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Based on review of facility Medical Staff Bylaws, policy and procedures, medical records and staff interviews, it was determined that Emergency Department (ED) staff failed to provide an appropriate Medical Screening Exam (MSE) for one (P) (Patient #1) of 20 patients reviewed when she presented on 11/12/25 accompanied by a service animal requesting treatment for knee pain and swelling. Facility staff refused to allow the service animal in the ED patient care area and P#1 left after three hours without being seen.

Cross Refer to A-2406 as it relates to the facility's failure to provide a medical screening examination.

Based on review of facility Medical Staff Bylaws, policy and procedures, medical records, and staff interviews, it was determined that the Emergency Department (ED) failed to provide an appropriate Medical Screening Examination (MSE) to one patient (Patient #1) out of 20 patients reviewed who came to the ED seeking treatment. Specifically, P#1 presented to the ED on 11/12/25 at 5:05 p.m. with a complaint of knee pain and swelling. Facility staff refused to allow P#1's service animal accompany her to the ED patient care area and P#1 left without receiving a MSE.

Findings included:

A review of the Medical Staff Bylaws, approved by the Board on 11/6/2023, and Rules and Regulations of the Medical Staff, approved 11/7/2024, Article 5, Emergency Services, Section C, Medical Screening Examinations (MSE), revealed that an MSE must be provided to any person who came to the facility's Emergency Department or the Labor and Delivery Department and requested examination or treatment.

Review of the facility's policy titled, "Access to Emergency Medical Treatment", 11355, revised 1/30/20, revealed that it was the policy of the facility to provide an appropriate medical screening examination to any person who came to the ED and requested examination or treatment.

Review of the facility's policy titled "Service Animals" 10143, revised 5/3/23, revealed that the facility recognized the right of individuals with disabilities who were accompanied by service animals to independently access facilities and services. A person using a service animal had the same access to facilities as a person who did not have a service animal. Service animals were individually trained to do work or perform tasks directly related to an individual's disability. If the role of an animal brought into the facility was not immediately apparent, staff may have asked two questions: was the animal required because of a disability, and what work or task was the animal trained to perform? An individual with a service animal was not asked about the nature or extent of the disability. If the presence of a service animal raised an issue that was not described in the policy and staff were considering limiting the service animal's access to the facility, the issue would be referred to Risk Management for disposition. If a decision was made to exclude a patient's service animal, the reason for the exclusion would be documented in the medical record.

A review of the "ED Clinic Summary" for P#1 revealed that P#1 arrived in the ED on 11/12/25 at 5:05 p.m. "ED Triage Part 1" by the Registered Nurse (RN) II at 5:36 p.m. revealed that P#1 was complaining of worsening severe knee pain and swelling. P#1 had a service dog with her that was calm and well-controlled.

Review of Discharge Information revealed that P#1 left without being seen on 11/12/25 at 8:50 p.m.

Review of the End of Shift Report by the ED Supervisor (EDS) AA, no date/time, revealed that the a patient had an emotional support animal. After following the policy, and the matter was escalated to administration and, security was made aware that the dog could not stay. The patient left without being seen.

During a telephone interview with the complainant on 11/24/25 at 10:54 a.m., the complainant stated that after being told the animal was a service dog, the ED supervisor (EDS AA) asked what tasks the dog performed. EDS AA was not satisfied with the answers given and said the dog was an emotional support animal. P#1 felt obligated to disclose medical and psychiatric conditions in front of a crowded waiting room to convince EDS AA that the dog was a service animal. P#1 offered to show the dog's registration information, but EDS AA refused to see it. EDS AA told P#1 she would not be seen in the ED because of the emotional support animal. P#1 was placed in a wheelchair and backed into a storage area where wheelchairs were normally stored in the Emergency Department (ED). The triage nurse told P#1 to wait in that place until things could be sorted out. P#1 waited three hours to be seen in the ED and was never taken to an exam room. Security was called multiple times to report that an emotional support animal was in the ED. Patient Relations also came to talk to P#1 twice. P#1 left the ED after the person who was taking the blood pressures told P#1 that she was not going to be seen and after P#1 overheard EDS AA tell staff to call security again.

A telephone interview was conducted with the ED Supervisor (EDS AA) on 11/25/25 at 10:07 a.m. EDS AA said that he was called to the triage area because Patient #1 (P#1) had a dog. EDS AA reviewed the hospital's service animal policy and began asking P#1 the required service animal questions. P#1 stated the dog helped her stay calm. EDS AA said this answer fell under "emotional support," and emotional support animals were not permitted under hospital policy. EDS AA told P#1 the dog would need to leave, but P#1 would be allowed to stay. P#1 requested to speak with a supervisor. EDS AA contacted the House Coordinator. Security was also contacted after the discussion escalated. According to EDS AA, the decision was made that the patient could stay but the dog could not remain in the ED. EDS AA confirmed that P#1 remained in the ED for approximately three hours and was seated in the alcove area behind triage.

A telephone interview was conducted with the House Coordinator (HC BB) on 11/25/25 at 10:36 a.m. HC BB responded after receiving a call from the ED Supervisor regarding a patient with a dog. HC BB located P#1 in the lobby with a small dog in her lap. P#1 told HC BB that the ED staff said P#1 could not be seen with the dog. HC BB said the dog was calm and not disruptive.

An interview was conducted with the Supervisor of Security (SS CC) on 11/25/25 at 11:04 a.m. in the Boardroom. SS CC said security received a call regarding a patient in the ED with a dog. SS CC asked P#1 the two permitted ADA questions, and P#1 said the dog performed a task related to PTSD. SS CC said the dog appeared well-controlled and that P#1 answered both questions appropriately. SS CC said there was no reason to doubt the dog was a legitimate service animal. SS CC said removing a patient with a service animal from the ED would be an EMTALA violation and that there was no basis to tell P#1 or the dog to leave.

An interview was conducted with Security Corporal (SC DD) on 11/25/25 at 11:11 a.m. SS DD said security received a call about a patient with a dog. SS DD spoke with P#1, asked the two ADA service animal questions, and P#1 answered appropriately. SS DD notified the charge nurse that the dog was allowed to remain with the patient. SS DD told P#1 that no one should interfere with her regarding the dog.

A telephone interview was conducted with House Coordinator (HC EE) on 11/25/25. HC EE arrived in the ED at 7:00 p.m. HC EE had been informed that P#1 was concerned about whether she would be permitted to have a service animal in the ED. HC EE observed P#1 in the alcove area and noted the dog was calm. HC EE said the ED staff continued trying to determine whether the dog was permitted to remain under policy.

An interview was conducted with the Clinical Supervisor (CS FF) on 11/25/25 at 11:44 a.m. CS FF received a call indicating there was a dog in the ED and the situation was being handled by EDS AA. CS FF was later told by the House Coordinator that the dog needed to leave, and CS FF passed that message to EDS AA. CS FF said P#1 was approached multiple times about the dog. CS FF contacted security because staff had been questioning the patient repeatedly. CS FF said she was told P#1 would be seen, but the dog could not remain unless the service animal criteria were met. CS FF confirmed the patient had been spoken to multiple times regarding the dog.

A telephone interview was conducted with Clinical Supervisor (CS GG) on 11/26/25 at 10:11 a.m. CS GG said P#1 was in the alcove and reported being asked multiple times about the service animal. CS GG said several staff members, including ES AA, CS FF, and PR HH, had asked questions about the dog. CS GG said staff continued reviewing the policy because they were unsure if the dog qualified as a service animal. CS GG said P#1 told her the repeated questioning made her believe she would not be seen with the dog. CS GG said security confirmed the patient answered both ADA questions correctly, but staff continued reviewing policy and discussing whether the dog could stay.

A telephone interview was conducted with the Patient Relations representative (PR HH) on 11/26/25 at 10:17 a.m. PR HH was approached by the house coordinator concerning a patient who was upset about a dog. PR HH spoke to security and SS CC went with PR HH to see the patient. PR HH asked P#1 what task the dog performed. P#1 said it was for PTSD. PR HH asked for a rabies tag, because the tag was not visible. P#1 was trying to show PR HH something on her phone, but PR HH said the physical rabies tag was required. PR HH did not look at the phone. P#1 was in a wheelchair by herself, and PR HH asked if there was someone who would help with the puppy. P#1 said that if she was admitted, she would call a family member to care for the dog. PR HH told P#1 the dog could not go for testing. P#1 got upset and began to scream that nobody was going to separate her from the dog.

A telephone interview was conducted with ED Tech (EDT JJ) on 11/26/25 at 10:27 a.m. EDT JJ said he took P#1's vital signs and noticed a dog. EDT JJ did not think anything of the dog because patients could have service animals. It was clear that leadership was aware of the dog. EDT JJ said P#1 verbalized that she was unhappy about waiting in alcove and mentioned that ES AA had been watching her. The dog was very well-behaved. EDT JJ was not sure why P#1 left the ED. It had been a very busy night and not uncommon for patients to be frustrated with waiting times. P#1 told EDT JJ that she did not think she was going to get a room.

A telephone interview was conducted with the ED Medical Director (MD MM) on 11/25/25 at 12:11 p.m. MD MM said that when a patient arrives with an animal, staff would ask whether the animal was a service animal or a pet. If the animal was a service animal, the patient would be allowed to remain and would not be treated differently than other patients. MD MM said the first step would be to contact Risk Management for directions, and in general the ED would err on the side of accommodating the situation. Staff were expected to take care of the patient.

An interview was conducted with the ED Nurse (RN) Manager (NM NN) on 11/25/25 at 1:42 p.m. in the Boardroom. NM NN learned the next morning that a patient had presented to the ED after 5 p.m. with what staff believed was an emotional support animal. The situation had been escalated to the house coordinator, patient relations, and security. The patient left without being seen.

An interview was conducted with the ED Tech (EDT JJ) on 11/26/25 at 10:27 a.m. EDT took P#1's vital signs in the alcove. EDT JJ noted that P#1 had a dog but did not question it. EDT JJ said P#1 was upset and frustrated about waiting and about staff repeatedly questioning her about the dog. The dog was well behaved. P#1 later left the ED.

A telephone interview was conducted with Risk Management (RM OO) on 11/26/25 at 10:35 a.m. RM OO said she was called after hours by ED staff. RM OO said a patient presented to the ED with what they believed was an emotional support animal. RM OO said staff were trying to arrange for someone to come get the dog. The patient told staff that a family member could come pick up the dog. ED staff asked whether they could call the family member to retrieve the dog. RM OO told the staff that it was acceptable to call.

An interview took place with ED Tech (EDT RR) on 11/26/25 at 11:02 a.m. in the Boardroom. EDT RR said P#1 came to the ED and was registered at the front desk. EDT RR brought P#1 to Station A and did vitals. The dog was well-behaved. Someone at registration let the supervisor know there was a dog. The supervisor came to discuss the dog and what services the dog provided. P#1 was upset.