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Based on document review and interview, the facility failed to provide a medical screening exam (MSE) for 1 of 20 medical records reviewed (patient #1).

Findings Include:

1. See findings cited at 42 CFR 489.24, A2406.

Based on document review and interview, the facility failed to provide a medical screening exam (MSE) for 1 of 20 medical records reviewed (patient #1).

Findings include:

1. Facility policy titled "EMTALA: Emergency Medical Screening, Stabilization and Transfer" last revised on 5/2024, indicates on page 1 under policy statements that EMTALA requires hospitals that participate in Medicare to provide a medical screening examination to any person who comes to the emergency department, regardless of the individuals ability to pay. Page 2 indicates under 1. Medical Screening Examination: The Hospital must provide an appropriate medical screening examination (MSE). An "appropriate MSE" is: a. An exam performed within the capability of the Hospital's emergency department, including any ancillary services routinely available to the ED (e.g. x-ray, lab services etc.), to determine if an emergency medical condition exists or not.

2. Review of patient #1's medical record from Facility #1 (Critical Access Hospital) indicated the following:

A review of Patient #1's Emergency Department Summary Report for Facility #1 dated 10/15/24 indicated the patient arrived via walk in to the emergency department on 10/15/24 at 9:46 p.m. with an acuity level of 3. Patient #1's chief complaint was a fall. Patient tripped on uneven ground and hit (his/her) left wrist. Family reports that (he/she) has passed out 4 times in the car ride over. ED vitals on 10/15/24 at 9:52 p.m. indicated the following: heart rate: 125 beats per minute, blood pressure: 168/98 mmHg (millimeter of mercury),

ED Disposition: Left Without Being Seen after triage: States they cannot wait for a room and are going to call an ambulance. The MR for patient #1 lacked a MSE performed at facility #1.

3. Review of patient #1's medical record from Facility #2 indicated the following:

A review of Patient #1's Emergency Department Summary from Facility #2 dated 10/15/24 indicated the following: Patient #1 was brought via EMS (Emergency Medical Services) to the Emergency Department at Facility #2 on 10/15/24 at 10:37 p.m. and was discharged on 10/16/24 at 1:00 a.m. with a diagnosis of a left radius fracture. Patient was given short-term pain medicine for home and plan to have (him/her) follow-up as an outpatient with orthopedics.

4. During an interview with Family Member #2 on 11/8/24 at 10:10 a.m., Family Member #2 indicated Patient #1 was registered and had an arm band at Facility #1 ED. Family Member #2 indicated that the nurse initially came out and took Patient #1's blood pressure and stated that the rooms were full, and it would be a while, but if the patient loses consciousness again to have the receptionist let (him/her) know. Family Member #2 indicated that the receptionist would not go get the nurse when Patient #1 went unconscious again and indicated that they would need to go to Facility #2. Family Member #2 indicated that (he/she) told the receptionist that you cannot turn us away. So, the Family Member #2 called 911, while they were on the premises of Facility #1 and 911 said to go out on to the street and call 911 to get an ambulance transport to Facility #2. EMS transported Patient #1 to Facility #2. Family Member #2 indicated that Patient #1 had a fall that ended up with multiple fractures to left arm and was the reason for the cycling of (his/her) in/out of consciousness.

5. During an interview with N2 on 12/2/24 at 4:42 p.m., N2 indicated that they worked as Charge Nurse in the Emergency Department on 10/15/24 and only remember that Patient #1 had left the ED before being seen by a provider.

6. During an interview with N1 on 12/2/24 at 4:44 p.m., N1 indicated that they worked on 10/15/24 when Patient #1 had come into the ED. N1 indicated that Patient #1 had never lost consciousness when they were in the ED. N1 indicated that Patient #1 was complaining of pain in (his/her) left wrist, was sitting in a wheelchair and had (Family Member #2) with them. N1 indicated that Patient #1 had a sling/cloth wrapped around (his/her) left shoulder/elbow to support their arm when they came into the facility. N1 indicated that (Family Member #2) kept asking to have Patient #1 go back into an ED room before anyone else because Patient #1's arm was broken. N1 indicated that (he/she) told them that they could not make an exception and that they go by the ESI (Emergency Severity Index) system. N1 indicated that they had a full waiting room/ED. N1 indicated that (Family Member #2) was observed to be on the phone when (Family Member #2) and Patient #1 left the facility.

7. During an interview with A2 on 12/3/24 at 9:49 a.m., A2 verified the medical record information for Patient #1.

8. During a phone interview with Patient #1 on 12/3/24 at 4:52 p.m., Patient #1 indicated that while (he/she) was in the ED waiting room of Facility #1, (he/she) kept going in and out of consciousness. Patient #1 indicated that Family Member #2 had went to the registration desk and told them that I kept going in and out of consciousness and that (he/she) was really worried about (him/her). Patient #1 indicated that they told Family Member #2 that if they wanted to be seen that Family Member #2 would need to take Patient #1 to another hospital, so Family Member #2 wheeled (him/her) out to the parking lot and started driving down the road and (he/she) stopped, called 911 because started having breathing problems. Patient #1 indicated that an ambulance came, gave (him/her) pain medications and it helped (him/her) from going in and out of consciousness as much.