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Based on staff interview and review of medical records and hospital policies, it was determined the hospital failed to ensure emergency services were provided in compliance with 42 CFR Part 489.24. The hospital failed to ensure a Medical Screening Examination was provided to 1 of 24 patients (Patient #24) whose records were reviewed. This resulted in the inability of the hospital to ensure patients with potential emergency medical conditions were cared for in a safe and effective manner. Findings include:

The policy "EMTALA Plan," revised 3/24/17, stated "All patients presenting to Weiser Memorial Hospital's Emergency Department...seeking care...must be accepted and evaluated regardless of the patient's ability to pay...All patients shall receive a medical screening exam that includes all necessary testing and on-call services within the capability of the hospital to reach a diagnosis."

This policy was not followed. Refer to A2406 as it relates to the failure of the hospital to provide Medical Screening Examination.

The hospital failed to implement policies to ensure compliance with the requirements at 42 CFR Part 489.24.

Based on staff interview and review of ED logs, incident reports, and medical records, it was determined the hospital failed to ensure a Medical Screening Examination was provided to 1 of 24 patients (Patient #24) whose records were reviewed. This resulted in an absence of treatment and potential worsening of a patient's condition. Findings include:

An untitled incident report from WMH's CEO, dated 7/21/17, was received by the Idaho Bureau of Facility Standards on 7/24/17. The incident report stated the CEO received a telephone call from another hospital alleging that a patient who presented to the Weiser ED was told the ED was full. The incident report stated the patient was told to go to a hospital in Ontario, Oregon for treatment. The incident report stated the patient was currently in the critical care unit at that hospital.

The incident report stated an investigation was conducted by WMH. The incident report stated the patient was not registered and her name was not entered into the Weiser ED log. The incident report stated the patient came to WMH and requested care to the ED Technician who directed the patient to go to the Ontario hospital. The incident report stated the technician was disciplined following the incident. The incident report stated ED staff would receive further education.

The WMH ED log did not include an entry for Patient #24 on 7/19/17. However, it did contain Patient #24's name as a late entry with other patients on 7/28/17. The log stated Patient #24 came to WMH at 5:40 PM on 7/19/17.

After leaving WMH, Patient #24 was taken to a nearby hospital.

Patient #24's "Emergency/Urgent Care" record from the second hospital stated she presented there with her daughter on 7/19/17 at 7:04 PM. Her symptoms included dehydration, diarrhea, altered mentation, and weakness. Patient #24 had a history of chronic obstructive pulmonary disease.

Patient #24's "Emergency/Urgent Care" record included a note by the RN at 8:42 PM that stated "Daughter tearful in room stating that Weiser hospital would not see patient due to 'no beds'."

Patient #24's "Emergency/Urgent Care" record stated she was examined by a physician and diagnosed with diarrhea, dehydration, and a low blood sodium level. The record stated Patient #24 was admitted to the second hospital as an inpatient on 7/19/17 at 10:45 PM.

The WMH Data Quality Analyst was interviewed on 8/02/17 beginning at 9:10 AM. She stated she participated in an investigation of the above incident. She stated Patient #24 did come to the hospital seeking treatment. She stated she spoke to the ED Technician on duty at the time. She stated the technician said the patient requested to lie down. She stated the technician told the patient the hospital was full. She stated the technician told the patient to go to another hospital for treatment.

The hospital failed to provide Patient #24 with a Medical Screening Examination.