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Based on interview and record review, the facility failed to maintain the central log on each individual who comes to the emergency department, as defined in ?489.24(b), seeking assistance and whether he or she refused treatment in 1 of 8 sampled patients (SP) #1.

Findings include:

Review of the policy: EMTALA -Central Log, revealed that the log shall contain the name of the individual seeking assistance; and the disposition (permitted dispositions include: 1) patient refused treatment, 2) transferred, 3) admitted and treated, 4) stabilized and transferred, or 5) discharged. The log entry must be made at the first point of contact. This normally takes place at triage.


Sample patient #1 a 35 weeks pregnant woman presented to the Emergency Department of Hospital #1 off site Emergency Department having contractions on 06/20/2013.

Review of the facility's registration log at Hospital #1 revealed that sampled patient #1 name and information was not written on the log on the following date: 06/20/2013.

Review of the medical records of sampled patient #1 revealed the patient presented to the Emergency Department at Hospital # 3 with complaints of pregnant ( 35 weeks, pelvic pain, with pelvis cramps, and lower back pain since the day before and was progressing to contracting every 20 minutes. The record further states that sample patient #1 was initially at Hospital #1 walk in ER, who instructed the patient to go to Hospital #3. A medical screening was completed by hospital #3 and the patient was transferred to Hospital # 4 via ambulance per the patient ' s request.


The Charge Nurse (CN) stated during a telephone interview conducted on 07-02-2013 from 12:04 P.M. to 12:24 P.M. I remember this case because [name of Registration Clerk (R.C.) #1] called me and said that a patient asked for a nurse because of some questions. The patient told me that she has been having contractions all day, every 30 (thirty) minutes. I told the patient that we will check her, she has to sign-in, the doctor will see her and that she will be transferred to [name of Main Hospital] where the Labor & Delivery (L&D) Department is located. I told her that she will be taken by ambulance to [name of Main Hospital #1]. The patient answered, " No, no I do not want to do that. I do not want an ambulance, I don' t want any of that." I told her again that we can register her, we can check her here, take her by ambulance, but the patient said that she would rather drive to the main hospital, her husband was with her. The patient told me, "Yeah, I'm OK." The patient never wanted to sign-in, did not want to give any information, she did not want to see the doctor. The patient was not in distress, she didn't complain of any contractions at that time. I told her that if you decide to go to [name of Main Hospital #1], they will take you to the L&D. The patient left with her husband.

The Registration Clerk (R.C. #1) stated, during an interview conducted on 07-02-2013 from 12:37 P.M. to 12:42 P.M. " The patient walked in together with the husband. The patient wanted to know what is to be done here so I called [name of Charge Nurse]. The nurse told the patient that she needs to register, that she will be seen in the Emergency Department and that she will be transferred to [name of Main Hospital #1] for the Labor & Delivery services. The patient declined and she said that the husband will drive her instead.