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Based on review of video footage, Florida Highway Patrol police report, review policy and Procedure review, Incident Report review, medical record review 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

Refer to findings in Tag - A 2406.

Based on review of video footage, Florida Highway Patrol police report, Computerized EMTALA Log, Facility policy and procedures, and interviews, it was determined the facility failed to maintain an central log for each 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 the Florida Highway Patrol police report dated 12/31/24 at 1:52am revealed the Highway Patrol Trooper (Law Enforcement Officer #2) stated "I was advised by the Doctor on duty that they would not accept [Patient #1] due to his aggressiveness and combativeness. I then decided to transport [Patient #1] to [Another hospital].

Review of the emergency room video footage (no sound) from 12/31/2024 at 2:51AM revealed the Law Enforcement Officer (LEO) #1 arrived at the emergency room ambulance bay and met the Staff A, DO outside. LEO #1 and Staff A, DO were in engaged in conversation when another LEO (#2) pulled into the ambulance bay with Patient #1 in his vehicle at 02:53 AM. LEO #2 is seen getting out of the patrol car and walking toward Staff A, DO. LEO #2 and Staff A, DO exchange conversation, then 6 minutes later, LEO #1 walks away and LEO #2 gets back in his patrol car and drives away. During the conversation between the LEO #2 and Staff A, DO, 2 RNs and 1 security officer are noted standing outside behind Staff A, DO.

Review of facility policy "Patient Access Department" last reviewed 05/1/2024 states "HCA Florida Trinity Hospital" It is the policy of the Patient Access Department to adhere to EMTALA standards and state law when performing Emergency Department (ED) patient registration.

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

Review of the computerized EMTALA Log for 12/31/2024 revealed no entry for Patient #1.

During an interview on 01/27/2025 at approximately 10:00 AM, Staff B, VP, ED, stated "I spoke with the physician on duty that night and he stated that he told the officer that he would see the patient and that he would never tell them that he would not treat this patient. Several statements from staff state that Staff A, DO told the officers to take him to a different hospital that can treat his needs, and stating he only had female staff on duty.

During an interview on 01/27/2025 at approximately 10:00am with Staff B, Vice President (VP), Emergency Services, "I spoke with the physician on duty that night and he stated that he told the officer he would see the patient and that he would never tell them that he would not treat this patient", however, the officer wanted to take him to [another hospital].

During an interview on 01/27/2025 at 12:10pm with Staff A, DO, he stated that while outside with the 1st Law Enforcement Officer, that officer was told by the 2nd officer (with the patient) that he was taking him to [another hospital] due to requiring multiple staff to assist due to his agitation. I was about to go back inside when the 2nd officer showed up. I'm unsure why he showed up with the patient in the back seat. I explained that I can take care of him here, but they did not let the patient out of the patrol car. They said they were taking him to [another hospital] and proceeded to leave.

During an interview on 01/29/2025 at 12:31 PM, Staff D, RN stated I'm not sure if he got out or talked through the window, but I heard the patient's yelling, and the patient never stepped foot in the ED.

During an interview with Staff F, Security Officer, on 01/29/2025 at 2:50pm, Staff A, DO told the Trooper (Law Enforcement Officer) that he believed that they should take him to a bigger hospital just because he had an all-female staff, so he just wasn't sure if we could provide what he needed since he was being so aggressive. That's what I remember about this incident. I did think it was odd to let him just go, but I can't tell a doctor what to do.

Based on review of video footage, Florida Highway Patrol police report, review policy and Procedure review, Incident Report review, medical record review 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 the Florida Highway Patrol police report dated 12/31/2024 at 1:52am revealed the Highway Patrol Trooper (Law Enforcement Officer #2) stated "While the patient was escorted to booking, he then began to smash his forehead into the partition which resulted in him sustaining a small laceration to his forehead. The booking staff stated that he needed to go to the hospital for medical clearance due to a cut on his forehead bleeding and a head injury. I then traveled down to the Emergency room to which upon arrival, I was advised by the Doctor on duty that they would not accept Patient #1 due to his aggressiveness and combativeness. I then decided to transport Patient #1 to [Another hospital].

Review of the emergency room video footage (no sound) from 12/31/2024 at 2:51am revealed the Law Enforcement Officer (LEO) #1 arrived at the emergency room ambulance bay and met the Staff A, DO (Doctor of Osteopathy) outside. LEO #1 and Staff A, DO were in engaged in conversation when another LEO (#2) pulled into the ambulance bay with Patient #1 in his vehicle at 02:53am. LEO #2 is seen getting out of the patrol car and walking toward Staff A, DO. LEO #2 and Staff A, DO exchange conversation, then 6 minutes later, LEO #1 walks away and LEO #2 gets back in his patrol car and drives away. During the conversation between the LEO #2 and Staff A/ DO, 2 RNs (Registered Nurse) and 1 security officer are noted standing outside behind Staff A, DO.

Review of facility policy EMTALA (Emergency Medical Treatment and Labor Act) - Medical Screening Examination and Stabilization: Policy #: ADMIN.L.D.009, last reviewed 09/2023. The policy revealed in part,
"PROCEDURE: 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."


Review of the Facility incident report shows that the patient was in police custody due to suspected Driving under the Influence and resisting arrest. An Officer came to ED to notify them of impending arrival of the patient. The Physician (Staff A, DO) met police outside and discussed behavior of the patient. Police arrived with patient and spoke to Staff A, DO. Police drove off with patient taking him to another hospital. No MSE was completed, and he was not on the EMTALA log. The Investigation confirmed Patient #1 was not seen or triaged. The history was given by Florida Highway Patrol of resisting arrest, kicking arresting officer in the jaw and self injury in squad car, banging head on seat resulting in bleeding from head. Patient #1 never left the car. No assessment was completed. No entry was entered into the EMTALA log. Security was present for part of the conversation and stated that Staff A, DO felt that due to combative, aggressive behavior of Patient #1, the Freestanding ED was not capable of handling patient. Staff A, DO stated that it was only him and 2 female nurses present, and he was concerned for their safety. Based on this he refused to see the patient.

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

Review of medical record from [Another Hospital] revealed Patient #1 presented with complaints of altered mental status today via Law Enforcement Officers (LEO) . Patient #1 had been placed under arrest, placed in a police car , and the patient became very combative and was hitting his head. The LEO attempted to take the patient to the HCA freestanding emergency department however they declined the patient due to the patient being so aggressive and out of control. The patient was brought to this facility in a very aggressive state and out of control. Patient refusing to answer any questions about anything that he may have taken. The patient also required sedation on arrival to be able to perform an evaluation and the patient was unable to answer questions. Assessment: multiply linear abrasions across the mid forehead which are superficial and needed no treatment. Laboratory tests, Computed Tomography of the Brain, and Chest X-Ray completed. The patient was also noted initially to have an elevated lactic acid which is likely secondary to the patient's fighting his incarceration as well as dehydration. The patient was hydrated with IV (Intravenous) fluids and had improvement in his lactic acid. The patient is now medically cleared and is just awaiting to become more alert after the medications he was given and then he will be released to the custody of the police.

During an interview on 01/27/2025 at approximately 10:00am with Staff B, Vice President (VP), Emergency Services, "I spoke with the physician on duty that night and he stated that he told the officer he would see the patient and that he would never tell them that he would not treat this patient", however, the officer wanted to take him to [another hospital].

During an interview on 01/27/2025 at 12:10pm with Staff A, DO, he stated that while outside with the 1st Law Enforcement Officer, that officer was told by the 2nd officer (with the patient) that he was taking him to [another hospital] due to requiring multiple staff to assist due to his agitation. I was about to go back inside when the 2nd officer showed up. I'm unsure why he showed up with the patient in the back seat. I explained that I can take care of him here, but they did not let the patient out of the patrol car. They said they were taking him to [another hospital] and proceeded to leave.

During an interview with Staff F, Security Officer, on 01/29/2025 at 2:50pm, Staff A, DO told the Trooper (Law Enforcement Officer) that he believed that they should take him to a bigger hospital just because he had an all-female staff, so he just wasn't sure if we could provide what he needed since he was being so aggressive. That's what I remember about this incident. I did think it was odd to let him just go, but I can't tell a doctor what to do.

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 a LEO because it was determined due to the patient's behavior and sustaining a laceration to his forehead he needed an evaluation. The facility failed to provide an appropriate MSE for patient #1 on 12/31/2024 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.