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Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to provide an appropriate medical screening examination within the capability of the Hospital's Emergency Department (ED), to determine whether or not a psychiatric emergency medical condition existed for one of five applicable ED medical records reviewed (MR1).

Findings include:

Review on August 19, 2105, of the facility's "Emergency Medical Screening, Treatment, Transfer and On-Call Roster" policy, last reviewed May 2015, revealed "Expected Outcomes: It is the policy of this hospital to comply with all applicable laws and regulations relating to the provision of emergency services, including the Emergency Medical Treatment and Active Labor Act, 42 U.S.C. ' 1395dd. This Act applies to hospitals with emergency departments participating in the Medicare program, and includes all individuals regardless of their Medicare/Medicaid eligibility or their ability to otherwise pay for services rendered. Observation status is subject to EMTALA requirements. Responsibility/Accountability: The responsibility/accountability for compliance with the EMTALA regulations rests with the physician and registered nurses involved in the patient's care. The disciplinary process will be followed for failure to comply with EMTALA requirements. Standard 1. Screening, Treatment and Transfer A. Screening (1) Any individual who presents in the Emergency Department of this hospital shall be provided with a medical screening examination to determine whether that individual is experiencing an emergency medical condition. ... 3) All patients shall be examined by an Emergency Department physician on duty. ... B. Stabilization (1) Any individual experiencing an emergency medical condition must be stabilized prior to transfer or discharge ..."

Review on August 19, 2015, of the facility's "Psychiatric Emergencies in the Emergency Department" policy, last reviewed March 2015, revealed "I. Purpose: This policy establishes a method for assuring psychiatric evaluation and treatment of the patient with a psychiatric emergency. II. Policy: Our major goal is to prevent self-destruction or destructive behavior and to provide for adequate psychiatric evaluation and treatment for the patient with a psychiatric emergency. It shall be our policy to provide only temporary care of such patients until arrangements can be made to transfer to a mental health facility or be discharged and treated as an outpatient. The patient is to be medically stabilized before transfer. It is the policy of the hospital to comply with all applicable laws and regulations including the Emergency Medical Treatment and Active Labor Act ("EMTALA"). III. Responsibility: The physician must indicate if the patient is medically stable for transfer or if the patient is to be admitted for medical stabilization. Nursing is responsible for assisting with the appropriate arrangement and for providing emotional and medical care as indicated. ... IV. Procedure: Emergency Department ... 5. The patient is to be evaluated and medically stabilized before the patient can be transferred to a mental health facility. Physician order must be obtained (see Mental Health Commitment policy also). Physician to physician communication and acceptance is required and documented. 6. Contact Social Services to assist with crisis counseling and making arrangements for further counseling. ... 9. If the psychiatric emergency has been temporarily resolved and the patient is in need of continued counseling beyond hospitalization, arrangements for further counseling should be made, upon patient consent prior to patient leaving hospital. ..."

Interview with EMP3 on August 19, 2015, at approximately 2:45 PM revealed MR1 was in a private vehicle with family in the hospital parking lot on August 19, 2015, at 2:56 AM. EMP3 revealed the family reported MR1 attempted to jump out of the private vehicle three to four times while en route to the hospital, that MR1 bit the mother on the arm several times, drawing blood, and that MR1 wanted to be seen and committed right away.

Review of MR1 on August 19, 2015, revealed the facility started a medical record for this patient on August 10, 2015, at 2:56 AM. The patient's reason for coming to the ED was for a psychiatric problem. There was no documentation the physician on duty completed a medical screening examination or a psychiatric evaluation to determine if the patient was experiencing an emergency medical condition or a psychiatric emergency.

Interview with EMP3 on August 19, 2015, at approximately 2:50 PM confirmed the facility started a medical record for this patient on August 10, 2015; MR1's reason for coming to the ED was for a psychiatric problem; and there was no documentation the physician on duty completed a medical screening examination or a psychiatric evaluation on MR1 to determine if this patient was experiencing an emergency medical condition or a psychiatric emergency.

Interview with EMP1 and EMP2 on August 19, 2015, at approximately 3:00 PM confirmed there was no documentation the physician on duty completed a medical screening examination or a psychiatric evaluation on MR1 to determine if this patient was experiencing an emergency medical condition or a psychiatric emergency.