1's ED visit was not present in a medical record.

Review of the clincal record and interview with the Chairman of Hospital #1's ED, Director of Quality, Manager of Regulatory Compliance and the ED Medical Director of Hospital #1 on 3/15/18 all identified that the hospital policy was not followed. Further interview identified that Patient #1 should have been assessed, stabilized and/or treated prior to transfer to Hospital #2. In addition, Hospital #2 was not notified of and/or accepted the transfer of Patient #1. Further review indicated that the ED record lacked a medical screening evalution and/or medical record documentation.

During a review of the audio call between Secretary #1, EMS and/or MD#1 with Manager of Quality on 3/15/18 at 11:15 AM verified that the hospitals investigation of the chain of events prior to Patient #1's transfer from Hospital #1 to Hospital #2. No discrepancies in the above interviews were identified.

Review of the hospital's EMTALA policy indicated each patient presenting to the ED with an Emergency Medical Condition (EMC) is entitled to a medical evaluation and necessary stabilization.

According to the Chairman of the ED the EMTALA violation occurred 2/14/18. The hospital became aware of the event on 2/23/18. On 2/23/18 the Chairman of the ED reviewed the incident and EMTALA policy with MD#1. On 2/24/18 all physicians received online education about EMTALA. On March 1, 2018 the incident was reviewed at a meeting for all providers. All providers subsequently completed a validation test and signed attestation statement between 3/9/18 and 3/13/18, indicating the EMTALA material was reviewed.

According to the Director and Manager of Quality, subsequent to the EMTALA violation all nursing/support staff were provided with formal education on Emergency Medical Treatment and Labor Act (EMTALA) from March 9 through March 14, 2018. In addition staff completed a validation test and signed attestation statement.

Based on a review of the clinical record, hospital documentation and interviews for one of twenty-one patients (Patient #1) reviewed who was transported to the Emergency Department with a medical condition, the hospital failed to ensure that the patient received a medical exam and treatment needed to stabilize a medical condition prior to transfer to another hospital. The findings include:

Patient #1 was transported to Hospital #1's ED (Emergency Department) on 2/14/18 at 8:19 AM via Emergency Medical Service (EMS) #1 for complaints of shortness of breath (SOB) and chest pain. The ambulance run sheet dated 2/14/18 identified that Patient #1 arrived at Hospital #1's ED via EMS #1 at 8:19 AM. ED Medical Doctor (MD) #1 tried to divert EMS, however, the EMS ambulance had already arrived at ED#1's ambulance entrance. During transport via ambulance to Hospital #1's ED, Patient #1 required supportive respiratory interventions and the administration of sublingual nitroglycerine x2 for respiratory difficulty and complaints of chest pain. Upon arrival to Hospital #1's ED, EMS personnel asked MD #1 to evaluate Patient #1 due to acute electrocardiogram (EKG) changes indicative of a STEMI (ST elevation myocardial infarction). Further review of the ambulance run sheet identified that after MD#1 evaluated Patient #1's EKG at 8:19 AM while patient was still in the ambulance. MD#1 instructed EMS to transport Patient #1 to Hospital #2's ED, indicating any delay in transfer would only delay time sensitive patient care/treatment. EMS personnel (Medic #1) requested a second medic to meet them for assistance. Medic #2 met Medic #1 at 8:27 AM and a third sublingual nitroglycerine was administered to Patient #1 at 8:42 AM. Patient #1 arrived at Hospital #2 at 8:52 AM with a total transfer time of 31 minutes from Hospital #1 to Hospital #2. Patient #1's medical record from Hospital #2 identified that the patient was evaluated at Hospital #2's ED on 2/14/18 with a heart rate of 131, blood pressure 150/90, respiratory rate of 24 and oxygen saturation of 94% on bi-pap. Patient #1 was diagnosed with an acute myocardial infarction, required intubation with mechanical ventilation and was subsequently admitted to the hospital. Patient #1's discharge summary dated 2/23/18 noted final diagnoses of acute pulmonary edema, hypertensive crisis, new paroxysmal atrial fibrillation and coronary artery disease status post stent placements.

Review of the ED record from Hospital #1 dated 2/14/18 failed to identify that an medical screening examination was conducted by the physician. Further review failed to indicate that the ambulance transport documentation for Patient #1's ED visit was not present in a medical record.

Review of the clincal record and interview with the Chairman of Hospital #1's ED, Director of Quality, Manager of Regulatory Compliance and the ED Medical Director of Hospital #1 on 3/15/18 all identified that the hospital policy was not followed. Further interview identified that Patient #1 should have been assessed, stabilized and/or treated prior to transfer to Hospital #2. In addition, Hospital #2 was not notified of and/or accepted the transfer of Patient #1. Further review indicated that the ED record lacked a medical screening evalution and/or medical record documentation.

During a review of the audio call between Secretary #1, EMS and/or MD#1 with Manager of Quality on 3/15/18 at 11:15 AM verified that the hospitals investigation of the chain of events prior to Patient #1's transfer from Hospital #1 to Hospital #2. No discrepancies in the above interviews were identified.

Review of hospital policy indicated each patient presenting to the ED with an Emergency Medical Condition (EMC) is entitled to a medical evaluation and necessary stabilization.

According to the Chairman of the ED the EMTALA violation occurred 2/14/18. The hospital became aware of the event on 2/23/18. On 2/23/18 the Chairman of the ED reviewed the incident and EMTALA policy with MD#1. On 2/24/18 all physicians received online education about EMTALA. On March 1, 2018 the incident was reviewed at a meeting for all providers. All providers subsequently completed a validation test and signed attestation statement between 3/9/18 and 3/13/18, indicating the EMTALA material was reviewed.

According to the Director and Manager of Quality, subsequent to the EMTALA violation all nursing/support staff were provided with formal education on Emergency Medical Treatment and Labor Act (EMTALA) from March 9 through March 14, 2018. In addition staff completed a validation test and signed attestation statement.