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Based on video review, interview, emergency room logs, record review, policy and procedure review, the facility failed to ensure all individuals presenting to the hospital's off-site free-standing emergency department for care received an appropriate medical screening examination within the off-site free-standing emergency department's capabilities (including but not limited to mental health services routinely available to an emergency department) to determine whether an emergency medical condition existed for one (1) of 20 sampled patients, Patients #1, who presented to the hospital's off-site free-standing emergency department with dehydration and nausea related conditions. On September 22, 2025, Patient #1, presented to the hospital's off-site free-standing emergency department with a chief complaint of dehydration and nausea. The hospital's off-site free-standing emergency department had the capability and capacity to conduct medical screening examinations to determine if an emergency medical health condition existed, however, the patient was not provided an examination and/or treatment.

Findings:

Cross Refer to A2406: Medical Screening Examination.

Based on video review, interview, emergency room logs, record review, policy and procedure review, police report and Medical Staff Rules and Regulations, the facility failed to ensure all individuals presenting to the hospital's off-site free-standing emergency department for care received an appropriate medical screening examination within the off-site free-standing emergency department's capabilities to determine whether an emergency medical condition existed for one (1) of 20 sampled patients, Patients #1, who presented to the hospital's off-site free-standing emergency department with dehydration and nausea related conditions. The hospital's off-site free-standing emergency department had the capacity and capability to conduct medical screening examinations to determine if an emergency medical condition existed when Patient #1 presented to the emergency department. Patient #1 was removed from the emergency department without treatment or being seen.

Findings include:

Review of the Emergency Department Log OH (Orlando Health) Emergency Room and Medical Pavillion Blue Cedar dated 09/22/2025 at 2:28 PM documented, "[Patient #1's name] CC [chief complaint] dehydration; ED [Emergency Department] Disposition: LWBS [left without being seen] after Triage.

During an interview on 10/7/2025 at 10:31 AM with the Operations Manager and the Corporate Risk Manager a request was made to view the video and provide a copy of the ED activity on 09/22/2025 beginning at 2:00 PM. The RM stated they would not be able to provide a copy, and a review of the video began at 15:22 (3:22 PM). A request was made to back the video footage back to 2:00 PM. Attempts were made to back up the video without success. (This did not allow for the observation video footage of Patient #1 entering the ED).

Review of the video footage, no audio, dated 09/22/2025 beginning at 15:22:42 (3:22 and 42 seconds PM) The video footage of Patient #1 shows Patient #1 sitting in a chair with an older female sitting in a chair to the left of Patient #1 observing facing the receptionist desk. Patient #1's chair was directly across from the receptionist desk, approximately 25 feet away. The receptionist desk cannot be viewed, except for the left side while facing the desk, due to the area having a decorative slanted covering that is suspended from the ceiling that obstructs the view of the receptionist desk. At 15:22:42 Patient #1 is seen standing up and rushing toward the receptionist work area followed by the female. Due to the decorative slanted covering the view of what occurred in that area cannot be observed on the footage. At 15:22:52 a security guard was observed rushing toward the receptionist desk. The older female was observed walking Patient #1 back to where they were sitting in the chairs. At 15:33:53 Patient #1 was seen standing and moving her arms in rapid motion as if in animated conversation "talking with her hands" but was not seen approaching other patients in the waiting room. Patient #1 sat down. The charge nurse is seen in the area between the receptionist and Patient #1 and has a telephone to her ear and her lips were moving. At 15:39:00 [name of City] Police officer arrives. At 15:46:34 a second Police Officer arrived on scene and apply handcuffs to Patient #1's wrists. This resulted in an approximate time lapse of 16 minutes from time Patient #1 was observed going toward the receptionist desk and the arrival of law enforcement on the scene.

Review of the ED in Orlando Health Emergency Room and Medical Pavilion Blue Cedar Encounter Information form dated 09/22/2025 for Patient #1 read, "Admission Information: Date of Admission: 09/22/2025 at 1428 (2:28 PM). Admission Type: Emergency. Means of Arrival: Personal Own Vehicle. Discharge Information: Discharge Date/Time: 09/22/2025 1600 [4:00 PM]. Discharge Disposition: Left Against Medical Advice Or Discontinued Care. Discharge Destination: None. Discharge Provider: None. Admission diagnoses/Reasons for Visit: Description: Procedure and treatment not carried out due to patient leaving prior to being seen by health care provider. Final Diagnoses: Description: Procedure and treatment not carried out due to patient leaving prior to being seen by health care provider... Date/Time: Tue [Tuesday] Sep [September] 23, 2025 10:54 AM. Comment: Pt. [Patient] was removed from facility/trespassed by [Name of local law enforcement] after physically attacking a team member in registration and attempting to physically assault several patients in the lobby. Discharge Information: Date/Time: 09/22/2025 1600 [4:00 PM] Disposition: Left Against Medical Advice Or Discontinued Care. Reason for Visit: Chief complaint: Dehydration. Medication List: Prior to Admission: None. Discharge Medication List: None. ED Care Timeline: 09/22/2025. 14:28 [2:28 PM] - Patient arrived in ED. 14:28 - Arrival Complaint: Nausea... 1454 - Triage Started. Chief Complaints Updated: Dehydration (Pt. family stated she has not been eating for 2 weeks and not drinking very nausea {sic} thinks she is dehydrated). 14:58 - Patient Location - Is the patient currently in the ED?: Yes. Section 1 - Is the patient cognitively impaired? Does the patient have a new diagnosis or history of dementia, Alzheimer's, or is there concern the patient lacks capacity to make their own medical decisions?: No. 1550 [3:50 PM] Departure Condition: Stable. Mobility at Departure: Restrained. Departure Mode: In police custody."

Review of the Arrest Affidavit/First Appearance From for Patient #1 dated 09/22/2025 at 1941 (7:41 PM) read, "On September 22, 2025, at approximately 1526 [3:26 PM] hours, officers responded to South Lake Hospital [address for the hospital], in reference to a battery that had just occurred in the lobby area between a female subject and the receptionist. Upon arrival, contact was made with the victim, who identified herself as the hospital receptionist. The victim advised that as she was walking back to her desk, a female later identified as [Patient #1's name] (hereinafter referred to as the defendant) followed her behind the desk. The victim stated the defendant then grabbed her by the hair and pulled her to the ground. While on the floor, the defendant struck the victim multiple times on the left side of her face, causing visible bruising and bleeding to the victim's upper left lip. The victim reported that the striking to the face lasted only a few seconds before the defendant's family members pulled her away. The victim confirmed she recognized the defendant from the check-in process and identified her as [Patient #1's name]. The defendant was present and identified at the scene by her family members. After being advised of her Miranda Rights, the defendant declined to provide a statement."

During an interview on 10/6/2025 at 11:30 AM the Main Emergency Department Clinical Assistant Nurse (MEDCAN) stated, "All patients need to receive a medical screening examination [MSE] prior to discharge. From reviewing the timeline, the patient [Patient #1] was never placed in a room, and the patient was discharged from the registration area/triage area via law enforcement who arrested her for attacking the receptionist." A request was made to review the documentation of the physician being notified Patient #1 was leaving without an MSE. The MEDCAN stated, "There is no documentation that the physician was notified that the patient was leaving without a MSE."

During an interview on 10/6/2025 at 12:25 PM, the Chief of Emergency Medicine stated, "All patients need to have a MSE completed and the provider should be notified if the patient wants to leave AMA [against medical advice]. Staff should have them sign the AMA form and if they refuse, document the patient's refusal."

During an interview on 10/6/25 at 12:45 PM the Orlando Health South Lake Hospital Emergency Room Physician stated, "If someone was in the lobby waiting to be seem and the police came in to arrest them, they would have to see them before they were escorted out by the police. I'm not going to get shot over it but they do need to have an examination."

During an interview on 10/7/2025 at 1:16 PM via telephone the Vice Chair of the Emergency Room stated, "I cannot recall who informed me of the Blue Cedar patient [Patient #1] not receiving an MSE, I heard by word of mouth. Everyone without failure is to receive an MSE. If a patient wants to leave after triage and before an MSE, the provider needs to be notified."

During an interview on 10/7/2025 at 2:40 PM, the Emergency Department Physician at Blue Cedar ED on duty at the time of the 9/22/2025 incident stated, "I had heard yelling out in the front lobby. I went out there and saw the charge nurse and security and saw the situation was under control. I returned to care for patients. I was not informed by anyone that the patient [Patient #1] left without an MSE. All patients must have an MSE."

During an interview on 10/7/2025 at 4:04 PM the Registered Nurse at Orlando Health South Lake Hospital Blue Cedar Emergency Room stated, "Everyone who comes in should have a medical screening. We usually have a very good relationship with law enforcement, and they will let us do the medical screening. If we know someone is leaving, we will alert the physicians so that we can do the examination

Review of the policy and procedure titled, "Compliance and Ethics Program" Policy #5706-0301 read, "Purpose: This policy outlines Orlando Health's Compliance and Ethics Program (CEP) and its commitment to conducting business in full compliance with laws and regulations, rules, the Orlando Health Code of Conduct (Code of Conduct) and policies and procedures. 4.2 EMERGENCY TREATMENT AND PATIENT TRANSFERS: We comply with the Emergency Medical Treatment and Active Labor Act (EMTALA) in providing emergency medical treatment to patients regardless of ability to pay. Anyone with an emergency medical condition or requesting emergency services is given an appropriate medical screening examination and treatment based on medical necessity. Prompt and effective delivery of emergency care will not be delayed for any reason. Each patient who presents to any Orlando Health Emergency Department must receive an appropriate medical screening examination. References: Florida Statute §395.1041, Access to Emergency Services and Care.

Review of the Medical Staff Rules and Regulations read, Article 9 Emergency Services: 9.A General: Emergency services care will be provided to any person in danger of loss of life or serious injury or illness whenever there are appropriate facilities and qualified personnel available to provide such services or care. Such emergency services and care will be provided without regard to the patient's race, ethnicity, religion, national origin, citizenship, age, sex, pre-existing medical conditions, physical or mental handicap, insurance status, economic status, sexual orientation, or ability to pay for medical services except to the extent such circumstance is medically significant to the provision of appropriate care to the patient. 9.B Medical Screening Examinations: (1) Medical Screening Examinations, within the capacity of the hospital will be performed on all individuals who come to the hospital requesting examination or treatment to determine the presence of an emergency medical condition. Qualified medical personnel who can perform medical screening examinations within applicable hospital policies and procedures are defined as: (a) Emergency Department: (i) Members of the medical staff with clinical privileges and emergency medicine (ii) other Active Staff Members (iii) appropriately credentialed Advanced Practice Providers. (2) The results of medical screening examination must be documented upon completion of the examination in the Emergency Department."