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Based on review of the emergency department (ED) log, and staff interviews, the facility failed to screen 1 one of 25 sampled individuals (Patient #13) who presented to the facility's emergency department to determine if an emergency medical condition existed.

Findings include:

During this visit from 03/24/10 through 03/26/10, medical record reviews were conducted of twenty five patients who presented to the emergency room for evaluation and treatment. Patient #13's ED medical record revealed the patient presented to the ED on 02/01/10 at 2:20 PM per squad. The record stated the patient had been at an urgent care for evaluation of vaginal bleeding, passing blood clots, and fainting the prior weekend. The patient was triaged at 2:20 PM and seen by the ED physician at 3:00 PM. The medical record stated the following physician's orders were followed: bolus of intravenous solution (IV), IV pain medication, and an IV medication for nausea and vomiting. A 12 lead EKG was also done during the visit. The patient was discharged at 5:40 PM to the lobby where the record documented the patient tried to get a ride home until at least 7:30 PM., according to interviews with Staff C on 03/26/10 at 10:45 AM, Staff D on 03/24/10 at 4:00 PM, Staff B on 03/24/10 at 4:25 PM, Staff E on 03/25/10 at 3:18 PM, and Staff H on 03/26/10 at 2:00 PM.


The patient's medical record on 02/01/10 between 2:20 PM and 5:40 PM was silent to the exact location of the abdominal pain, the effectiveness of the intravenous pain and nausea/vomiting medications, and to a physician's order for a headache pain medication given by mouth to the patient. The ED record was also silent to any subsequent vital signs after the patient was triaged. An interview with Staff A on 03/25/10 at 4:15 PM verified the lack of documentation in this patient's ED record for this visit. Staff A stated staff should have reassessed the patient's vital signs before discharging the patient at 5:40 PM.


An interview was conducted with Staff A on 03/25/10 at 1:30 PM regarding Patient #13's ED record and investigation into the patient's phone call complaints received on 02/02/10 by Staff B. The investigation summary dated 02/03/10 by Staff A revealed the patient left the ED, walked to drug store located 0.3 miles away, and called the local life squad for complaints of severe abdominal pain. The squad notified the hospital of the patient's intended arrival and complaints, and arrived at the hospital ED at 8:21 PM. The patient was brought into the ED hallway on a stretcher, and was seen by the ED physician (Staff F) in the hallway upon arrival. The patient and physician were observed conversing about the patient's desired care, and then the patient was observed getting off the stretcher, and walked out of the emergency room. This was verified with Staff C and H on 03/26/10 at the times mentioned above.

The life squad run sheet dated 02/01/10 stated the following: Upon entering (hospital) ER, Dr. advised the patient the patient will not be seen again and that they already did all the workup on the patient and for the patient to get off the cot and leave. The physician and patient had words and the patient got off the cot and headed out the door. The squad run sheet also stated the patient was rejected by the hospital and not evaluated.

An interview conducted with Staff F on 03/25/10 at 3:35 PM revealed the physician met the patient, who arrived by squad, at the nurses' station. Staff F stated they did read the patient's record before the patient arrived and determined the patient did not need further evaluation as they had just been evaluated a couple hours prior to this arrival. On 03/26/10 at 10:45 AM, Staff C stated the physician and the patient had words about the patient's evaluation, and the physician told the patient to leave, prompting the patient to get off the stretcher and leave the facility. Staff C and F verified the patient was not triaged or received a medical screening during this visit. Staff F stated the decision not to triage and assess the patient was made after the physician observed the patient in the hallway and conversed with the patient. An interview with Staff H on 03/26/10 at 2:00 PM revealed the ED physician informed the patient they had been evaluated and there was not anything the physician could do for the patient. Patient was then observed getting off the cot and walked out.

This was verified with Staff A on 03/25/10 at 4:15 PM and with Staff B on 03/25/10 at 4:25 PM and with Staff G on 03/26/10 at 2:45 PM.

This substantiates the EMTALA complaint.

Based on review of the emergency department (ED) log and staff interviews the facility failed to ensure all individuals presenting to the ED for evaluation were included in the emergency department central log as defined in 489.24 (b). This affected 1 one of 25 sampled patients (Patient #13).

Findings include:

During this visit from 03/24/10 through 03/26/10, Patient #13's ED medical record revealed the patient presented to the ED on 02/01/10 at 2:20 PM per squad. This visit was also noted on the ED log. The record stated the patient had been at an urgent care for evaluation of vaginal bleeding, passing blood clots, and fainting the prior weekend. The patient was triaged at 2:20 PM and seen by the ED physician at 3:00 PM. The medical record stated the following physician's orders were followed: bolus of intravenous solution (IV), IV pain medication, and an IV medication for nausea and vomiting. A 12 lead EKG was also done during the visit. The patient was discharged at 5:40 PM to the lobby where the record documented the patient tried to get a ride home until at least 7:30 PM., according to interviews with Staff C on 03/26/10 at 10:45 AM, Staff D on 03/24/10 at 4:00 PM, Staff B on 03/24/10 at 4:25 PM, E on 03/25/10 at 3:18 PM , and Staff H on 03/26/10 at 2:00 PM.

An interview was conducted with Staff A on 03/25/10 at 1:30 PM regarding Patient #13's ED record, and investigation into the patient's phone call complaints received on 02/02/10 by Staff B. The investigation summary dated 02/03/10 by Staff A revealed the patient left the ED, walked to drug store located 0.3 miles away, and called the local life squad for complaints of severe abdominal pain. The squad notified the hospital of the patient's intended arrival and complaints, and arrived at the hospital ED at 8:21 PM. The patient was brought into the ED hallway on a stretcher, and was seen by the ED physician (Staff F) in the hallway upon arrival. The patient and physician were observed conversing about the patient's desired care, and then the patient was observed getting off the stretcher, and walked out of the emergency room. This was verified with Staff C and H on 03/26/10 at the times mentioned above.

There was no documented evidence in the emergency room log of this patient's arrival by squad the second time on the day of 02/01/10, nor was there any documentation in the patient's medical record of the arrival and departure without being evaluated. This was verified by Staff G on 03/26/10 at 2:45 PM.

Based on review of the emergency department (ED) log and staff interviews the facility failed to screen 1 one of 25 sampled individuals (Patient #13) who presented to the facility's emergency department to determine if an emergency medical condition existed.

Findings include:

During this visit from 03/24/10 through 03/26/10, medical record reviews were conducted of twenty five patients who presented to the emergency room for evaluation and treatment. Patient #13's ED medical record revealed the patient presented to the ED on 02/01/10 at 2:20 PM per squad. The record stated the patient had been at an urgent care for evaluation of vaginal bleeding, passing blood clots, and fainting the prior weekend. The patient was triaged at 2:20 PM and seen by the ED physician at 3:00 PM. The medical record stated the following physician's orders were followed: bolus of intravenous solution (IV), IV pain medication, and an IV medication for nausea and vomiting. A 12 lead EKG was also done during the visit. The patient was discharged at 5:40 PM to the lobby where the record documented the patient tried to get a ride home until at least 7:30 PM., according to interviews with Staff C on 03/26/10 at 10:45 AM, Staff D on 03/24/10 at 4:00 PM, Staff B on 03/24/10 at 4:25 PM, Staff E on 03/25/10 at 3:18 PM, and Staff H on 03/26/10 at 2:00 PM.


The patient's medical record on 02/01/10 between 2:20 PM and 5:40 PM was silent to the exact location of the abdominal pain, the effectiveness of the intravenous pain and nausea/vomiting medications, and to a physician's order for a headache pain medication given by mouth to the patient. The ED record was also silent to any subsequent vital signs after the patient was triaged. An interview with Staff A on 03/25/10 at 4:15 PM verified the lack of documentation in this patient's ED record for this visit. Staff A stated staff should have reassessed the patient's vital signs before discharging the patient at 5:40 PM.


An interview was conducted with Staff A on 03/25/10 at 1:30 PM regarding Patient #13's ED record and investigation into the patient's phone call complaints received on 02/02/10 by Staff B. The investigation summary dated 02/03/10 by Staff A revealed the patient left the ED, walked to drug store located 0.3 miles away, and called the local life squad for complaints of severe abdominal pain. The squad notified the hospital of the patient's intended arrival and complaints, and arrived at the hospital ED at 8:21 PM. The patient was brought into the ED hallway on a stretcher, and was seen by the ED physician (Staff F) in the hallway upon arrival. The patient and physician were observed conversing about the patient's desired care, and then the patient was observed getting off the stretcher, and walked out of the emergency room. This was verified with Staff C and H on 03/26/10 at the times mentioned above.

The life squad run sheet dated 02/01/10 stated the following: Upon entering (hospital) ER, Dr. advised the patient the patient will not be seen again and that they already did all the workup on the patient and for the patient to get off the cot and leave. The physician and patient had words and the patient got off the cot and headed out the door. The squad run sheet also stated the patient was rejected by the hospital and not evaluated.

An interview conducted with Staff F on 03/25/10 at 3:35 PM revealed the physician met the patient, who arrived by squad, at the nurses' station. Staff F stated they did read the patient's record before the patient arrived and determined the patient did not need further evaluation as they had just been evaluated a couple hours prior to this arrival. On 03/26/10 at 10:45 AM, Staff C stated the physician and the patient had words about the patient's evaluation, and the physician told the patient to leave, prompting the patient to get off the stretcher and leave the facility. Staff C and F verified the patient was not triaged or received a medical screening during this visit. Staff F stated the decision not to triage and assess the patient was made after the physician observed the patient in the hallway and conversed with the patient. An interview with Staff H on 03/26/10 at 2:00 PM revealed the ED physician informed the patient they had been evaluated and there was not anything the physician could do for the patient. Patient was then observed getting off the cot and walked out.

This was verified with Staff A on 03/25/10 at 4:15 PM and with Staff B on 03/25/10 at 4:25 PM and with Staff G on 03/26/10 at 2:45 PM.

This substantiates the EMTALA complaint.