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Based on policy review, record review, EMS Endcode Log review, surveillance video review, Fire Rescue documents review, and interview, it was determined, the hospital failed to substantiate the provision of emergency services for 1 of 21 sampled patients (Patient #21) as evidenced by failure to perform a Medical Screening Exam (MSE) within the capability of the hospital's ED, including ancillary services routinely available to the emergency to the ED, to determine whether or not an emergency medical condition exists and if so to provide care and treatment to relieve or eliminate the condition.

Refer to findings in citations A-2406

Based on record review, video surveillance review, policy review, HCA Florida JFK Hospital, Admissions Electronic Log, and interview, it was determined, the hospital failed to ensure the central log included all individuals who presented to the Emergency Department (ED) seeking treatment. This failure affected 1 of 21 sample patients (Patient #21).

The findings included:

Facility policy titled "EMTALA Central Log" last reviewed on 05/2025 documents "This policy reflects guidance under the Emergency Medical Treatment and Labor Act (EMTALA) and associated state laws only.

Policy: 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 need 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 or she was transferred admitted or treated, stabilized and transferred or discharged.
The central log includes the patient logs from the traditional ED and either by direct or indirect reference, patient logs from any other areas of the hospital that may be considered dedicated emergency department's or where an individual may present for emergency services or receive a medical screening exam, such as labor and delivery.

Procedure:
All hospitals must maintain the Central Log in an electronic format. An electronic template that includes all federal requirements for EMTALA is available on Medictech for each market or division to customize.
The Central Log, including all additional logs incorporated into the Central Log by reference, shall be maintained in the same manner and with the same central core information. The logs must contain at a minimum, the name of the individual and whether the individual refused treatment, was refused treatment, was transferred, was admitted and treated, was stabilized and transferred, was discharged or expired.
A log entry for all individuals who have come to the hospital; seeking medical attention or who appear to need medical attention must be made by the appropriate individual. Further.
The Central Log of individuals who have come to the hospital seeking medical attention or who appear to need medical attention will be available within a reasonable amount of time for surveyor review and must be retained for a minimum of five years from the disposition of the individual."

Review of the surveillance video conducted on 08/13/25 revealed the following:
On 08/05/25 starting at 4:59 AM, a Fire Rescue vehicle pulled up to the ambulance entrance. The Fire Rescue was transporting Patient #21 to the Emergency Department.
At 5:00 AM, two hospital staff members are observed putting a sign on the entrance door. The Fire Rescue emergency crew is seen walking around towards the other side of the vehicle talking on the phone.
At 5:09 AM, the Fire Rescue crew is seen at the ambulance entrance, looking at the sign.
At 5:16 AM, the crew gets back in vehicle.
At 5:19 AM, the Fire Rescue vehicle leaves the premises.

The facility's Log titled, "HCA Florida JFK North Hospital "Admissions" Electronic Central Log dated dated 8/5/2025 was reviewed. Review of the Electric Central Log failed to revealed that Patient #21 was entered on the ED log on August 5, presented to the hospital via Fire Rescue on 08/05/25 seeking medical assistance.

Review of the Fire Rescue documents dated 08/05/25 documents the unit was dispatched to a suicide attempt, upon arrival they found a 14-year-old female walking down stairs, accompanied by a police officers and parents. The patient appeared to be in moderate distress. "Baker Act" Police officer stated the patient posted that she took medication on social media, and a friend called her parents. Patient states she took 24 capsules of 25 mg Benadryl. Pt has 2 small superficial lacerations to left forearm ... ...Rescue drove to HCA Florida JFK North Hospital (Hospital A) as per protocol; while encoding Hospital A advised they are on diversion and after talking to another rescue unit the patient was diverted to Hospital B.

Interview with Staff A, a Registered Nurse, conducted on 08/13/25 at 9:30 AM, revealed she worked the night shift on 08/04/25. The nurse explained the emergency department was busy, they were holding critical patients in the hallway, and the charge nurse told her they were going on diversion. The staff stated she continued to care for her patients. Later, she and the secretary put a sign on the ambulance entrance door, the staff can't recall exactly what the sign said, something to the effect of "Diversion" and does not know who removed the sign. Staff A confirmed she saw an ambulance in the bay when the sign was being placed but she did not speak to them and the emergency personnel never came in.

Interview with Staff B, Unit Secretary, conducted on 08/13/25 at 9:36 AM revealed on 08/04/25 the ED was busy, she recalled they were holding many patients. The charge nurse told her the hospital was going on diversion. The staff was asked what that meant and stated that means they are not accepting patients now. The secretary explained it was her idea to put the sign up, the sign said, "behavioral diversion". The staff stated she placed the sign up around 5 AM and she took the sign down about 30 minutes later, because they were off diversion by 6 AM.

Interview with the Charge Nurse on duty on 08/05/25 was conducted on 08/13/24 at 10:27 AM, revealed the staff recalled Fire Rescue called over the radio and she told him that they were diversion, she did see a Fire Rescue unit outside, but they never came in. The charge nurse does not recall if the crew gave any patient information or where they were at the time of the call, she just remembers telling them they were on diversion.

Interview with the representative from the Fire and Rescue Department conducted on 08/14/25 at 3:46 PM revealed the crew involved notify him that the hospital turned away an adolescent Baker Act patient on 08/05/25 and he subsequently notified the hospital's Chief Executive Officer.

Emergency personnel provided details of the event on 08/21/25. The Fire Rescue crew reported while transporting Patient #21 to the hospital, the patient was turned away based on their diversion status. When the crew arrived at Hospital A's emergency department, they were working on alternate destination and observed the hospital staff placing a sign on the door indicating the hospital was on diversion.

Based on policy review, record review, EMS Endcode Log review, surveillance video review, Fire Rescue documents review, and interview, it was determined, the hospital failed to substantiate the provision of emergency services for 1 of 21 sampled patients (Patient #21) as evidenced by failure to perform a Medical Screening Exam (MSE) within the capability of the hospital's ED, including ancillary services routinely available to the emergency to the ED, to determine whether or not an emergency medical condition exists and if so to provide care and treatment to relieve or eliminate the condition.

The findings included:

Facility policy titled "EMTALA Medical Screening Examination and Stabilization" dated 05/2025 documents:

"Purpose: To establish guidelines for providing appropriate medical screening examinations ("MSE") and any necessary stabilizing treatment or an appropriate transfer for the individual as required by EMTALA, 42 U.S.C. S 1395dd, and all Federal regulations and interpretive guidelines promulgated thereunder, as well as section 395.1041, Florida Statutes, and all related administrative rules.

Policy: An EMTALA obligation is triggered when:
1. an individual or a representative acting on the individual's behalf, including EMS or a transferring hospital, requests emergency services and care; or
2. a prudent layperson observer observing an individual who comes to the dedicated emergency department ("DED") would conclude from the individual's appearance or behavior that the individual needs an examination or treatment of a medical condition.
Such obligation is further extended to those individuals presenting elsewhere on hospital property requesting examination or treatment for an emergency medical condition ("EMC"). Further, if a prudent layperson observer would believe that the individual is experiencing an EMC, then an appropriate MSE, within the capabilities of the hospital's DED (including ancillary services routinely available and the availability of on-call physicians), shall be performed. The MSE must be completed by an individual (i) qualified to perform such an examination to determine whether an EMC exists.... If an EMC is determined to exist, the individual will be provided necessary treatment to relieve or eliminate the EMC, within the capacity and capability of the facility, or an appropriate transfer as defined by and required by EMTALA. Emergency treatment shall be applied in a non-discriminatory manner...or any other basis prohibited.

Procedure:
1. When an MSE 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, to determine whether or not an EMC exists: (i) to any individual,... (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 individual's appearance or behavior needs an MSE. An MSE shall be provided to determine whether or not the individual is experiencing an EMC.... An MSE is required when:
a. A request is made by the individual or on the individual's behalf for examination or treatment for a medical condition, including where:
i. The individual requests medication to resolve or provide stabilizing treatment for a medical condition.
ii. The individual arrives as a transfer from another hospital or health care facility. Upon arrival of a transfer, a physician or qualified medical person ("QMP") must perform an appropriate MSE. The physician or QMP shall provide any additional screening and treatment required to relieve or eliminate the EMC. The MSE of the individual must be documented. This type of screening cannot be performed by the triage nurse. If an EMC is determined to exist and the hospital admits the individual as an inpatient for further treatment, the hospital's obligation under EMTALA ceases. Note: The MSE and other emergency services need not be provided in a location specifically identified as a DED. The hospital may use areas to deliver emergency services that are also used for other inpatient or outpatient services. MSEs or necessary treatment may require ancillary services available only in areas or facilities of the hospital outside of the DED.
b. The individual arrives on the hospital property other than an Off-Campus Emergency Department (OED) and makes a request or another makes a request on the individual's behalf for examination or treatment for an EMC.
i. Screening where the individual presented: If an individual is initially screened in a department or location on-campus other than the OED, the individual may be moved to another hospital department or facility on-campus to receive further screening or stabilizing treatment without such movement being a transfer. The hospital shall not move the individual to an off-campus facility or department (such as an urgent care center or satellite clinic) for an MSE.
ii. Transporting to the DED: The hospital may determine that movement of an individual to the hospital's OED may be necessary for screening. However, common sense and individual Emergency Medical Services (EMS) personnel may request an evaluation or treatment on an individual's behalf.
c. The individual arrives on the hospital property, either in the DED or property other than the DED, and no request is made for evaluation or treatment, but the appearance or behavior of the individual would cause a prudent layperson observer to believe that the individual needed such examination or treatment.

3. Extent of the MSE
a. Determine if an EMC exists. The hospital must perform an MSE to determine if an EMC exists. It is not appropriate to merely "log in" or triage an individual with a medical condition and not provide an MSE. Triage is not equivalent to an MSE. Triage entails the clinical assessment of the individual's presenting signs and symptoms at the time of arrival at the hospital in order to prioritize when the individual will be screened by a physician or other QMP.
b. Definition of MSE. An MSE is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether the individual has an EMC or not. It is not an isolated event. The MSE must be appropriate to the individual's presenting signs and symptoms and the capability and capacity of the hospital.
c. An on-going process. The individual shall be continuously monitored according to the individual's needs until it is determined whether or not the individual has an EMC, and if he or she does, until the EMC is relieved or eliminated or the individual is appropriately admitted or transferred. The medical record shall reflect the amount and extent of monitoring that was provided prior to the completion of the MSE and until discharge or transfer.

Review of the surveillance video conducted on 08/13/25 revealed the following:
On 08/05/25 starting at 4:59 AM, a Fire Rescue vehicle pulled up to the ambulance entrance.
At 5:00 AM, a Fire Rescue crew member gets out of the vehicle and is on the phone.
At 5:00 AM, two hospital staff members are putting a sign on the entrance door. The Fire Rescue emergency crew is seen walking around towards the other side of the vehicle talking on the phone.
At 5:01 AM, the two hospital staff members are seen leaving the area.
At 5:02 AM to 5:05 AM, a Fire Rescue crew member is seen walking towards door and talking on phone.
At 5:09 AM, the Fire Rescue crew is seen at the ambulance entrance, looking at the sign.
At 5:13 AM, the Fire Rescue crew is seen walking and talking on the phone.
At 5:14 AM, the Fire Rescue vehicle driver comes out of the vehicle and speaks to the other crew member
At 5:16 AM, the crew gets back in the vehicle.
At 5:19 AM, the Fire Rescue vehicle leaves the premises.

The video surveillance confirmed that Patient #21 did not receive a medical screening examination.

Review of the EMS Endcode Log revealed no evidence that Fire Rescue personnel contacted the hospital regarding Patient #21.

Review of Fire Rescue documents dated 08/05/25 documents the unit was dispatched to a suicide attempt, upon arrival they found a 14-year-old female walking downstairs, accompanied by a police office and parents. The patient appeared to be in moderate distress. "Baker Act" Police officer stated the patient posted that she took medication on social media, and a friend called her parents. Patient states she took 24 capsules of 25 mg Benadryl. Pt has 2 small superficial lacerations to left forearm ... ...Rescue drove to HCA Florida JFK North Hospital (Hospital A) as per protocol; while encoding Hospital A advised they are on diversion and after talking to another rescue unit the patient was diverted to Hospital B.

Interview with Staff A, a Registered Nurse, conducted on 08/13/25 at 9:30 AM, revealed she worked the night shift on 08/04/25. The nurse explained the emergency department was busy, they were holding critical patients in the hallway, and the charge nurse told her they were going on diversion. The staff stated she continued to care for her patients. Later, she and the secretary put a sign on the ambulance entrance door, the staff cannot recall exactly what the sign said, something to the effect of "Diversion" and does not know who removed the sign. Staff A confirmed she saw an ambulance in the bay when the sign was being placed but she did not speak to them and the emergency personnel never came in.

Interview with Staff B, Unit Secretary, conducted on 08/13/25 at 9:36 AM revealed on 08/04/25 the ED was busy, she recalled they were holding many patients. The charge nurse told her the hospital was going on diversion. The staff was asked what does that mean and stated that means they are not accepting patients now. The secretary explained it was her idea to put the sign up, the sign said, "behavioral diversion". The staff stated she placed the sign up around 5 AM and she took the sign down about 30 minutes later, because they were off diversion by 6 AM.

Interview with the Charge Nurse on duty on 08/05/25 was conducted on 08/13/24 at 10:27 AM, revealed the staff recalled Fire Rescue called over the radio and she told him that they were diversion, she did see a Fire Rescue unit outside, but they never came in. The charge nurse does not recall if the crew gave any patient information or where they were at the time of the call, she just remembers telling them they were on diversion.

Interview with the representative from the Fire and Rescue Department conducted on 08/14/25 at 3:46 PM revealed the crew involved notified him that the hospital turned away an adolescent Baker Act patient on 08/05/25 and he subsequently notified the hospital's Chief Executive Officer.

Emergency personnel provided details of the event on 08/21/25. The Fire Rescue crew reported while transporting Patient #21 to the hospital, the patient was turned away based on their diversion status. When the crew arrived at HCA Florida JFK North Hospital emergency department, they were working on alternate destination and observed the hospital staff placing a sign on the door indicating the hospital was on diversion.

Based on record review, surveillance video review and interview, it was determined that the hospital failed to provide a medical screening exam to Patient #21, an adolescent under Baker Act (involuntary examination for an individual with mental illness that poses a danger to themselves or others) due to suicide attempt. The patient presented via Fire Rescue to the hospital property and was turned away by the charge nurse during endcode due to the hospital diversion status and in addition, the staff placed a behavioral health diversion sign on the ambulance bay entrance to deter patients from entering the emergency department.