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Based on record review and interview, the facility failed to comply with 489.24. The facility failed to provide a medical screening exam, and provide an appropriate transfer for 1 of 1 patient (Patient #20) who was air evaced to Hospital A after sustaining multiple injuries from a motor vehicle accident. Hospital A had both capacity and capability to accept Patient #20 on 05/02/14.
Findings Included:
1) Hospital B's air evacuation run sheet dated 05/02/14 indicated Patient #20 was a pediatric trauma with multiple injuries from a motor vehicle accident. Patient #20 had a closed fracture of an unspecified site of the mandible. He was transported to Hospital A on 05/02/14 and arrived at Hospital A at 23:43. At 23:55 Patient #20 arrived at Hospital B with injuries to the chin and face.

2) Hospital A's emergency log dated 05/02/14 did not include Patient #20.

3) In an interview with the surveyor on 6/18/14 at noon the facility representative for Hospital A, Executive Nursing Leadership/Emergency, stated a facility emergency department registered nurse told the flight crew to take patient #20 to another acute care facility. The representative stated Patient #20 did not receive a medical screening exam or stabilizing treatment and was not transferred according to regulatory requirements.

4) In an interview with the surveyor on 6/18/14 at 1600 Hospital A's facility representative, Director of Regulatory and Accreditation, stated the facility did not provide patient #20 with a medical screening exam or stabilizing treatment and patient #20 was not transferred according to regulatory requirements.

Cross Refer to A2406 and A2409

Based on record review and interview, the facility failed to maintain a central log of each patient who came to the emergency room seeking assistance, in that 1 of 1 patient (Patient #20 who was air evaced to Hospital A was not listed on the emergency room log for Hospital A.

Findings included:

1) Hospital B's air evacuation run sheet dated 05/02/14 indicated Patient #20 was a pediatric trauma with multiple injuries from a motor vehicle accident. Patient #20 had a closed fracture of an unspecified site of the mandible. He was transported to Hospital A on 05/02/14 and arrived at Hospital A at 23:43.

2) Hospital A's emergency log dated 05/02/14 did not include Patient #20.

2) In an interview with the surveyor on 6/18/14 at noon Hospital A's representative, Executive Nursing Leadership/Emergency, stated a facility emergency department registered nurse told the flight crew to take Patient #20 to another acute care facility. The representative stated patient #20 was not registered on the central log.

Based on record review and interview, the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department in that 1 of 1 patient (Patient #20) who was air evaced to Hospital A after sustaining multiple injuries from a motor vehicle accident that included a closed fracture of an unspecified site of the mandible was not provided a medical screening exam at Hospital A.

Findings included:

1) Hospital B's air evacuation run sheet dated 05/02/14 indicated Patient #20 was a pediatric trauma with multiple injuries from a motor vehicle accident. Patient #20 had a closed fracture of an unspecified site of the mandible. He was transported to Hospital A on 05/02/14 and arrived at Hospital A at 23:43. At 23:55 Patient #20 arrived at Hospital B with injuries to the chin and face.

2) Hospital A's emergency log dated 05/02/14 did not include Patient #20 and there was no documentation that Patient #20 was provided a medical screening at Hospital A.


3) In an interview with the surveyor on 6/18/14 at noon Hospital A's facility representative, Executive Nursing Leadership/Emergency, stated a facility emergency department registered nurse told the flight crew to take patient #20 to another acute care facility. The representative stated Patient #20 did not receive a medical screening exam.

4) Hospital A's policy "... System Patient Transfer and Emergency Medical Treatment and Active Labor Act (EMTALA) Compliance - update June of 2012" included, "...A MSE (medical screening exam) is required when an individual come by him or herself, or with another individual, to Hospital Property (and within 250 yards) and a request is made by the individual or on the individual's behalf, or a prudent lay person observer would conclude from the individual's appearance or behavior a need, for examination or treatment of emergency medical condition (EMC)."

Based on record review and interview, the facility failed to provide an appropriate transfer in that 1 of 1 patient (Patient #20) who sustained multiple injuries from a motor vehicle accident was air evaced to Hospital A and 12 minutes later arrived at Hospital B without being screened and/or evaluated at Hospital A. The RN at Hospital A directed the patient to Hospital B where care was initiated by the Hospital B Trauma team.

Findings Included:

1) Hospital B's air evacuation run sheet dated 05/02/14 indicated Patient #20 was a pediatric trauma with multiple injuries from a motor vehicle accident. Patient #20 had a closed fracture of an unspecified site of the mandible. He was transported to Hospital A on 05/02/14 and arrived at Hospital A at 23:43. At 23:55 Patient #20 arrived at Hospital B and care was assumed by Hospital B's Trauma team. The emergency room diagnosis included a closed mandible fracture. On 05/06/14, Patient #20 was taken to the operating room for an open reduction and internal fixation of his symphysis fracture and bilateral subcondylar fractures.

2) In an interview with the surveyor on 6/18/14 at noon Hospital A's facility representative, Executive Nursing Leadership/Emergency, stated a facility emergency department registered nurse told the flight crew to take patient #20 to another acute care facility. The representative stated patient #20 did not receive stabilizing treatment and was not transferred according to regulatory requirements.

3) In an interview with the surveyor on 6/18/14 at 1600 Hospital A's facility representative, Director of Regulatory and Accreditation, stated the facility did not transfer the patient according to regulatory requirement.

4) Hospital A's "...Health and Hospital System Patient Transfer and Emergency Medical Treatment and Active Labor Act (EMTALA) Compliance - update June of 2012" included, "...Transfers from (Hospital A): The following procedures presume that at the transfer an ME has been initiated to determine the needs of the individual and, if an emergency medical condition exists, stabilization of the individual's condition to the capability of the hospital has occurred..."