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Based on record review, policy review, interview, and video footage, the facility failed to ensure that 1) All patients that present to the emergency department seeking medical care are logged into the hospital's emergency room log and 2) Failed to ensure an appropriate medical screening examination was conducted that was within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed. This failure impeded the facility's ability to provide emergency care for 1 (Patient #1) out of 20 patient records reviewed and had the potential to affect all patients who presented to the ED for medical care with a minor child.

The findings included:

(1) Based on record review, policy review, interview, and video footage, it was determined that the facility failed to maintain an accurate log of everyone who presented to the emergency department seeking medical care whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for 1 (Patient #1) of 20 patient records reviewed. Cross Refer to A2405.

(2) Based on record review, policy review, interview, and video footage, the facility failed to ensure that an appropriate medical screening examination was conducted that was within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed. This failure impeded the facility's ability to provide emergency care for 1 (Patient #1) out of 20 patient records reviewed and had the potential to affect all patients who presented to the ED for medical care with a minor child. Cross Refer to A2406.

Based on record review, policy review, interview, and video footage, it was determined that the facility failed to maintain an accurate emergency department (ED) log of everyone who presented to the emergency department seeking medical care whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for 1 (Patient #1) of 20 patient records reviewed.

The findings included:

Review of hospital Policy No. 209, Emergency Treatment and Patient Transfer Policy, Last revised 01/03/2025 documented:

I. Purpose. The purpose of this policy is to ensure compliance with the Emergency Medical Treatment and Labor Act (EMTALA), its amendments, regulations, and reporting requirements. EMTALA requires that all patients who request medical treatment for an emergency medical condition, or have such a request made on their behalf, receive certain basic threshold services and stabilizing treatment as necessary.

III. Procedure
A. Requests for Emergency Treatment
1. All patients who request medical treatment for an emergency medical condition EMC in any manner, or who have such a request made on their behalf, must receive a medical screening examination (MSE) by a qualified medical provider (QMP).
2. All such patients shall be registered and logged into the Emergency Department log.
3. Key Point: A patient does not need to be in the Emergency Department to make such a request.
4. Patient's financial status will have no bearing on or delay in any way the conducting of the MSE.

Review of the video footage (soundless video) dated 04/06/2025 was reviewed on 05/20/2025 at 10AM. Patient #1 is seen walking into the ED foyer with a child around 8:30AM and going to the security desk which is not visible in the video. Patient #1 begins walking toward the 2nd entrance and turns around and walks out of the facility with the child. Patient #1 returned approximately 2 minutes later with the child and entered the ED, stopping at the front desk. At 8:37AM, there was a brief conversation, and less than a minute later, Patient #1 is seen walking out of the ED while Staff B (greeter/patient care technician [PCT]) watched Patient #1 leave. Patient #1 was not observed to be checked in or offered /advised to complete a registration form to be seen and evaluated.

During an interview on 05/20/2025 at 10:47AM, Staff B, ED Greeter/PCT who was at the ED registration desk on 04/06/2025 stated, Patient #1 was asked if there was anyone to keep the child because if she is admitted she might want to call someone to pick up the child.

Review of the hospital's ED log for 04/06/2025 revealed, Patient #1 was not found on the log for the 04/06/2025 ED visit.

During an interview conducted with Staff L, (ED greeter/PCT) on 05/21/2025 at 12:40PM revealed, patients are told we don't let the child go into the adult ED with the parent. We will try to accommodate them by treating the parents on the side to make sure the child is safe. Staff L reported, they had received EMTALA training.

During an interview on 05/21/2025 at 3:40PM, Staff A (Risk Manager) stated that an Incident Report was not completed because the complaint about Patient #1 came through the Guest Relations Department. The surveyor was provided with investigative notes/staff interviews dated 04/30/2025. Staff A documented investigative notes and staff interviews, ED staff education was implemented (1) regarding the process for adult patients that present with minor children; that there were no barriers for medical care and (2) The process for escalation to the Charge Nurse, the Assistant Nurse Manager (ANM), and the Administrator in charge (AIC). Date completed 04/30/2025.

Based on record review, policy review, interview, and video footage, the facility failed to ensure that an appropriate medical screening examination was conducted that was within the capability of the hospital's emergency department(ED), including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed. This failure impeded the facility's ability to provide emergency care for 1 (Patient #1) out of 20 patient records reviewed and had the potential to affect all patients who presented to the ED for medical care with a minor child.

The findings included:

Review of Policy No. 209, Emergency Treatment and Patient Transfer Policy, Last revised 01/03/2025 documented:

I. Purpose. The purpose of this policy is to ensure compliance with the Emergency Medical Treatment and Labor Act (EMTALA), its amendments, regulations, and reporting requirements. EMTALA requires that all patients who request medical treatment for an emergency medical condition, or have such a request made on their behalf, receive certain basic threshold services and stabilizing treatment as necessary.

III. Procedure
A. Requests for Emergency Treatment
1. All patients who request medical treatment for an emergency medical condition (EMC) in any manner, or who have such a request made on their behalf, must receive a medical screening examination (MSE) by a qualified medical provider (QMP).
2. All such patients shall be registered and logged into the Emergency Department log.
3. Key Point: A patient does not need to be in the Emergency Department to make such a request.
4. Patient's financial status will have no bearing on or delay in any way the conducting of the MSE.
5. The MSE must be documented in the patient's medical record.
6. Patients who are deemed to have an EMC must be stabilized to the best of the treating facility's service capabilities.

Review of the video footage (soundless video) dated 04/06/2025 was reviewed on 05/20/2025 at 10AM. Patient #1 is seen walking into the ED foyer with a child around 8:30AM and going to the security desk which is not visible in the video. Patient #1 begins walking toward the 2nd entrance and turns around and walks out of the facility with the child. Patient #1 returned approximately 2 minutes later with the child and entered the ED, stopping at the front desk. At 8:37AM, there was a brief conversation, and less than a minute later, Patient #1 is seen walking out of the ED while Staff B (greeter/patient care technician [PCT]) watched Patient #1 leave. Patient #1 was not observed to be checked in or offered /advised to complete a registration form to be seen and evaluated.

During an interview on 05/20/2025 at 10:47AM, Staff B, ED Greeter/PCT who was at the ED registration desk on 04/06/2025 stated, Patient #1 was asked if there was anyone to keep the child because if she is admitted she might want to call someone to pick up the child. Staff B (ED greeter/PCT) reported Patient #1 was not told she could not be seen. Staff B reported, we try to accommodate all patients and Patient #1 was not told to leave and left on her own.

During an interview with Staff H, (ED Social Worker) on 05/20/2025 at 3:30PM revealed, if a patient is being admitted to the hospital, the nurse asks the parent if there is anyone to pick up the child. If not, the nurse contacts the Social Worker. The social worker speaks with the parent, and they are told the case may be escalated to the Department of Children and Families (DCF). The parents always find someone to pick up the child. Staff H stated this process is not dependent on the patient being admitted. When asked if there was a policy for this process, Staff H (ED Social Worker) did not know if there was a policy and stated this process was "learned from the manager".

During an interview on 05/21/2025 at 10:45AM, Staff J, (Associate ED Medical Director) stated all patients need to be seen and evaluated. Staff J reported, a medical provider is stationed in the triage area Monday through Friday from 10:00AM to 10:00PM. If there are no rooms available, the medical staff will come out to the triage area to see patients. Staff J stated, the case regarding Patient #1 was recently discussed with the Chief Medical Officer (CMO) and they are currently working on a policy to address the issue so that it doesn't happen again. Staff J stated, the decision is usually made where to take the patient in triage. The welfare of the child is also considered and depending on the age, the patient may be placed in the pediatric ED. The pediatric physicians are scheduled from 11:00AM to 11:00pm. When they are not here, all ED physicians are able to care for all pediatric patients. Staff J stated, there is no protocol for treating patients that come in with lethargy, difficulty breathing, swallowing, and sweating. Treatment is based on symptoms and presentation. When asked what the facility's policy is as it relates to the care of children or a child who presents to the facility with a medical complaint and/or an identified emergency medical condition (EMC), Staff J stated, pediatric patients are fast tracked and a message is sent. Security and the triage staff have walkie-talkies to get a room as quickly as possible. The pediatric nurse may come out to assess the child. All pediatric patients are transferred if inpatient hospital admission is needed.

During an interview with Staff K, (ED Physician) on 05/21/2025 at 11:45AM revealed, Staff K (ED Physician) has worked at the facility for many years. Staff K stated, all patients are always seen and it was very surprising to hear that a patient was not seen and evaluated because they had a child with them. We see patients with their children all the time. It's never been an issue that I'm aware of. The front desk should always notify the nurse manager if they are unsure of what to do in certain situations.

During an interview conducted with Staff L, (ED greeter/PCT) on 05/21/2025 at 12:40PM revealed, patients are told we don't let the child go into the adult ED with the parent. We will try to accommodate them by treating the parents on the side to make sure the child is safe. Staff L reported, they had received EMTALA training.

During an interview on 05/21/2025 at 3:40PM, Staff A (Risk Manager) stated that an Incident Report was not completed because the complaint about Patient #1 came through the Guest Relations Department. The surveyor was provided with investigative notes/staff interviews dated 04/30/2025. Staff A documented investigative notes and staff interviews, ED staff education was implemented (1) regarding the process for adult patients that present with minor children; that there were no barriers for medical care and (2) The process for escalation to the Charge Nurse, the Assistant Nurse Manager (ANM), and the Administrator in charge (AIC). Date completed 04/30/2025.

During an interview in the pediatric ED on 05/21/2025 at 12:55PM, Staff N (Pediatric ED RN) stated their capacity is 9 patients. Staff N reported, there are 7 private rooms and 2 hallway beds. Staff N, confirmed that the rooms are used on occasion for adult patients that have small children with them.

During an interview with Staff O, (ED Assistant Head Nurse) on 05/21/2025 at 1:10PM revealed, there was a recent ED meeting regarding the care of a patient that comes in with a child. The meeting was attended by the Risk Manager and Nurse Educator, and the ED staff were encouraged to focus on the patient's concerns first, then follow-up with caring for the child.