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Based on interview and record review the facility failed to comply with the requirements of 42 CFR 489.24 by failing to provide a medical screening exam (MSE) and failing to log the arrival of a patient in the Emergency Department (ED) log for 1 patient (P-1) of 20 patients reviewed for Emergency Medical Treatment and Labor Act (EMTALA) requirements, resulting in the potential for an unidentified medical emergency. Findings include:

See Tags:

A-2405 Failure to maintain an Emergency Department Log including names of all patients presenting to the ED seeking Emergency Services.

A-2406 Failure to complete a medical screening exam.

Based on interview and record review the facility failed to maintain an emergency department log for 1 (P-1) of 20 patients reviewed for seeking emergency services, resulting in the omission of P-1's arrival and request for emergency screening and or treatment. Finding include:

On 04/30/2025 at 1017 a telephone interview was conducted with Triage RN (Staff U), she confirmed that she was the triage nurse on duty in the ED on 03/23-24/2025 from 2:00pm-2:00am.
Staff U explained that (P-1) presented to the ED two times on 03/24/2025, (the initial presentation time was unknown, the second presentation was observed on a video recoding at 0128). During the interview Staff U shared that she informed P-1 that she would not be seen without parental or guardian consent, and P-1 exited the ED. The House Supervisor was then informed of the minor (P-1) presenting to the ED. Staff U stated, "The House supervisor confirmed that, parental consent was necessary to be seen." When queried if Staff U placed P-1's name into the ER log at anytime she stated no.

On 04/30/2025 at 0840 an interview was conducted with the Patient Access Representative (PAR) that was on duty the night of the incident involving P-1. Staff O was queried regarding P-1's arival being placed into the ED log. Staff O stated, "Yes I did place the name of (P-1) into the ED log when she arrived around 0300 with a parent." Staff O denied logging P-1's name into the ED log at any other time on 03/24/2025. Staff O also confirmed that he recalled P-1 presenting to the ED and being told by the triage nurse that P-1 would not be seen without the consent of a parent or guardian. When queried if Staff O had ever received EMTALA training or if he had ever turned a minor away from the ED. Staff O stated, "Yes I have had training, we have it every year. No, I have never turned a minor away before. I don't meet the requirements to make that decision, that would be the triage nurse."

On 04/29/2025 at 1520, a review of security video footage dated 03/24/2025 was viewed with the Director of ED Staff E, the Manager of ED Staff F, and Security Supervisor Staff V. The video revealed the following:

At 0128, P-1 enters the ED and is seen speaking with the Patient Access Rep, Staff O. Two (2) male security guards are also viewed behind the desk.

At 0135, another patient access representative appeared at the desk, while Staff O walked to the triage room. Unable to visualize anyone in the triage room due to tinted windows.

P-1 moves to a seat in the waiting area as another patient is seen entering the ED.

At 0140, Staff O was visualized speaking with P-1 who appears to be on her cell phone and holds the phone up towards Staff O. At 0142, P-1 was seen exiting the ED.

At 0304, P-1 was visualized on the video recording returning to the ED with another person and it appeared that P-1 was registered. Review of records confirmed the registration was completed at that time.

Review of the "ER LOG" dated 11/01/2024 through 04/29/2025 revealed that P-1's name was entered into the "ER LOG" on 03/24/2025 at 0305.

Both the Director of ED, Staff E, and the Director of Quality Improvement Staff C, confirmed the above findings. P-1 presented to the ED two times on 03/24/2025 and was refused treatment without parental or guardian consent. After being refused an evaluation P-1 drove herself 30 minutes to retrieve a parent and drove 30 minutes back to the hospital with her mother to receive treatment.

Review of policy titled: "Emergency Center Initial Medical Screening Evaluation", effective 4/25
4.2. All persons will be triaged (completion of the patient profile) will be triaged in the
Emergency Center treatment area.

4.3. Individuals who present at the Emergency Center will have quick registration completed.
4.5. The Emergency Center provider will perform the Medical Screening Exam and provide
medical treatment including any necessary diagnostic procedures or test that reasonably ensures no material deterioration of the condition is likely to result. The physician may discharge, admit, or transfer the patient to another facility.

Based on interview and record review the facility failed to provide a Medical Screening Examination (MSE) for 1 (P-1) of 20 patients reviewed, resulting in the potential for an unrecognized medical emergency for patients seeking medical screening and/or treatment. Findings include:

On 04/29/2025 at 1400 review of the ED log from 11/01/2024 to 04/29/2025 revealed P-1 presented to the ED on 03/24/2025 at 0305 with a parent.

On 04/29/2025 at 1520 review of security video dated 03/24/2025, at 0128, P-1 presenting to the ED by herself.
At 0128, P-1 is seen by herself approaching the Patient Access Representative (PAR).
At 0135, P-1 is seen sitting in the waiting area.
At 0141, P-1 is seen with a cell phone and holding the phone up to Staff O.
At 0142, P-1 is seen leaving the ED.
At 0304, P-1 is seen with another person approaching the PAR.

On 04/30/2025, at 1017, during a telephone interview with triage nurse Staff U, it was confirmed that P-1 presented to the ED twice before the 0304 presentation. Staff U stated, "The initial presentation was a few minutes before the 0128 presentation, and [P-1] knew she couldn't be seen without parental or guardian consent." The patient left the ED at 0142 without an ESI, or an MSE being completed.

On 04/30/2025 a review of records revealed that P-1 presented to the ED with her mother on 03/24/2025 at 0304, with a chief complaint of abdominal pain starting approximately 1500 on 03/23/2025.

Staff E confirmed that P-1 presented to the ED by herself with complaint of abdominal pain requesting an evaluation. P-1 did not receive triage or a MSE, due to not having a parent or guardian consent. Attempts were made to contact P-1's parents without success and P-1 was not evaluated/assessed until she returned with her parent at 0304.

Review of policy titled: "Emergency Center Initial Medical Screening Evaluation", effective 4/25
1. Purpose: To ensure that individuals are to be treated in a timely manner based upon the acuity of their illness or injury by an Emergency Center (EC) physician, regardless of their ability to pay. To make an initial determination within the resources of the medical center whether an emergency medical condition exists for all patients who come to the Emergency Center requesting an examination or treatment.
2. Scope: 4.1. The RN will sort each person who presents to the Emergency Center and assign an ESI
acuity level (See EC 260).
4.2. All persons will be triaged (completion of the patient profile) will be triaged in the
Emergency Center treatment area.
4.3. Individuals who present at the Emergency Center will have quick registration completed.
4.5. The Emergency Center provider will perform the Medical Screening Exam and provide
medical treatment including any necessary diagnostic procedures or test that reasonably ensures no material deterioration of the condition is likely to result. The physician may discharge, admit, or transfer the patient to another facility.