Based on document review and interview, it was determined the Hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24. Findings include: 1. The Hospital failed to ensure a patient who presented to the Emergency Department (ED) was captured in the ED Central log. (Refer to tag A 2405) 2. The Hospital failed to provide a medical screening examination. Refer to tag A 2406.

Based on document review and interview, it was determined that for 1 of 20 (Pt. #1) sampled patients, the Hospital failed to ensure a patient who presented to the Emergency Department (ED) was captured in the ED log. Finding include: 1. Pt #1 was a [AGE] year old male who presented to the Emergency Department (ED) on 7/27/14 and was greeted at 6:32 AM with a complaint of chronic pain. The record of the presentation contained an account number and the "Greeter Assessment" was completed to include vital signs (B/P, pulse, respiration, temperature, and Oxygen at 98 %). The record did not include any additional documentation in regards to this visit. 2. On 1/20/16 at 1:15 PM the Unit Director of Emergency Department (E #4) presented the ED log for the date of 7/27/14. Pt#1 could not be found in this log. 3. On 1/20/16 at 1:20 PM E #4 stated there is no ED log policy, although the Hospital maintains an ED log. E #4 stated the patients are entered in the log after they are triaged. E #4 stated this is the reason why Pt. #1 could not be found in the log. On 1/21/16, at 11:30 AM after reexamining their ED log, E #4 stated that Pt. #1 should have been found in the log but did not know why once the log was archived Pt #1 was not included in the log.

Based on document review and interview, it was determined that for 1(Pt #1) of 20 sampled patients who presented in the Emergency Department (ED), the Hospital failed to provide a medical screening examination (MSE). Finding include: 1. Policy entitled "Transfer of Patients from the Emergency Department" (Revised 6/2014) indicated "Procedure: 1. Medical Screening Examination: All individuals who come to the Emergency Department...will be provided the opportunity to receive a medical screening examination.... A mid-level provider or physician may perform the medical screening examination." 2 On 1/21/16 the The "Medical Staff Bylaws" (Revised 2013) and the Rules and Regulation (Revised 5/2012) were reviewed. These documents failed to designate or identify the qualified medical personnel who can provide the MSE, nor did it define who are the mid-level providers to perform the MSE in the ED, as stated in the policy. 3. Pt #1 was a [AGE] year old male (MDS) dated [DATE] at 6:35 AM with a complaint of chronic pain. A "Greeter Assessment" was completed that contained Pt #1's vital signs (temperature 37.3 Celsius, respirations 18, blood pressure 175/113, pulse 105 and pulse oximetry of 98%) and a past medical history of hypertension, and diabetes. No additional documentation was included in this chart for this visit. Subsequently, Pt #1 was not triaged nor received a medical screening examination (MSE). The "Patient Audit Trail" for this visit (7/27/14) indicated Pt#1's reason for visit to the ED was "Body Pain". On 7/27/14 at 6:57 AM the audit reflects the status event was edited "Checked-In /Pre-Registered Canceled". This audit does not reflect the reason why it was canceled. 4. On 1/21/16 at approximately 9:42 AM the Emergency Department Chairman (MD #4) was interviewed. MD #4 stated it is the expectation that every patient that presents to the ED is seen by a physician and/or midlevel provider for a medical screening examination (MSE) to determine the process to follow for the treatment of the patient. 5. On 1/21/16 at 10:00 AM the Director of the Emergency Department (E #4) was interviewed. E #4 stated the staff is also required to document the attempts of when the patient was called to be triaged. E #4 stated the staff are also required to document if the patient left without being seen. E #4 stated the staff failed to document what happened to this patient after he was greeted.