HospitalInspections.org

Based on review of video footage, EMS (Emergency Medical Services) report, medical record, electronic central log, facility policy, and interviews, it was determined the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition exists for 1 (Patient #1) of 20 patients reviewed

Findings included:

Cross Refer to A-2406.

Based on review of video footage, EMS (Emergency Medical Services) report, electronic central log, medical record, facility policy, and interviews, it was determined the facility failed to maintain a central log on each individual who comes to the emergency department, seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated for 1 (Patient #1) of 20 patients reviewed.

Findings Included:

Review of video footage revealed:
00:38 EMS is seen taking Patient #1 inside facility.
2:32 EMS is seen taking Patient #1 out the facility.
2:55 Patient #1 seen moving arms and speaking to EMS.
3:40 security outside with EMS and Patient #1.
5:37 CNC (Clinical Charge Nurse) comes outside speaking with EMS and security while Patient #1 appears to be agitated.
7:20 CNC goes back inside facility.
8:00 Patient #1 seemed extremely agitated while talking to EMS.
9:13 Female EMS (EMS supervisor) on scene speaking to Patient #1 and EMS; Patient #1 appears to be yelling and agitated.
10:41 Patient #1 agitated and trying to get off stretcher while it appears to be yelling at EMS and security.
12:25 Patient #1 throwing himself around on the stretcher.
13:26 EMS Supervisor enters facility while Patient #1 still appears to be yelling and agitated on stretcher.
14:53 EMS Supervisor walks back out of the facility.
18:41 EMS raises Patient #1 stretcher and rolls Patient #1 away from facility.

Review of the EMS (Emergency Medical Services) report dated 03/05/2025 at 9:00 PM revealed arrived-on scene to find Patient #1 pacing outside the police department. Patient #1 states he is suicidal, homicidal and is scared for his life; he believes people are trying to kill him. Patient #1 was extremely paranoid and uncooperative. Patient #1 then agrees to go to hospital. Arrived at the hospital, the hospital immediately informed EMS the patient could not be there as he has been trespassed from that hospital. According to the staff, they are not even going to register the patient unless it is a true medical emergency. Patient #1 then transported to [another hospital].

Review of the electronic central log for 03/05/2025 revealed no entry for Patient #1.

No facility medical record was available to review for Patient #1.

Review of facility policy "EMTALA- Central Log Policy" last revised 08/2024 states "The hospital will maintain a central log containing information on each individual who requests emergency services or care or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment, whether he or she left before a medical screening examination could be performed, whether he or she refused treatment, whether he or she was refused treatment, or whether he where she was transferred, admitted and treated, stabilized and transferred or discharged."

During an interview on 03/25/2025 10:15 AM, the ED (Emergency Department) Medical Director stated when I found out the ED MD (Medical Doctor) assessed the patient and he was never registered, I knew it was an EMTALA.

During an interview on 03/25/2025 at 11:45 AM, the ED MD stated I went outside to do quick assessment and make sure the patient did not have a medical emergency, then came back inside. I went to see other patients. The ED charge RN (registered Nurse) told me the house supervisor called and said no do not register the patient. So, he was not registered.

During an interview on 04/01/2025 at 6:00 PM, the CNC (Clinical Charge Nurse) stated I was made aware the patient coming in had been trespassed from our facility. So, I called the house supervisor for advice on what to do. She told me to only register the patient if he has a medical emergency. When the patient got here, the MD went outside to do a quick assessment on the patient and the MD said he is fine. So, I went outside to tell EMS he is cleared by the ER MD. EMS said they will have to call their chief (supervisor). The chief comes in and tells EMS to take the patient to another hospital since we will not register him here because he is trespassed. I did not get a full report from EMS so I do not know if his vitals were stable or abnormal. I just went by MD's quick assessment. Then they left.

Based on review of video footage, EMS (Emergency Medical Services) report, electronic central log, medical record, facility policy, and interviews, it was determined the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition exists for 1 (Patient #1) of 20 patients reviewed.

Findings Included:

Review of video footage revealed:
00:38 EMS is seen taking Patient #1 inside facility.
2:32 EMS is seen taking Patient #1 out the facility.
2:55 Patient #1 seen moving arms and speaking to EMS.
3:40 security outside with EMS and Patient #1.
5:37 CNC (Clinical Charge Nurse) comes outside speaking with EMS and security while Patient #1 appears to be agitated.
7:20 CNC goes back inside facility.
8:00 Patient #1 seen extremely agitated while talking to EMS.
9:13 Female EMS (EMS supervisor) on scene speaking to Patient #1 and EMS; Patient #1 appears to be yelling and agitated.
10:41 Patient #1 agitated and trying to get off stretcher while it appears to be yelling at EMS and security.
12:25 Patient #1 throwing himself around on the stretcher.
13:26 EMS Supervisor enters facility while Patient #1 still appears to be yelling and agitated on stretcher.
14:53 EMS Supervisor walks back out the facility.
18:41 EMS raises Patient #1 stretcher and rolls Patient #1 away from facility.

Review of the EMS (Emergency Medical Services) report dated 03/05/2025 at 9:00 PM revealed arrived-on scene to find Patient #1 pacing outside the [police department]. Patient #1 states he is suicidal, homicidal and is scared for his life; he believes people are trying to kill him. Patient #1 was extremely paranoid and uncooperative. Patient #1 then agrees to go to hospital. Arrived at the hospital, the hospital immediately informed the patient could not be there as he has been trespassed from that hospital. According to the staff, they are not even going to register the patient unless it is a true medical emergency. Patient #1 then transported to [another hospital].

Review of the electronic central log for 03/05/2025 revealed no entry for Patient #1.

No facility medical record was available to review for Patient #1.

Review of medical record from [Hospital where EMS took patient after refusal to evaluate] revealed Patient #1 is a 55yr old male with a history of methamphetamine and alcohol abuse, presents to the ER by EMS with complaints of suicidal and homicidal ideations. On arrival he is intoxicated and requires [medication name] and [medication name] with improvement; patient is less agitated. His vital signs are stable, he has no additional complaints, and he is stable for transfer to psychiatric facility under a Baker Act (a state law in Florida that allows for the involuntary hospitalization of individuals who are experiencing a mental health crisis and pose a serious threat to themselves or others).

Review of facility policy EMTALA (Emergency Medical Treatment and Labor Act) - Medical Screening Examination and Stabilization last reviewed 08/2024. The policy revealed "An EMTALA obligation is triggered when: an individual or a representative acting on the individual's behalf, including EMS or a transferring hospital, request emergency services and care .....When a MSE (Medical Screening Examination ) is required" A hospital must provide an appropriate MSE within the capability of the hospital's emergency department, including ancillary services routinely available to the DED (Dedicated Emergency Department), to determine whether or not an EMC (Emergency Medical Condition) exists: (i) to any individual, ...who requests an examination; (ii) an individual who has such a request made on his or her behalf; or (iii) an individual whom a prudent layperson observer would conclude from the individuals appearance or behavior needs an MSE."

During an interview on 03/25/2025 at 10:15 AM, the ED (Emergency Department) Medical Director stated I found out the ED MD assessed the patient and did not document because he was never registered, I knew it was an EMTALA.

During an interview on 03/25/2025 at 11:45 AM, the ED MD (Medical Doctor) stated I went outside to do quick assessment and make sure the patient did not have a medical emergency, then came back inside. I went to see other patients. Then, the charge nurse said the house supervisor called and said no do not register the patient. So, he was not registered. I did see the patient to make sure there was no medical condition, but I did not document anything because he was not registered.

During an interview on 04/01/2025 at 6:00 PM, the CNC (Clinical Charge Nurse) stated I was made aware the patient coming in had been trespassed from our facility. So, I called the house supervisor for advice on what to do. She told me to only register the patient if he has a medical emergency. When the patient got here, the MD went outside to do a quick assessment on the patient and the MD said he is fine. So, I went outside to tell EMS he is cleared by the ER MD. EMS said they will have to call their chief (supervisor). The chief comes in and tells EMS to take the patient to another hospital since we will not register him here because he is trespassed. I did not get a full report from EMS so I do not know if his vitals were stable or abnormal. I just went by MD's quick assessment. Then they left.

The facility failed to ensure that their policy and procedure was followed as evidenced by failing to ensure that when a request was made on Patient #1's behalf by EMS for an evaluation because it was determined due to the patient's behavior he needed a medical screening exam. The facility failed to provide an appropriate MSE for Patient #1 on 03/05/2025 that was within the capability if the hospital's emergency department, including ancillary services routinely available to the emergency to determine whether or not an emergency medical condition existed, as stated in the facility's policy.