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Based on record review and interviews, it was determined that the hospital failed to ensure that the central log contained the name of an individual, who was seeking medical attention, on November 4, 2018 (Patient 0).

Finding:

The Division of Licensing and Certification received information that Patient 0 went to the hospital on November 4, 2018 seeking medical treatment.

The Emergency Department Log was reviewed for December 4, 2018. There was no evidence on this log that Patient 0 had presented to the hospital nor was Patient 0 registered.

On December 4, 2018, at approximately 8:00 AM, after being seen at his/her Primary Care Physician's [PCP] office, Patient 0 presented to the hospital seeking treatment related to a low heart rate of 32 beats per minute.

Patient 0 went to Registration in the lobby of Hospital A and stated why he/she was there. Registration called the Emergency Department [ED] and Physician A came to the Registration area and instructed Patient 0 to go to Hospital B because there was no Cardiologist on site.

During an interview with Emergency Department (ED) Registered Nurse (RN) A on December 12, 2018 at 10:05 AM, she stated that in the morning, on December 4, 2018, she received a phone call from a PCP office wanting to give her report on someone they were sending to the hospital which she sent to Physician A. Physician A asked her if the cardiologist [Physician B] was on that day so she called their access center and found out he was off. When she told Physician A he asked her to call the PCP back to tell them that the cardiologist was not on. ED RN A said she told Physician A she would rather he do it where he already knew what it was all about. She stated that she dialed the PCP phone number and handed the phone to Physician A. After he was done talking on the phone he asked ED Nurse A to then go out to registration to tell them not to register this patient [Patient 0]. She said she immediately told him she felt like it was an EMTALA violation. The Physician responded by telling her that he didn't believe it was because the man/woman had asymptomatic bradycardia and had been seen at his/her PCP office prior. ED RN A said that Physician A ended up going out to talk to registration himself because she wouldn't.

During a telephone interview with Patient 0 on December 11, 2018, at 12:58 PM, he/she stated that he/she drove himself/herself to the ED at Hospital A after seeing his/her PCP. He/she stated that he/she went to the main entrance and told the clerks that he/she needed to see Physician B. He/she stated that a physician from the ED came out and instructed him/her to drive to Hospital B. He/she added that Physician A told him/her that if he/she was going to drive to pull the car over if he/she got dizzy.

During interviews with Registration staff at 1:40 PM on 12/11/2018, it was stated that on the morning of December 4, 2018, two Registration staff were sitting at the front entrance registration desk. Physician A, an ED Physician, came out and handed Clerk B a piece of paper with a name on it and told the clerks that Patient 0 would be coming in asking for Physician B, who was off that day. Physician A asked the clerks to let Patient 0 know that he/she needed to go to Hospital B and not sign him/her in here. Patient 0 presented to the Registration desk. Clerk B told Patient 0 what Physician A had said. Clerk B than went to the ED to question Physician A about whether Patient 0 was to go to the ED or the Cardiologist's Office. Physician A ended up coming to the reception area with the Clerk. Physician A spoke to Patient 0 telling him/her that the Cardiologist was not there, he/she needed to drive to Hospital B because he/she probably needed a pacemaker, and that there was nothing that Physician A could do here for him/her. Clerk A stated Physician A ended the conversation with 'if you start to get dizzy pull over to the side of the road'.

Based on document review and interviews, it wad determined that the hospital failed to provide an appropriate medical screening examination for 1 of 23 patients (Patient 0).

Finding:

Patient 0 was evaluated by his/her primary care office (PCP) on December 4, 2018 and instructed to proceed to Hospital A for further treatment due to a low heart rate of 32 beats per minute. Patient 0 was offered an ambulance ride to Hospital A but refused and drove there in his/her automobile.

Patient 0 presented to Hospital A at approximately 8:00 AM, on December 4, 2018, seeking treatment.

During an interview with Emergency Department (ED) Registered Nurse (RN) A on December 12, 2018 at 10:05 AM, she stated that in the morning, on December 4, 2018, she received a phone call from a PCP office wanting to give her report on someone they were sending to the hospital which she sent to Physician A. Physician A asked her if the cardiologist [Physician B] was on that day so she called their access center and found out he was off. When she told Physician A he asked her to call the PCP back to tell them that the cardiologist was not on. ED RN A said she told Physician A she would rather he do it where he already knew what it was all about. She stated that she dialed the PCP phone number and handed the phone to Physician A. After he was done talking on the phone he asked ED Nurse A to then go out to registration to tell them not to register this patient [Patient 0]. She said she immediately told him she felt like it was an EMTALA violation. The Physician responded by telling her that he didn't believe it was because the man/woman had asymptomatic bradycardia and had been seen at his/her PCP office prior. ED RN A said that Physician A ended up going out to talk to registration himself because she wouldn't.

During a telephone interview with Patient 0 on December 11, 2018, at 12:58 PM, he/she stated that he/she drove himself/herself to the ED at Hospital A after seeing his/her PCP. He/she stated that he/she went to the main entrance and told the clerks that he/she needed to see Physician B. He/she stated that a physician from the ED came out and instructed him/her to drive to Hospital B. He/she added that Physician A told him/her that if he/she was going to drive to pull the car over if he/she got dizzy.

During interviews with Registration staff at 1:40 PM on 12/11/2018, it was stated that on the morning of December 4, 2018, two Registration staff were sitting at the front entrance registration desk. Physician A, an ED Physician, came out and handed Clerk B a piece of paper with a name on it and told the clerks that Patient 0 would be coming in asking for Physician B, who was off that day. Physician A asked the clerks to let Patient 0 know that he/she needed to go to Hospital B and not sign him/her in here. Patient 0 presented to the Registration desk. Clerk B told Patient 0 what Physician A had said. Clerk B than went to the ED to question Physician A about whether Patient 0 was to go to the ED or the Cardiologist's Office. Physician A ended up coming to the reception area with the Clerk. Physician A spoke to Patient 0 telling him/her that the Cardiologist was not there, he/she needed to drive to Hospital B because he/she probably needed a pacemaker, and that there was nothing that Physician A could do here for him/her. Clerk A stated Physician A ended the conversation with 'if you start to get dizzy pull over to the side of the road'.

Patient 0 did not receive a medical screening exam and instead was instructed by Physician A to proceed to Hospital B for treatment because a Cardiologist was not available on site. Patient 0 drove his/her automobile to Hospital B.

A review of the Patient 0's ED record at Hospital B was completed. The patient was diagnosed with complete heart block, hypertensive urgency, and elevated troponin and was admitted to the hospital for treatment.

Based on document review and interviews it was determined that the hospital failed to ensure patients received stabilizing treatment for 1 of 23 patients (Patient 0).

Finding:

Patient 0 was evaluated by his/her PCP on December 4, 2018 and instructed to proceed to Hospital A for further treatment due to a low heart rate of 32 beats per minute. Patient 0 was offered an ambulance ride to Hospital A but refused and drove there in his/her automobile.

Patient 0 presented to Hospital A at approximately 8:00 AM, on December 4, 2018, seeking treatment.

During an interview with Emergency Department (ED) Registered Nurse (RN) A on December 12, 2018 at 10:05 AM, she stated that in the morning, on December 4, 2018, she received a phone call from a PCP office wanting to give her report on someone they were sending to the hospital which she sent to Physician A. Physician A asked her if the cardiologist [Physician B] was on that day so she called their access center and found out he was off. When she told Physician A he asked her to call the PCP back to tell them that the cardiologist was not on. ED RN A said she told Physician A she would rather he do it where he already knew what it was all about. She stated that she dialed the PCP phone number and handed the phone to Physician A. After he was done talking on the phone he asked ED Nurse A to then go out to registration to tell them not to register this patient [Patient 0]. She said she immediately told him she felt like it was an EMTALA violation. The Physician responded by telling her that he didn't believe it was because the man/woman had asymptomatic bradycardia and had been seen at his/her PCP office prior. ED RN A said that Physician A ended up going out to talk to registration himself because she wouldn't.

During a telephone interview with Patient 0 on December 11, 2018, at 12:58 PM, he/she stated that he/she drove himself/herself to the ED at Hospital A after seeing his/her PCP. He/she stated that he/she went to the main entrance and told the clerks that he/she needed to see Physician B. He/she stated that a physician from the ED came out and instructed him/her to drive to Hospital B. He/she added that Physician A told him/her that if he/she was going to drive to pull the car over if he/she got dizzy.

During interviews with Registration staff at 1:40 PM on 12/11/2018, it was stated that on the morning of December 4, 2018, two Registration staff were sitting at the front entrance registration desk. Physician A, an ED Physician, came out and handed Clerk B a piece of paper with a name on it and told the clerks that Patient 0 would be coming in asking for Physician B, who was off that day. Physician A asked the clerks to let Patient 0 know that he/she needed to go to Hospital B and not sign him/her in here. Patient 0 presented to the Registration desk. Clerk B told Patient 0 what Physician A had said. Clerk B than went to the ED to question Physician A about whether Patient 0 was to go to the ED or the Cardiologist's Office. Physician A ended up coming to the reception area with the Clerk. Physician A spoke to Patient 0 telling him/her that the Cardiologist was not there, he/she needed to drive to Hospital B because he/she probably needed a pacemaker, and that there was nothing that Physician A could do here for him/her. Clerk A stated Physician A ended the conversation with 'if you start to get dizzy pull over to the side of the road'.

Patient 0 did not receive a medical screening exam and instead was instructed by Physician A to proceed to Hospital B for treatment because a Cardiologist was not available on site. Patient 0 drove his/her automobile to Hospital B.

A review of the Patient 0's ED record at Hospital B was completed. The patient was diagnosed with complete heart block, hypertensive urgency, and elevated troponin and was admitted to the hospital for treatment.