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Based on documentation and interviews, the hospital failed to ensure compliance with requirements of 42 CFR 489.24, when the hospital failed to provide an individual, who presented to the dedicated emergency department, with a medical screening evaluation resulting in deficient practice cited at 42 CFR 489.24 (a) A2406.

Based on documentation and interviews, the hospital failed to provide a medical screening examination of 1 of 21 patients (patient #1) who presented to the dedicated emergency department. Findings include:

There was no documented record of patient #1 at the hospital on 04/10/2011.

Employee (B)/nurse was interviewed on 04/18/2011 at 12:15 p.m. and indicated the following: She was the triage nurse assigned in the ED on 04/10/2011 from 7:00 a.m. to 3:00 p.m. At (exact time unknown) a cab driver came in to the ED and reported to the receptionist that a bar had paid him to bring an intoxicated patient (patient #1) to the hospital or detox and he needed help getting the patient out of the car. She went out to the cab and patient #1 was "intoxicated," would not get out of the car, and stated he wanted to be brought to "detox." She went back into the ED and called employee (C)/nurse to ask her what to do. Employee (C) instructed her to call the police to bring the patient to detox. Employee (B) indicated that the ED was very busy that day and it would not be good for patient #1 to sit in the lobby drunk. She denied that patient #1 entered the hospital. After the police arrived, patient #1 was stating that he wanted to go to detox or go to (another named hospital). When the police asked her what they should do, she told them to take the patient to detox. The police called an ambulance without her knowledge. When the paramedics arrived, they questioned her why the hospital was refusing to see the patient. She told the paramedics that she was not refusing to see the patient.

Employee (C)/nurse was interviewed on 04/18/2011 at 1:00 p.m. and indicated that she was the charge nurse on 04/10/2011. She verified that employee (B) called her (exact time unknown) and stated that a patient (patient #1) was in a cab and not wanting to get out. Employee (C) indicated that the ED was very busy and "full" that day. She directed employee (B) to call the police to see if he wants to be seen or sent to detox. After the discussion, she asked employee (D)/Assessment and Referral (ANR) staff (a department that assists with assessments and referrals) to talk to the patient and see what he wanted to do.

Employee (D) was interviewed on 4/19/2011 at 9:00 a.m. and indicated that on 4/10/2011 (exact time unknown) employee (C) called her and indicated that patient #1 was outside and wanted to go to detox, the police were called, and the police had questions. Employee (C) asked if she could go and talk to them. She went out to talk to patient #1 and asked him if he wanted to come in or go to detox. At the time, the patient was in the getting into the ambulance and indicated that he wanted to go to (another named hospital).

Police Officer (F) was interviewed on 04/28/2011 at 4:00 p.m. and indicated that the police were dispatched to the ED on 4/10/2011 regarding patient #1. It was reported to Police Officer (F) that there was a male passing out and intoxicated who needed to go to detox. When he arrived to the hospital, patient #1 was in the backseat of a cab "passed out" and "pretty intoxicated." The triage nurse indicated to the police officer that the patient was passing out in the waiting room, that they could not have that, and that the ED was too full and they could not take him. Police Officer (F) stated that he completed a preliminary alcohol breathalyzer test with patient #1 which showed a result of 0.33. Police Officer (F) indicated that if an individual tests at 0.30 or above, they bring the individual to the hospital and not to detox. Since Unity Hospital was not going to see the patient, he called for another ambulance.

Hospital #2's medical record, dated 04/10/2011, for patient #1 was reviewed and documented that patient #1 reported to hospital staff that "they would not see him at Unity Hospital." Hospital #2 provided a medical screening examination and diagnostics, including labs and and EKG. Patient #1 was evaluated at hospital #2 for six hours and discharged home.

Employee (E)/administrative nurse was interviewed on 04/18/2011 at 1:45 p.m. and verified that patient #1 was not seen in the ED. She indicated that this was an EMTALA violation and that patient #1 did not receive a required medical screening examination by a physician in the ED. The hospital is in the process of mandatory education for all ED staff regarding EMTALA policies and procedures.

The hospital's EMTALA policy and procedure, dated 06/2010, documents "The hospital must provide an appropriate MSE (Medical Screening Examination) to a person who presents to a dedicated emergency department and makes a request for examination or treatment for a medical condition, or who presents anywhere at the hospital and requests an examination or treatment of an emergency medical condition ..." The policy defines a MSE as "An examination performed by a physician or Qualified Medical Person for the purpose of determining with reasonable clinical confidence whether the person who has come to the emergency department has an emergency medical condition." The policy defines a Qualified Medical Professional as "A person who has been designated in hospital medical staff bylaws or rules and regulations as qualified to perform an MSE."