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Based on policy review, document review, medical record review and interview, it was determined the hospital failed to ensure the Emergency Department (ED) provided a Medical Screening Examination (MSE) in order to determine if an emergency medical or psychiatric condition existed in order to provide appropriate treatment for such conditions for 1 of 20 (Patient #1) patients.

Refer to findings in deficiency C2406

Based on the hospital's Emergency Department (ED) Central log, the Emergency Medical Services (EMS) ambulance report, Emergency Department policy and interview, it was determined the hospital failed to ensure that each patient presenting to the ED central log for 1 of 21 (Patient # 1) sampled patients who presented to the hospital's ED seeking emergency care.

The findings included:

1. Review of Hospital #1's "Emergency Screening, Stabilization and Transfer" policy, revealed " ...The screening is to be recorded in the patient's medical record and in the Emergency Department's Register or Log Book ... "

2. Review of Hospital #1's ED central log dated 3/11/13 revealed no documentation that Patient #1 had come to the hospital ED seeking care. The log did not contain Patient #1's name or any other information concerning the patient.

3. Review of the EMS ambulance report dated 3/11/13 revealed Patient #1 was transported by ambulance to and arrived at Hospital #1's ED at 11:18 PM.

4. During a telephone interview in the conference room on 3/20/13 at 9:35 AM, Paramedic #1 verified Patient #1 arrived by ambulance to Hospital #1's ED on 3/11/13 seeking care for a medical condition.

5. During a telephone interview in the conference room on 3/20/13 at 9:45 AM, Nurse #1 verified she did not enter Patient #1 on the ED log because, "the patient did not come into the ED."

Based on review of hospital Emergency Department (ED) policies, Emergency Medical Services (EMS) document review and interview, it was determined the hospital failed to ensure a Medical Screening Examination (MSE) was performed for 1 of 21 (Patient #1) sampled patients who came to the ED seeking medical care.

The findings included:

1. Review of Hospital #1's ED policy, "Emergency Department Policy and Procedure" revealed, "...Policy: Emergency patients of [hospital # 1] will be screened...in accordance with all [state] hospital regulations and with federal emergency care (COBRA) requirements...Screening Procedure: 1...Prompt Examination:..patient shall be examined promptly utilizing all appropriate screening resources of the ED..."

2. Review of the EMS record for Patient #1 revealed on 3/11/12 at 10:58 PM a call came to the ambulance's dispatch for transport of Patient #1 from the Nursing Home to Hospital #1 because of a possible dislodged nephrostomy. At 2316 (11:16 PM), a report regarding Patient #1's condition was called to Hospital #1's ED via the hospital network radio. Upon arrival to Hospital #1 at 2318 (11:18 PM), the ED Doctor (Physician #1) on duty met the ambulance personnel at the ambulance bay, opened the door to the ambulance and told the ambulance personnel to transport Patient #1 to Hospital #2 that there was "nothing they could do for the pt [patient] here." No MSE was performed and at 2324 (11:24 PM) Patient #1 was transported to Hospital #2 by EMS, arriving at 2354 (11:54 PM).

3. During a telephone interview in the conference room on 3/20/13 at 9:35 AM, Paramedic # 1 verified that on 3/11/13 Patient #1 was transported by EMS to Hospital #1 where the patient was never taken out of the ambulance and that the ED physician came to the ambulance door but did not examine the patient.

4. During a telephone interview in the conference room on 3/20/13 at 9:45 AM, Nurse #1 stated the ED physician (Physician #1) did not perform a medical screening examination for Patient # 1 and sent him to Hospital #2 because, "...of a lack of ultrasound capabilities..."

5. Review of the medical record from Hospital #2 for Patient #1 revealed the patient arrived by ambulance to the ED on 3/12/13 at 00:09 AM. He was admitted as an inpatient to the hospital with diagnoses listed in the History and Physical report as, Urinary track infection with leukocytosis, Probable early sepsis, Frank blood in Foley catheter, High-grade bladder tumor, and Nephrostomies, Iliac stent. The patient was discharged on 3/14/13.