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Based on reviews of clinical records, review of hospital policies and procedures, and staff interviews, it was determined the hospital failed to enforce policies and procedures that comply with the requirements of 42CFR 489.20 and 42 CFR 489.24, responsibilities of Medicare participating hospitals in emergency cases as evidenced by:

Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)", revealed: " ...Policy. Every patient regardless of ability to pay, who (i) presents to the hospital's Dedicated Emergency Department or presents on Hospital property and (ii) requests an examination or treatment of a potential Emergency Medical Condition ("EMC") shall receive an appropriate Medical Screening Examination ("MSE") to determine whether the patient is experiencing an EMC ...Medical Screening Examination (MSE): Means the screening process required to determine with reasonable clinical confidence whether an EMC does or does not exist. Depending on the patient presenting symptoms, The MSE represents a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures within the capability of the Hospital. Triage does not constitute an MSE. Triage involves the clinical assessment of the patient presenting signs and symptoms at the time of arrival at the Hospital to prioritize when the patient will be seen by a physician or QMP ...Procedure. I. Medical Screening Examination Requirements. All patients who present to the Hospital DED or on Hospital Property and request examination or treatment of a potential EMC shall receive an appropriate MSE ...B. Scope of the MSE. 1. A physician or QMP must perform the MSE to determine if an EMC exists ...."

Hospital policy titled "Emergency Department Triage" revealed: "...Policy. Emergency Department registered nurses who have met the clinical competencies will perform triage assessment,...Procedure. 1. All patients receive a rapid triage assessment including: a. Chief complaint, b. Allergies, c. Vital signs, including temperature, pulse, respirations, blood pressure and pain intensity.,d. Other information, if appropriate, may include oxygen saturation, last menstrual period, past medical history and weight ...2. Whenever possible, patients are immediately placed into open treatment spaces and triage is performed at the bedside ...."

Twenty ED medical records, Patients 1 through 20, in May through July 2022, were randomly selected for review including patients who were transferred, admitted, left before triage, or left before Medical Screening Examinations (MSE).

Four out of twenty medical records revealed patients who did not receive an appropriate MSE:

Patient # 1, 07/22/2022, arrived 0923, triaged 2246, no MSE, Left 11:00. Time elapsed 1 hour and 14 minutes
2. Patient #4, 07/31/2022, arrived 10:34, triaged 10:52, MSE 15:29. Time elapsed 4 hours, 37 minutes.
Patient #11, 05/01/2022, arrived 13:46, no triage, no MSE, left 15:00. Time elapsed 1 hour 14 minutes.
Patient #15, 05/26/2022, arrived at 0359, no triage, no MSE, left 0501, Time elapsed 1 hour 2 minutes.

An additional 5 ED medical records, (Patients 21-25), in December 2023, who left without being triaged, were reviewed.

Four out of five records revealed patients who did not receive an MSE:

Patient # 21, on 12/04/2023, chest pain, arrived at 0023, no triage, no MSE exam, left 0057. Time elapsed 34 minutes.
Patient # 22, on 12/10/2023, at 1523, no triage, no MSE, left 1643. Time elapsed 1 hour 20 minutes.
Patient # 23, on 12/24/2023, abdominal pain, arrived 0643, no triage,no MSE, left 0711. Time elapsed 28 minutes.
Patient #24, on 12/25/2023, panic attack, arrived 0449, no triage, no MSE, Left 0545. Time elapsed 54 minutes.

Employee # 1 confirmed during an interview on 12/29/2023, that 8 out of the 25 medical records reviewed did not receive a medical screening examination or treatment before leaving the ED.

Based on review of clinical records, policies and procedures, hospital documents, and staff interviews, it was determined the hospital failed to provide a Medical Screening Examination (MSE) to a patient who was taken to the Emergency Department by ambulance (Patient #1).

Findings include:

Patient # 1 was brought to Tempe St. Luke Emergency Department by EMS after passing out while working as a UPS delivery driver. Upon arrival to the Emergency Department the patient was offloaded from the ambulance and sent to the lobby. The patient waited in the lobby for 83 minutes before being triaged. After being triaged the patient decided to leave. No medical screening exam was completed.

Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)", revealed: " ...Policy. Every patient regardless of ability to pay, who (i) presents to the hospital's Dedicated Emergency Department or presents on Hospital property and (ii) requests an examination or treatment of a potential Emergency Medical Condition ("EMC") shall receive an appropriate Medical Screening Examination ("MSE") to determine whether the patient is experiencing an EMC ...Medical Screening Examination (MSE): Means the screening process required to determine with reasonable clinical confidence whether an EMC does or does not exist. Depending on the patient presenting symptoms, The MSE represents a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures within the capability of the Hospital. Triage does not constitute an MSE. Triage involves the clinical assessment of the patient presenting signs and symptoms at the time of arrival at the Hospital to prioritize when the patient will be seen by a physician or QMP ...Procedure. I. Medical Screening Examination Requirements. All patients who present to the Hospital DED or on Hospital Property and request examination or treatment of a potential EMC shall receive an appropriate MSE ...B. Scope of the MSE. 1. A physician or QMP must perform the MSE to determine if an EMC. Exists ...."

Document titled "TFMRD Pre-Hospital Care Report," dated 07/22/2022, revealed: " ...At Tempe St. Luke ER at 2123, patient stood and walked to ER Lobby from the gurney and sat down in a chair. Patient care turned over to RN and a report was given ...."

A review of Patient #1 ' s medical record revealed that the patient was brought to Tempe St. Luke Emergency Department by EMS on 07/22/2022 at 2123. The Emergency Department's Visit summary reveals a triage time of 2246.

An additional 19 ED medical records, Patients 2 through 20, in May through July 2022, were randomly selected for review including patients who were transferred, admitted, left before triage, or left before Medical Screening Examinations (MSE).

Four out of twenty medical records revealed patients who did not receive an appropriate MSE:

Patient # 1, 07/22/2022, arrived 0923, triaged 2246, no MSE, Left 11:00. Time elapsed 1 hour and 14 minutes.
Patient #4, 07/31/2022, arrived 10:34, triaged 10:52, MSE 15:29. Time elapsed 4 hours, 37 minutes.
Patient #11, 05/01/2022, arrived 13:46, no triage, no MSE, left 15:00. Time elapsed 1 hour 14 minutes.
Patient #15, 05/26/2022, arrived at 0359, no triage, no MSE, left 0501, Time elapsed 1 hour 2 minutes.

An additional 5 ED medical records, (Patients 21-25), in December 2023, who left without being triaged, were reviewed.

Four out of five records revealed patients who did not receive an MSE:

Patient # 21, on 12/04/2023, chest pain, arrived at 0023, no triage, no MSE, left 0057. Time elapsed 34 minutes.
Patient # 22, on 12/10/2023, at 1523, no triage, no MSE, left 1643. Time elapsed 1 hour 20 minutes.
Patient # 23, on 12/24/2023, abdominal pain, arrived 0643, no triage,no MSE, left 0711. Time elapsed 28 minutes.
Patient #24, on 12/25/2023, panic attack, arrived 0449, no triage, no MSE, Left 0545. Time elapsed 54 minutes.

Employee #1 confirmed during an interview on 12/29/2023, that 8 out of the 25 medical records reviewed left without receiving a medical screening examination. Employee # 1 also confirmed that Patient #1 waited in the ED lobby for 83 minutes before being triaged and did not receive a medical screening examination.

Based on review of clinical records, policies and procedures, hospital documents, and staff interviews, it was determined the hospital the hospital delayed screening and treatment of 8 out of 25 patients who presented to the Emergency Department.

Findings include:

Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)", revealed: " ...Policy. Every patient regardless of ability to pay, who (i) presents to the hospital's Dedicated Emergency Department or presents on Hospital property and (ii) requests an examination or treatment of a potential Emergency Medical Condition ("EMC") shall receive an appropriate Medical Screening Examination ("MSE") to determine whether the patient is experiencing an EMC ...Medical Screening Examination (MSE): Means the screening process required to determine with reasonable clinical confidence whether an EMC does or does not exist. Depending on the patient presenting symptoms, The MSE represents a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures within the capability of the Hospital. Triage does not constitute an MSE. Triage involves the clinical assessment of the patient presenting signs and symptoms at the time of arrival at the Hospital to prioritize when the patient will be seen by a physician or QMP ...Procedure. I. Medical Screening Examination Requirements. All patients who present to the Hospital DED or on Hospital Property and request examination or treatment of a potential EMC shall receive an appropriate MSE ...B. Scope of the MSE. 1. A physician or QMP must perform the MSE to determine if an EMC. Exists ...."

Hospital policy titled "Emergency Department Triage" revealed: "...Policy. Emergency Department registered nurses who have met the clinical competencies will perform triage assessment, Procedure. 1. All patients receive a rapid triage assessment including: a. Chief complaint, b. Allergies, c. Vital signs, including temperature, pulse, respirations, blood pressure and pain intensity. Other information, if appropriate, may include oxygen saturation, last menstrual period, past medical history and weight ...2. Whenever possible, patients are immediately placed into open treatment spaces and triage is performed at the bedside ...."

Four out of twenty medical records, Patients 1 through 20, in May through July 2022, were randomly selected for review including patients who were transferred, admitted, left before triage, or left before Medical Screening Examinations (MSE).

Four out of twenty medical records revealed patients who did not receive an appropriate MSE:

Patient # 1, 07/22/2022, arrived 0923, triaged 2246, no MSE, Left 11:00. Time elapsed 1 hour and 14 minutes.
Patient #4, 07/31/2022, arrived 10:34, triaged 10:52, MSE 15:29. Time elapsed 4 hours, 37 minutes.
Patient #11, 05/01/2022, arrived 13:46, no triage, no MSE, left 15:00. Time elapsed 1 hour 14 minutes.
Patient #15, 05/26/2022, arrived at 0359, no triage, no MSE, left 0501, Time elapsed 1 hour 2 minutes.

An additional 5 ED medical records, (Patients 21-25), in December 2023, who left without being triaged, were reviewed.

Four out of five records revealed patients who did not receive an MSE:

Patient # 21, on 12/04/2023, chest pain, arrived at 0023, no triage, no MSE exam, left 0057. Time elapsed 34 minutes.
Patient # 22, on 12/10/2023, at 1523, no triage, no MSE, left 1643. Time elapsed 1 hour 20 minutes.
Patient # 23, on 12/24/2023, abdominal pain, arrived 0643, no triage,no MSE, left 0711. Time elapsed 28 minutes.
Patient #24, on 12/25/2023, panic attack, arrived 0449, no triage, no MSE, Left 0545. Time elapsed 54 minutes.

Employee # 1 confirmed during an interview on 12/29/2023, that 8 out of the 25 medical records reviewed from did not receive a medical screening examination or treatment.