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Based on record review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to provide 1 (#2) of 20 patients, who presented to the hospital's emergency department, with a medical screening exam and the failure to arrange an appropriate transfer for 1(#2) of 20 patients. See A 2406 and A 2409.

Based on document review, interview and policy review, the facility failed to provide 1 (#2) of 20 patients, who presented to the emergency department (ED), with a medical screening examination (MSE). Findings include:

During review of the ED registration log for the hospital on 02/13/2013, revealed that patient #2 was brought by the Emergency Medical Services (EMS) to the emergency department on 10/21/2012, after sustaining an injury at the nursing home where she resided. The patient received a "quick reg" (quick registration) at the hospital. Once in the ED, the EMS staff were informed by the nurse, that the patient would need to be diverted to another hospital. The patient was not given a MSE and the EMS staff left with the patient to go to another hospital.

There was no medical record available for patient #2, only documentation that the patient was brought into the hospital by the EMS and registered.

On 02/13/2013 at 10:00 AM during an interview with the Director of Patient Safety & Quality and the ED Clinical Manager, they confirmed that on 10/21/2012, patient #2 was brought to the emergency department from a local nursing home by EMS staff. The Director of Patient Safety & Quality stated that "the patient was brought into the emergency room on a stretcher and went through the 'quick reg ' (quick registration) process."

On 02/13/13 at 6:00 PM during a phone interview with Staff D, she stated that "a radio call from EMS came in regarding a patient with a chronic condition of a dislocated hip and that the patient's vital signs were stable." Staff E then stated that she advised them (EMS) that "orthopedics was not available and to use their best judgment." According to Staff E, this was the "end of the radio report" with the EMS staff. Staff E stated that she 'then went and spoke with the physician in regards to the patient with a dislocated hip and that the physician stated that she was not comfortable doing them". Staff E then stated "the next thing I know EMS came in the door (of the ED) with the patient (#2) and called their dispatch and discussed taking the patient to Mercy for Ortho care and (then) they left the building." When queried if she called Mercy to inform them that the patient would be coming their way she stated "I did not call them, EMS may have."

A review of Gerber Memorial Health Services RM16ADM reads 1."All individuals coming to the Hospital for examination or treatment will be appropriately evaluated within the capability of the Emergency Department utilizing any ancillary services routinely available to the department regardless of the individual's ability to pay or method of payment. 2. All individuals determined to be in an emergency medical condition or a pregnant woman having contractions, will be given further examination and stabilizing treatment or appropriate transfer regardless of the individual's ability to pay or method of payment."

Based on record review and interview, the facility failed to arrange for an appropriate transfer for 1 (#2) of 20 patients that presented to the emergency department (ED) with an emergency medical condition (EMC). Findings include:

On 02/13/2013, during a review of the registration documentation for patient #2, revealed that the patient was brought to the ED on 10/21/2012 at 3:38 AM by EMS transport. The patient resided in a nursing home and was being transported for a "possible dislocated hip." The patient was brought to the hospital ED and entered into the hospital's "quick registration" process. The patient was then "backed out of registration." and further, transported by EMS to (another hospital) Mercy Health Partners.

On 02/13/2013 at 6:00 PM, during a phone interview with Staff D, the ED registered nurse, she stated that she "received a radio call from EMS that they were bringing in a patient with a possible dislocated hip and that the patient's vital signs were stable." She went on to say that she "advised them that ortho (orthopedics) was not available and to use their best judgment." After ending the radio contact, Staff D stated that she "then went and spoke to the ED physician and discussed the patient with her." According to Staff D, the ED physician stated that "she was not comfortable with them" (hip dislocation). Staff D then stated "the next thing I know, EMS came through the door (of the ED) with the patient, called their dispatch and discussed taking the patient to Mercy for ortho (orthopedic) care and they then left the building." When queried if she (Staff D) called Mercy (hospital) to inform them that the patient would be coming she stated "I did not call them, EMS may have."

On 02/13/2013 at 5:35 PM, during an interview with staff E (ED physician), she confirmed the above interview. She stated that she "was not aware that the patient had arrived (in the ED) there. I did not realize they were here until they were leaving. I saw the stretcher leaving the ER. Then I realized, 'hey what just happened'."