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Based on observation, medical record review and review of facility policy, the facility failed to implement all requirements of their policy for EMTALA Medical Screening Examinations for 1 of 20 patients (#16) in the medical record sample.

Findings:

The facility failed to provide necessary stabilizing treatment prior to discharging patient #16 on 8/9/2023. (See findings at A2407).

The facility's "Emergency Department and EMTALA" policy (Policy # 9307, Rev. Date 10/21) reviewed by the State Agency (SA) on 11/15/2023 states, "an individual who comes to the emergency department will receive an MSE, performed by a physician or a QMP, appropriate to the individuals presenting signs and symptoms". It also states, "If the treating physician determines that the individual has an emergency medical condition, the hospital will provide: 1) further medical examination and treatment as required to stabilize the medical condition, within the capabilities of the staff and facilities, or 2) for transfer of the individual to another medical facility in accordance with EMTALA obligations".

Based on observation and record review, the facility failed to comply with the Emergency Medical Treatment and Labor Act (EMTALA) requirement for sign posting.

Findings:

The "Ellis" site Emergency Department (ED) was toured by the State Agency (SA) on 11/14/2023 at 1040.

There was only one EMTALA sign in the waiting room, which could not be seen from all areas of the waiting room. There was no EMTALA signage in the non-urgent area of the ED and no EMTALA signage in any of the patient rooms in the main ED.

A sign posted at the ED registration desk read: "The Emergency Department is for serious and life-threatening emergencies ONLY." This sign indicated to patients and visitors when it is appropriate to come to the Emergency Department, when to go to a primary care physician and when to go to an urgent care.

The facility's "Emergency Department and EMTALA" policy (Policy # 9307, Rev. Date 10/21) reviewed by the SA on 11/15/2023 indicates that "The hospital will post signage conspicuously in lobbies, waiting rooms, admitting areas, and treatment rooms where treatment and examination occurs in the form required by CMS that specifies the rights of individuals to examination and treatment for emergency medical conditions and whether the Hospital participates in the Medicaid program. Signage will be posted in each dedicated emergency department. The hospital will not post any sign that discourages an individual from remaining for an appropriate medical screening examination."

"In general, the sign should be visible from anywhere in the area or at a reasonable distance (e.g. 20 feet) or whichever is less."

Based on medical record review, the facility failed to provide necessary stabilizing medical treatment for 1 of 20 patients (patient #16) in the medical record sample.

Findings:

Patient #16 was brought to the Emergency Department (ED) on 8/8/2023 at 1908 accompanied by police after the patient attempted to hang self at a juvenile detention facility.

The patient was seen by behavioral health crisis staff at approximately 1945 on 8/8/23. It was determined that the patient would stay in the ED and be re-evaluated by a psychiatrist in the morning. (8/9/2023).

The patient verbalized suicidal ideation and that they would try to hang self or cut their neck.

Per the Staff H's assessment/Behavioral Health note for 8/9/23 at 1454, entered on 8/18/23 at 1515 indicated the patient was in need of psychiatric hospitalization, and needed a forensic facility. Staff H wrote a letter dated 8/9/23, to the detention facility that indicated the patient needed a forensic mental health facility due to the patient being in the custody of the criminal justice system. The documentation further revealed a transfer to a forensic unit would not be possible at this time, as it requires going through the court system. The facility discharged the patient on 8/9/23 at 1758 indicating that the patient was to be maintained on constant observation at the detention facility.

The facility policy entitled "Emergency Department and EMTALA" policy (Policy # 9307, Rev. Date 10/21) reviewed by the SA on 11/15/2023 indicates "If the treating physician determines that the individual has an emergency medical condition, the hospital will provide: 1) further medical examination and treatment as required to stabilize the medical condition, within the capabilities of the staff and facilities, or 2) for transfer of the individual to another medical facility in accordance with EMTALA obligations".