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Based on document review, interview and observation, the facility failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24 for 1 of 30 Emergency Department (ED) patients.

Findings:

1. See under tags 2402: 489.20(q), 2405: 489.20(r)(3), 2406: 489.24(a), 2408: 489.24(d)(4).

Based on observation and interview, the facility failed to ensure the conspicuous posting of signage in the emergency department or in a place or places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination and treatment in areas other than traditional emergency departments (that is, entrance, admitting area, waiting room, treatment area) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; and to post conspicuously (in a form specified by the Secretary) information indicating whether or not the hospital participates in the Medicaid program under a State plan approved under Title XIX.

Findings:

1. Review of policy titled EMTALA (MEDICAL SCREENING, TREATMENT, TRANSFER & ON-CALL ROSTER) on 07/22/10 at 03:45 PM indicated under "POLICY: It is the policy of the hospital..........hospital has posted signs in conspicuous locations, which specify the rights of patients under EMTALA as required by law."

2. Tour of the ED on 07/22/10 at 03:20 PM with #S1 indicated a lack of EMTALA signs in the ambulance entrance, waiting area and walk-in area.

3. Interview with #S1 during tour indicated the EMTALA sign was in the registration room off the walk-in area.

Based on document review and interview, the facility failed to assure a central log on each individual who comes to the ED, as defined in ?489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged.

Findings:

1. Review of the Emergency Department Patient Log on 07/22/10 for 05/10-12/10 indicated lack of documentation of #P1's visit.

2. Review of policy titled EMTALA GUIDELINES for EMERGENCY DEPARTMENT SERVICES on 07/22/10 at 03:45 PM indicated ON PAGE 2 UNDER under "MEDICAL SCREENING EXAMS:
? Medical Screening Exams should include at least a minimum the following:
Emergency Department log entry including disposition of patient"

3. Review of Patient & Family Complaint Report Form confirmed #P1's visit to #F1's ED on 05/11/10.

4. Interview with #S1 on 07/22/10 at 01:55 PM confirmed patient had presented to the ED and had not been logged in.

Based on interview and document review, the facility failed to assure an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the ED, to determine whether or not an emergency medical condition existed for 1 patient presenting to the ED.

Findings include:

1. On 07/22/10 at 01:55 PM, #S1 indicated that #P1 had presented to the facility ED on 05/11/10 seeking treatment for complaint of (R) foot/ankle injury which had occurred on the job. #S3 saw patient come into walk-in area and advised that #F1 did not do workman's compensation and #P1 needed to go to #F2. Patient left #F1. There was no medical record or other written evidence that #P1 was logged in, triaged, and had a medical screening exam performed by a physician. After patient left, #S3 questioned his/her own actions regarding following procedure and contacted #S2, who advised that #P1 should have been logged in, triaged, and had a medical screening exam performed by a physician. #P1 also called #F1 on 05/11/10 to complain of refusal of treatment. The complaint process was put into place at that point.

2. Review of policy titled EMTALA (MEDICAL SCREENING, TREATMENT, TRANSFER & ON-CALL ROSTER) on 07/22/10 at 03:45 PM indicated on page 1 under "Medical Screening Examinations (MSE):, A. Emergency patients: Any person who presents to the hospital Emergency Department will be provided a MSE by a physician, The purpose of the MSE is to determine whether such person has an Emergency Medical Condition (EMC)." Policy titled EMTALA GUIDELINES for EMERGENCY DEPARTMENT SERVICES indicated on page 1 under "POLICY:
? All patients shall receive a medical screening exam that includes providing all necessary testing and on-call services within the capability of the hospital to reach a diagnosis."
Policy titled EMERGENCY SCREENING PROCEDURES indicated on page 1 under "POLICY: It is the policy of the hospital that a physician shall provide all patients presenting to the Emergency Department (Ed) an appropriate medical screening examination in order to determine the existence of an emergency medical condition."

3. Review of #S3's Disciplinary Action Form dated 05/11/10 and signed by #S2 indicated #S3 recognized that procedure had not been followed and notified #S2 on 05/11/10 and face to face verbal counseling was conducted on 05/11/10 by #S2. Action plan was to inform staff that #F1 "sees all patients. Pts are triaged then medically screened by ED physician."

4. Review of Patient & Family Complaint Report Form confirmed #P1's visit to #F1's ED on 05/11/10, that #S3 had refused to see #P1, that #P1called facility the same night to complain about refusal of treatment and the facility started the complaint process.

5. There was no documentation of if or when an education session for staff regarding EMTALA procedures took place.

Based on interview and document review, the facility failed to ensure no delay in providing an appropriate medical screening examination following knowledge of #P1's payer source.

Findings:

1. In interview with #S1 on 07/22/10 at 01:55 PM, it was confirmed that #P1 did arrive at #F1and was told that #F1 did not handle workman compensation cases, and the patient needed to go to #F2 and he/she left #F1. #P1 was not logged in, not triaged, and not medically screened by a physician or treated at #F1.

2. There was no documentation that #P1 was logged in, triaged, medically screened or treated prior to leaving #F1.

3. Review of policy titled EMTALA (MEDICAL SCREENING, TREATMENT, TRANSFER & ON-CALL ROSTER) on 07/22/10 at 03:45 PM indicated on page 2, B. "Medical Screening Examinations (MSE): A MSE shall not be delayed in order to inquire about the patient's method of payment...."

4. Review of #P1's medical record at #F2 indicated #P1 did arrive at #F2 via private vehicle at 10:49 PM, was treated and released to home at 01:33 PM on 05/12/10.