Based on hospital policy review and medical record review, the hospital failed to comply with 42 CFR 489.24. The findings include: Central Maine Healthcare, Administrative Policy No.: HC-ED, SUBJECT: Emergency Medical Treatment and Active Labor Act (EMTALA) stated: -"POLICY: To ensure that all patients presenting to a CMH's hospital requesting emergency services receive an appropriate medical screening examination within Hospital's capability to determine whether or not an emergency medical condition exists. If a patient is determined to have an emergency medical condition, then Hospital will either stabilize and/or transfer the patient in accordance with the Emergency Medical Treatment and Active Labor Act (EMTALA)." -Comes to the Emergency Department: Is defined as the individual (not yet a patient): Presents at the Hospital's Emergency Department or on hospital property and examination or treatment for a medical condition is requested or it can reasonably be inferred that the individual needs evaluation or treatment for a medical condition; Patient #1 presented at the hospital's Emergency Department (ED) on October 28, 2017 at approximately 10:08 AM, seeking care. A hospital security log and a police report indicated that Patient #1 completed the ED registration process and remained seated at the ED registration desk. Documentation obtained indicated that Patient #1 became uncooperative prior to being triaged (assessed for level of illness/injury), and was eventually removed from the ED by security and placed under arrest by the police. The registration log entry was deleted from the ED log, causing this patient encounter to not be seen in the Emergency Department Log. Additionally, the hospital failed to provide a medical screening examination for an individual presenting to a CMH's hospital requesting emergency services.

Based on Emergency Department observations, the hospital failed to ensure required signage was posted conspicuously. The findings include: While conducting observations of the Emergency Department and areas in which patients may enter or be waiting to be seen by the emergency department providers between May 14, 2018 and May 15, 2018, it was noted that the signage in place was not conspicuous. Upon entering the emergency department (ED) walk in entrance adjacent to the security entrance, there was one sign noted that stated "Emergency Department Notices" which was obstructed and not in an area likely to be noticed by patients entering for ED services as there was a sign immediately in front of it stating: "MRI registration and waiting area." On the side of the ED registration window was a small 8.5 x 11 inch piece of paper which had wording stating, "IT'S THE LAW" in 4 different languages, but it was not of sufficient size or location to be seen or noticed by all entering. Within the ambulance entrance area was a small 8.5 x 11 inch piece of paper which had wording stating, "IT'S THE LAW" in 4 different languages, but it was not of sufficient size or location to be seen or noticed by all entering. This paper was covered in plastic and located directly above the heating control and on the wall between the emergency department entrance wall and a large glass encased bulletin board on the wall. In an interview conducted with several Emergency Medical Services (EMS) staff on the dates of observation, the surveyor was informed that approximately 70% of the patients they bring into the hospital are seated upright and able to look forward as they enter the emergency department. None of the EMS staff could read the posted signage standing next to their stretchers and one stated "it would be next to impossible for someone on a stretcher to read the sign as posted.

Based on record review, the facility failed to register all individuals in a central log who came to the emergency department seeking care, in 1 of 16 Emergency Department (ED) patients (Patient #1). Findings include: The Emergency Department log was received on 5/14/18 at approximately 5:18 PM. This log failed to identify an entry for Patient #1's name on October 28, 2017. A review of the Emergency Department security log provided on May 16, 2018 at approximately 1:40 PM, indicated entry 17-5156; that Patient #1 arrived at the hospital Emergency Department on October 28, 2017 at approximately 10:08 AM. Security log entry stated: "[Patient #1] JUST PRESENTED TO THE ER ...ADVISED THAT IF [HE/SHE] NEEDED TO BE SEEN TO REGISTER ... PT REFUSES TO COOPERATE AND IS ESCALATING. ESCORTED OUT OF ER @1020 BY [security]. LPD [police department] CALLED @ 1021. SUBJECT PLACED UNDER ARREST @ 1039." Document titled "LPD Statement Related to IR 17-5156" was provided on May 21, 2018 at approximately 2:45 PM. This document included a photograph of a police statement, dated October 28, 2017 at 10:45 AM, completed by RN #8. The police statement indicated: "[Patient #1] arrived to the Central Maine Medical center waiting room at approximately 10:15 AM. Upon registration [his/her] chief complaint was to demand an MRI exam for self reported brain cancer. [Patient #1] refused to proceed with the triage process and refused to self ambulate to an exam room for medical examination ... [Patient #1] has been medically evaluated for similar complaint recently and has been deemed mentally competent with most recent consultation of October 25, 2017. [Patient #1] has been told that if [he/she] can comply with the medical evaluation process [he/she] will be evaluated at any time. [He/She] is denying intent to self harm at this time." Document titled "Canceled Registration 2017.10.28" was provided on May 21, 2018 at approximately 2:45 PM. This document demonstrated that Patient #1 was registered to the Emergency Department on October 28, 2017 at 10:15 AM, although the ED log failed to show that patient registered on that date and time.

Based on record review, the facility failed to provide a screening examination to a patient who came to the emergency department seeking care in 1 of 16 (Patient #1) Emergency Department (ED) patient records reviewed. The finding includes: Patient #1 presented on October 28, 2017 at approximately 10:08 AM seeking emergency care. The patient reportedly was seeking an examination to rule out brain cancer. The patient was registered as an ED patient, however; was described as uncooperative with the nursing triage process and was removed from the ED by security and police prior to receiving a medical screening examination. Documentation provided by the hospital indicated that Patient #1 was arrested and removed from the hospital property. (See Tag A-2405).