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Based on interviews, medical record and policy review and review of the facility's self-report of an EMTALA violation to CMS, the facility failed to comply with 489.24(A2405) by failure to maintain a central log on each individual who comes to the emergency department and failed to comply with 489.20 (A2406) by failing to provide an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition exists. The cumulative effect of this systemic practice resulted in the facility's inability to ensure all patients pain needs would be met. The average daily census of the Emergency Department is 76 patients.

Based on review of Facility A's self-report of an EMTALA violation to CMS, interview, review of Facility A's Emergency Department log, review of the medical record from Facility B and review of Facility A's EMTALA Central Log Policy, Facility A failed to maintain a central log on each individual who comes to the emergency department for one (Patient #21) of 21 medical records reviewed.

Findings include:

Facility A's self-report of an EMTALA violation to CMS was reviewed. The report stated Patient #21 was brought to Facility A on 10/3/14 by ambulance. Staff A and Staff B told the medics Facility A was on psychiatric diversion. The ambulance left and took Patient #21 to a Facility B.

Facility A's Emergency Department log was reviewed on 10/31/14 at 10:20 AM. The log did not contain the name of the Patient #21 on 10/3/14. On 10/31/14 at 8:57 AM, Staff E reported Patient #21's name was not get recorded on the Emergency Department log from Patient #21's visit to Facility A on 10/3/14.

The medical record of Patient #21 from Facility B was reviewed. The record contained an Emergency/EMS Pre-Hospital Patient Care Report. The report revealed the EMS was sent away by two nurses at the emergency room doors on 10/3/14. A physician documented Patient #21 was initially taken to Facility A where the ambulance crew was told they don't treat psychiatric patients and were sent to Facility B.

Facility A's EMTALA Central Log Policy was reviewed. The policy stated each hospital must maintain a Central Log to track the care provided to each individual who comes to the Hospital seeking care for an Emergency Medical Condition.

Based on review of Facility A's self-report of an EMTALA violation to CMS, interview, review of the medical record from Facility B and policy review, Facility A failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition exists for one (Patient #21) of 21 medical records reviewed.

Findings include:

Facility A's self-report of an EMTALA violation to CMS was reviewed. The report stated Patient #21 was brought to Facility A on 10/3/14 by ambulance. Staff A and Staff B told the medics Facility A was on psychiatric diversion. The ambulance left and took Patient #21 to Facility B.

On 10/31/14 at 8:49 AM, Staff E was interviewed. Staff E reported the emergency medical services (EMS) called Facility A on 10/3/14 to notify that Patient #21 was on the way. Emergency Department staff informed the EMS that Facility A was on diversion due to lack of a secure room. The EMS called Facility A back to inform they were bringing Patient #21 to Facility A due to another local hospital was also on diversion for psychiatric patients.

The EMS brought and unloaded Patient #21. While the EMS were transporting Patient #21 down a hallway to the Emergency Department, Staff A and Staff B were walking toward the exit for a break and instructed the EMS to leave with Patient #21. The EMS called their boss who had the EMS take Patient #21 to Facility B.

The medical record of Patient #21 from Facility B was reviewed. The record contained an Emergency/EMS Pre-Hospital Patient Care Report. The report revealed the EMS was sent away by two nurses at the emergency room doors on 10/3/14. A physician documented Patient #21 was initially taken to Facility A where the ambulance crew was told they don't treat psychiatric patients and were sent to Facility B. Patient #21 was admitted to the intensive care unit on 10/3/14 and was discharged on 10/13/14.

Facility A's EMTALA Medical Screening Stabilization Policy was reviewed. The policy include states "all individuals presenting on Hospital property requesting emergency medical services, individuals presenting to a Dedicated Emergency Department requesting medical services, and patients arriving/presenting via ambulance requesting medical services shall receive an appropriate Medical Screening Examination and Stabilization services". "Even when on diversionary status, if a patient arrives on campus, Hospital must provide a Medical Screening Examination within its Capacity and Capability, as well as Stabilizing Treatment".