Based on review of policies, procedures, hospital documents, Emergency Department Logs, and interviews with staff, it was determined the hospital failed to include 1 of 1 patient (Pt #1) on the central log who presented in respiratory distress, diaphoreses, and ashen color. This failure could result in the potential risk of patients not being evaluated by Emergency Department personnel. Findings include: The hospital policy titled EMTALA included: "...Central Log...The Hospital must maintain a central log of individuals who come the the emergency department and include in such a log whether such individuals refused treatment, were refused treatment, or whether such individuals were treated, admitted , stabilized, and/or transferred or were discharged . The log must register all patients who present for examination or treatment, even if they leave prior to triage or MSE..." According to the hospital's document dated 10/07/13, included the following: "...Mr. (name of Patient #1) was discharged at approximately 1730 on 10/06/13 with a spare O2 tank to use until (name of home health) delivered O2. The patient woke up with SOB (shortness of breath) and found tank empty and came to the ER (emergency room ). His sat (oxygen saturation) was 72% and he was put on O2 by (Emergency Department Charge Nurse Employee # 13) and his sats came up to 95%...." Review the ED Log for 10/07/13, revealed, Patient #1 was not entered into the ED Central Log. Employee #1 and #13, confirmed on 02/11/15, that Patient #1 was not enter into the log. Interviews with the employees on duty in the ED on 10/07/13, at 0100 hours were conducted. One employee (#14) was no longer employed at the hospital and was not interviewed. Employee #13 was interviewed on 02/11/15, at 1400 hours. She was the ED Charge Nurse on duty when Patient #1 returned to the ED on 10/07/13. Employee # 13 remembered Patient #1 and explained he returned to the ED on 10/07/13. Patient #1 he was diaphoretic, ashen, with labored breathing. He was upset that he hadn't been sent home with enough oxygen. She took the patient back to the triage area in the ED and placed him on oxygen. His O2 saturation on room air upon arrival was 72%. After applying oxygen, his saturation levels increased to 95%. Employee #14 was also with her in the triage area taking care of the patient. She confirmed she knew the name of the patient and that she did not document any findings in a medical record for Patient #1. She confirmed that Patient #1 was not entered into the ED central log. Employee #22 was interviewed on 02/17/15, at 1517 hours. He was a Respiratory Therapist on duty the night of 10/07/13. He remembers Patient #1. He explained that Employee #14 called him to get 2 E-Cylinders of oxygen for Patient #1. He saw Patient #1 in the triage area, on a gurney with oxygen administered via nasal cannula. His oxygen saturation at this time was 95% and he remembers thinking "that's acceptable." He assisted Patient #1 and family member to the car and helped load the 2 O2 tanks in the car.

Based on review of policies,procedures, hospital documents, and staff interviews, it was determined that the hospital failed to provide a medical screening examination for Patient #1, who presented to the ED with respiratory distress, diaphoreses and ashen color, on 10/07/13. This failure could result in the potential harm for a patient with an emergency medical condition. Findings include: The hospital's policy titled EMTALA required: "...If an individual comes to the Emergency Department: A. The Hospital will provide an appropriate medical screening examination within the capability of the Hospital's Dedicated Emergency Department, including ancillary services routinely available, to determine whether or not an emergency medical condition exists..B. Medical Screening Examination 1. The Hospital shall provide a medical screening examination to any individual who comes to the Emergency Department...." Patient #1 was discharged from the hospital on [DATE], after a cerebral vascular accident. He was sent home with an oxygen tank from the hospital. According to Patient #1 he awoke in the middle of the night short of breath, as the oxygen tank was empty. He returned to the ED on 10/07/13 around 0100 hours. Employee #13 was interviewed on 02/11/15, at 1400 hours. She was the ED Charge Nurse on duty when Patient #1 returned to the ED on 10/07/13. Employee # 13 remembered Patient #1 and explained he returned to the ED on 10/07/13, he was diaphoretic, ashen, with labored breathing and "looked horrible." Patient #1 was upset that he hadn't been sent home with enough oxygen. She took the patient back to the triage area in the ED and placed him on oxygen. His O2 saturation on room air upon arrival was 72%. After applying oxygen, his saturation levels increased to 95%. According to her, Patient #1 was refusing to be checked into the ED and said he didn't want another bill and he did not want to see a physician. She confirmed Patient #1 did not see a provider for a medical screening examination, as he was refusing treatment. Patient #1 did not sign out Against Medical Advice. Employee #22 was interviewed on 02/17/15, at 1517 hours. He was a Respiratory Therapist on duty the night of 10/07/13. He remembers Patient #1. He explained that Employee #14 called him to get 2 E-Cylinders of oxygen for Patient #1, since he had ran out of oxygen and was awaiting delivery of oxygen by the Home Health Agency. He saw Patient #1 in the triage area, on a gurney with oxygen administered via nasal cannula. His oxygen saturation at this time was 95% and he remembers thinking "that's acceptable." The patient was joking with him, speaking in full sentences and asking questions about the O2 tanks. He assisted Patient #1 and the family member to the car and helped load the two O2 tanks in the car. The hospital sent Patient #1 a letter dated 10/25/13. The letter contained the following information: "...In order to thoroughly investigate your concerns we reviewed your medical records and interviewed the care team that facilitated your discharge on October 6 as well as the staff that rendered treatment to you in the ED on October 7...Upon arrival the ED staff checked your oxygen saturation and found it to be (approximately) 78%. They placed oxygen on you. It is the staff's recollection that you informed them that you did not want to be registered or admitted because you were not going to have your insurance company pay another bill for the 'lack of proper oxygen given to you.' The Nursing Supervisor made arrangements for you to be provided two loaner oxygen tanks until the situation surrounding you home oxygen delivery could be resolved...Prior to your departure, ED staff checked your oxygen level and found it had increased to (approximately) 94%...." Patient #1 (MDS) dated [DATE] around 0100 hours. He was diaphoretic, ashen, with labored breathing according to nurses. He was treated by nurses in the Triage area and given oxygen. The patient did not sign out AMA and he was not given the risks of leaving without treatment. The patient did not have a medical screening examination. Employee #'s 1 and 13 confirmed Patient #1 did not see a provider.