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Based on reviews of clinical records, review of hospital policies and procedures, and staff interviews, it was determined the hospital failed to enforce policies and procedures that comply with the requirements of 42CFR 489.20 and 42 CFR 489.24, responsibilities of Medicare participating hospitals in emergency cases.

Findings include:

The hospital failed to provide a medical screening examination to a patient presenting to the ED with shortness of breath, dizziness, chest pain, and lethargy. (Patient #1)

The hospital failed to document Patient #1 on the ED log and document Patient #1 as left without being seen (LWBS) on the ED log.

Based on interview and document review, it was determined that the hospital failed to maintain a central log of each individual who presented to the emergency department seeking care by not registering a patient that requested treatment and whether he or she refused treatment, was refused treatment, or if he or she was transferred, admitted and treated, stabilized and transferred, or discharged pursuant to the Federal Regulations.

Findings include:

Hospital policy titled, "Emergency Department Nursing Triage", revealed: "...All patients receive a rapid triage assessment including: a. Chief complaint, b. Allergies, c. Vital signs, including temperature, pulse, respirations, blood pressure and pain intensity, d. Other information, if appropriate, may include oxygen saturation last menstrual period, past medical history and weight (pediatric weight in kilograms)...Whenever possible patients are immediately placed into open treatment spaces and triage is performed at the bedside...."

Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA) ", revealed: "...Every patient regardless of ability to pay, who (i) presents to the Hospital ' s Dedicated Emergency Department or presents on Hospital Property and (ii) requests an examination or treatment of a potential Emergency Medical Condition ( " EMC " ) shall receive an appropriate Medical Screening Examination ( " MSE " ) to determine whether the patient is experiencing an EMC...If a patient leaves the Hospital without notifying a Hospital staff member, this must be documented. The documentation must reflect that the patient had been at the Hospital and the time the patient was discovered to have left the premises. Triage notes, registration documentation and/or additional records must be retained. If the patient leaves prior to triage, but after registration, the information shall be documented on the triage documentation form...The Hospital shall maintain a central log of each patient who presents to the Hospital ' s DED or on Hospital Property seeking medical treatment and whether he or she (i) refused treatment, (ii) was refused treatment, (iii) was transferred prior to stabilization, (iv) was admitted and treated, (v) was stabilized and transferred, or (vi) was discharged.... "


The hospital failed to document Patient #1 on the ED log and document Patient #1 as left without being seen (LWBS) on the ED log.

Employee #2 confirmed during an interview on 01/19/2023 that there was no documentation present to show that Patient #1 was a patient at the hospital's ED on [03/22/2022].

Based on review of policies and procedures, hospital documents, observations, and interviews, it was determined that the hospital failed to provide a Medical Screening Examination to a patient who presented to the ED for examination and treatment (Patient #1).

Findings include:

Patient #1 presented to the Emergency Department of the facility on [03/22/2022] at approximately 00:15 A.M. with shortness of breath, dizziness, chest pain and lethargy, arriving by personal vehicle. Upon arrival to the ED, Patient #1 was asked for her/his insurance information. Patient #1 had vital signs taken by a staff member and was told s/he was having a panic attack and to go to urgent care or come back later as s/he was not a priority case. Patient #1 then left the ED and went home.

Hospital policy titled,"Emergency Department Nursing Triage", revealed: "...All patients receive a rapid triage assessment including: a. Chief complaint, b. Allergies, c. Vital signs, including temperature, pulse, respirations, blood pressure and pain intensity, d. Other information, if appropriate, may include oxygen saturation last menstrual period, past medical history and weight (pediatric weight in kilograms)...Whenever possible patients are immediately placed into open treatment spaces and triage is performed at the bedside...."

Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA) ", revealed: "...Every patient regardless of ability to pay, who (i) presents to the Hospital ' s Dedicated Emergency Department or presents on Hospital Property and (ii) requests an examination or treatment of a potential Emergency Medical Condition ( " EMC " ) shall receive an appropriate Medical Screening Examination ( " MSE " ) to determine whether the patient is experiencing an EMC. If it is determined that the patient is experiencing an EMC, the Hospital shall either stabilize the EMC within the capability of the Hospital or transfer the patient to another facility in accordance with the provisions of the Emergency Medical Treatment and Active Labor Act (EMTALA) and this Policy...A physician or QMP (qualified medical personnel) must perform the MSE to determine if an EMC exists. The MSE must be appropriate to the patient's presenting complaint and symptoms, and the medical history of the patient...The MSE and any necessary stabilizing treatment shall be provided in a nondiscriminatory manner, without regard to the patient's financial status, age, race, color, ethnicity, sexual orientation, religion, mental health status, national origin or disability ...Staff may follow the Hospital's normal registration procedures for a patient, including asking for his/her insurance card and providing financial responsibility forms, as long as the process does not delay the provision of the MSE and/or stabilizing treatment. Under no circumstance, however, shall staff verify a patient's payer status or obtain pre-approval from third party payers prior to the MSE and initiation of any medically necessary stabilizing treatment...If a patient refuses to consent to medical screening examination and indicates his/her intention to leave the Hospital prior to receiving a MSE, ED staff should, whenever practicable, inform the patient of the risks and benefits of the examination and, if the patient continues to refuse examination, request that the patient sign the " Refusal of a Medical Screening Exam " form reflecting the refusal and indicating that the patient has been informed of the risks and benefits of medical screening examination...If the patient refuses to sign the form, staff shall document on the ED Sign-In Sheet that the patient refused to sign the "Refusal of a Medical Screening Exam" form...If a patient leaves the Hospital without notifying a Hospital staff member, this must be documented. The documentation must reflect that the patient had been at the Hospital and the time the patient was discovered to have left the premises. Triage notes, registration documentation and/or additional records must be retained. If the patient leaves prior to triage, but after registration, the information shall be documented on the triage documentation form...The Hospital shall maintain a central log of each patient who presents to the Hospital ' s DED or on Hospital Property seeking medical treatment and whether he or she (i) refused treatment, (ii) was refused treatment, (iii) was transferred prior to stabilization, (iv) was admitted and treated, (v) was stabilized and transferred, or (vi) was discharged.... "

Hospital policy titled, "Patient Assessment, Reassessment, and Documentation of Care in the Emergency Department", revealed: "...All assessments are documented in the electronic medical record or on paper during downtime...."

Review of the "Tempe St Luke's Hospital Medical Executive Committee Meeting Minutes" dated 01/25/2022 revealed discussion of the ED's LWBS (left without being seen) rate was increasing.

Review of the ED logs from February, March and April 2022 revealed 272 patients were documented as leaving without an MSE. Further review of the March 2022 ED log revealed a LWBS rate of 2% for the week before Patient #1 presented to the ED with an increase to 4% the week Patient #1 presented to the ED and a decrease in the LWBS rate to 1.5% the week after Patient #1 presented to the ED.

A review of the hospital's electronic medical records (EMR) revealed no evidence of an admission for Patient #1 on [03/22/2022].

A review of the hospital ' s Emergency Activity Log revealed no evidence of Patient #1 being registered in the ED on [03/22/2022].

Observation on tour of the hospital Emergency Department on 01/19/2022 revealed patients entering the ED lobby are given an intake form and asked for identification and insurance information. After completing the intake form the patient is "quick registered" into the computer and a patient armband is placed on the patient's wrist and the patient intake form is placed in the triage nurse inbox for triage.


Employee #2 confirmed during an interview on 01/19/2023 that there was no documentation present to demonstrate that Patient #1 was registered at the hospital's ED on [03/22/2022]. Employee #2 confirmed that when a patient is registered at the front desk in the computer, the patient is automatically entered into the ED log. Employee #2 confirmed there was no encounter for Patient #1 on the date of the allegation [03/22/2022]. Employee #2 stated that if a patient enters the ED and completes an intake form but leaves before the quick registration or triage, the patient is entered into the computer as leaving before treatment. Employee #2 stated that there was no record of Patient #1 in the hospital's EMR or ED activity log for [03/22/2022].