Based on document review and interview, it was determined that in 1 (patient #26) of 26 medical records (MR) reviewed of patients who presented to the hospital requesting emergency services, the facility failed to ensure compliance with 489.24 in that the facility failed to provide a medical screening exam. Findings include: 1. See findings cited at 42 CFR 489.24(1), C2406.

Based on observation & interview the facility failed to post conspicuously in a place or places likely to be noticed by all individuals entering the emergency department the sign specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; and to post conspicuously (in a form specified by the Secretary) information indicating whether or not the hospital or rural primary care hospital (e.g., critical access hospital) participates in the Medicaid program under a State plan approved under Title XIX for 1 of 2 entrances to the Emergency Department (ED). Findings include; 1. During the facility tour of the ED on 06-14-17 at 1000 hours, the main entrance of the facility lacked a posted sign specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor. A sign was observed on a wall by the outpatient registration area, however patients presenting to the ED would not see the sign when walking to the ED as the sign was not located near the hallway where patients would be presenting. 2. On 06-14-17 at 1000 hours staff #40 (Regional Quality) confirmed that ambulatory patients presenting to the ED may use the main entrance of facility.

Based on document review & interview, the facility failed to maintain a central log on each individual who comes to the emergency department, for 1 of 26 patients presenting to the facility. (Patient #26) Findings include: 1. Review of policy/procedure Emergency Medical Treatment and Active Labor ACT (EMTALA) indicated the following; E. Treatment Logs 1. The Emergency Department will maintain a log to track the care provided to individuals who present seeking care for a medical condition. The log will include patient identification, date of service, presenting complaint, physician / provider name and patient disposition. This policy/procedure was last reviewed/revised on June 2017. 2. Review of patient #26's medical record (MR) dated 06-04-17 at 0245 hours from facility #2 indicated the following; We arrive at facility #1 and are met in the ambulance bay by MD #1 advising that facility #1 will not be accepting this pt. 3. On 06-14-17 at 1030 hours staff #42 (Chief Nursing Officer) & 43 (Emergency Department Director)confirmed that on 06-04-17 at approximately 3 AM an ambulance was heard backing up to the ambulance area of the Emergency Department (ED). No patient came in the facility. When MD #1 was asked where patient was, MD #1 indicated he/she waved the patient on to another facility. 4. On 06-14-17 at 1035 hours staff #40 confirmed that patient #26's information was not listed in the facility's ED Log Book. 5. Review of the ED Log lacked documentation that patient #26 presented on [DATE].

Based on document review & interview the facility failed to ensure that written policies and procedures governing an appropriate medical screening examination of all patients presenting to the facility was followed for 1 of 26 Emergency Department (ED) medical records (MR) reviewed. (Patient #26) Findings include: 1. Review of policy/procedure Emergency Medical Treatment and Active Labor ACT (EMTALA) indicated the following; II. Scope A. This policy applies to all individuals who present to the IU Health Frankfort campus seeking attention for a medical condition, behavioral / psychiatric conditions, or women in labor. V. Policy Statement(s) A. Individuals who present to the IU Health Frankfort campus seeking attention for a medical condition shall receive a MSE. Should an EMC be identified, efforts to stabilize, within the Hospital's capabilities, will occur regardless of the individual's ability to pay. VI. Procedures A. Arrival and Requests for Attention for a Medical Condition 6. Individuals seeking attention for a medical condition and arrive to the hospital campus by ambulance shall receive an MSE. This policy/procedure was last reviewed/revised on June 2017. 2. Review of patient #26's medical record (MR) dated 06-04-17 at 0245 hours from facility #2 indicated the following; We arrive at facility #1 and are met in the ambulance bay by MD #1 advising that facility #1 will not be accepting this pt. 3. On 06-14-17 at 1030 hours staff #42 & 43 confirmed that on 06-04-17 at approximately 3 AM an ambulance was heard backing up to the ambulance area of the Emergency Department (ED). No patient came in the facility. When asked, MD #1 indicated he/she waved the patient on to another facility. 4. On 06-14-17 at 1035 hours staff #40 confirmed there was no MR for patient #26's visit on 06-04-17.