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Based on documentation review and interview, the hospital did not comply with the requirements of 42 CFR 489.24 as evidenced by a citation issued at 489.24(r) and 489.24 (c) A2406.

Based on a review of the central log maintained by the hospital's Emergency Department (ED) between December 17, 2009 and May 17, 2010, the hospital failed to ensure that the central log accurately reflected the discharge disposition of 18 of 30 patients who presented to the ED. Findings include:

The central log between December 17, 2009 and May 17, 2010 was reviewed and indicated the following:

Patient #14 presented to the ED on April 6, 2010 by ambulance with a fever. The discharge disposition for patient #14 indicates organ donor. A review of patient #14's ED record indicates that patient #14 was admitted to the hospital for intravenous fluid hydration.

Patient #4 presented to the ED on April 8, 2010 by private car with hives. The discharge disposition for patient #4 indicates organ donor. A review of patient #4's ED record indicates that the patient was discharged to home.

Patient #18 presented to the ED on April 11, 2010 by helicopter with status epilepticus. The discharge disposition for patient #18 indicates home/self care. A review of patient #18's ED record indicates that the patient was admitted to this hospital.

Patient #13 presented to the ED on May 2, 2010 for seizures. The ED visit lasted four days, sixteen hours and 43 minutes. The discharge disposition for the patient indicates AMA (against medical advice). A review of patient #13's ED record indicates that the patient did not stay four days in the ED, but was admitted to the hospital epilepsy unit.

Patient #1, 10, and 21's discharge disposition on the ED log indicated short term hospital. According to their ED records they were transferred to another hospital.

Patient #29 presented to the ED on May 12, 2010 due to intentional ingestion. The discharge disposition indicates NA. According to the patient's ED record the patient was transferred from another hospital and admitted to this hospital.

Patient #17, #22, #27, #25, #20, #7, #8, #2, #11, and #28's discharge disposition on the ED log indicates NA (not applicable). According to the patients' ED records, the patients were admitted to the hospital.

The hospital failed to provide a medical screening exam for one of thirty patients (#5) who presented to the emergency department (ED) requesting treatment. Findings include:

Patient #5 presented to the ED on May 6, 2010 with a laceration to his face. According to the documentation by employee (D)/triage nurse, the patient's Band-Aid was removed and there was no need for sutures. The patient left after triage.

Employee (D) was interviewed by phone on May 18, 2010 at 10:44 a.m., and said that she removed patient #5's Band-Aid to apply Lido. Patient #5's mom wanted to know if the laceration on the patient's cheek required sutures. Employee (D) stated that it did not, however, the patient could be seen by a physician and the laceration cleaned out. The patient's mother informed the nurse that she had cleaned the laceration out prior to presenting to the ED. Employee (D) stated that she explained the risks and benefits to the patient's mother, prior to patient #5 and his mother leaving the ED.

Physician (E) was interviewed on May 18, 2010 at 2:05 p.m., and stated that a physician or nurse practitioner determine if a laceration requires sutures. However, during the triage process if a parent or guardian is requesting to know if sutures are needed for a laceration on a child patient, the nurses can respond with absolutely, possibly, or probably not but let the physician take a look and make the determination.

The Rules and Regulations of the Professional Staff, indicate that the individuals authorized to perform a medical screening exam are physician members, Advanced Practice Registered nurse members, residents, or fellows under the supervision of an attending physician who follow physician approved protocols.