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GATEWAY REGIONAL MEDICAL CENTER 2100 MADISON AVENUE GRANITE CITY, IL 62040 Aug. 14, 2015
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
Based on document review and staff interview it was determined in 1 of 20 (Pt #1) ED patient being medically screened for a medical emergency that the Hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24.

Findings include:

1. The Hospital failed to provide the patient with an appropriate medical screening. (C2406).
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on document review and interview it was determined the Hospital failed to provide a Medical Screening Examination to 1 of 20 patients (Pt. #1) presenting to the emergency department for medical care.

Findings include:


1. On 8/14/15 at 1:00 PM reviewed Pt #1 ' s clinical record from Receiving Hospital (H #2). Pt #1 ' s clinical file notes, Pt #1 was admitted to H #2 ' s emergency department accompanied by an aunt on 7/10/15 at 4:00 PM. Pt #1 ' s clinical record notes, "Pt #1 has supracondylar fracture (fracture of the elbow commonly seen in children due to a fall) after falling from adult bed. Injury fits history. No other apparent injury. Patient had closed reduction repair (non surgical intervention) and casting by orthpedics in emergency department... Closed reduction of left supracondylar fracture by orthopedics ... under deep sedation ... Cast applied. Discharge home on 7/10/15 at 10:19 PM, with pain medications and orthopedic follow up. "

2. On 8/13/15 at approximately 2:00 PM reviewed Transferring Hospital (H #1's) policy titled " Emergency Medical Treatment And Active Labor Act (EMTALA) (Revised 8/12/15) ". Policy requires, "F. A hospital is required to provide a MSE (Medical Screening Examination) to anyone who requests exams or treatment, or who " comes " to the DED (Dedicated Emergency Department) or if a request is made on behalf or implied by their behavior. Persons under [AGE] years old presenting to the Emergency Department will be offered a Medical Screening Examination regardless of whether they are accompanied by a parent or legal guardian. "

3. On 8/13/15 at approximately 2:30 PM reviewed H#1's document titled " Emergency Department (ED) Log " dated 3/1/2015 to 8/12/2015. Pt #1 was not noted in the ED log.

4. During an interview with H #1 ' s Chief Quality Officer (E #2) and Director of Emergency Department (E #5) conducted on 8/13/15 at 10:00 AM-10:30 AM, E #5 stated, " We became aware that Pt. #1 was turned away from our emergency department when H #2 ' s administration called me on 7/30/15. H #2 ' s administration informed us that Pt #1 accompanied by an aunt came to our ED on 7/10/15 and was told Pt #1 could not be treated unless a parent or guardian signed consents. I spoke to Pt. #1 ' s mother on 7/30/15 by phone, and mother stated that the aunt brought Pt #1 to our ED and was told by patient access that Pt #1 could not be treated without a parent's consent. Aunt took Pt #1 to H #2. I notified E #2 and an investigation was initiated. I pulled the emergency department surveillance video (has no audio) for 7/10/15 and noted that Pt #1 and an adult came to the registration desk, spoke with Patient Access Employee (E #7), E #7 turned to speak to Patient Access Employee (E # 6), then turned back to speak to Pt. #1 ' s adult escort. Pt. #1 ' s escort spoke on her phone for a few seconds then left the emergency department. There is no record of Pt. #1 on our ED log or registered in our system for that day. The video has since been erased by our system. We spoke to E #6 and E #7 and they do not remember the incident. I could reasonably assume that Pt. #1 did not receive a medical screening and should have received a medical screening. "