Based on documentation review and interview, the hospital failed to ensure compliance with the requirements of 42 CFR 489.24 as evidenced by the deficient practice cited in 489.24 (a) and (c). The hospital failed to ensure all patients who presented to the Emergency Department (ED) received an appropriate medical screening examination (MSE).

Based on documentation review and interview, the hospital failed to maintain an accurate central log for 1 of 22 patients (P22) reviewed who presented to the emergency department (ED). Findings include: Review of a police report, dated 2/22/16 at 10:09 p.m., noted law enforcement transported P22 to the hospital from the community, met with a staff member who advised an ambulance be called to transport P22 to another hospital. On 3/10/16 at 3:45 p.m., there was no documentation or any other indication that P22 (MDS) dated [DATE]. Employee C-Quality Risk Manager verified there was no evidence documented that P22 (MDS) dated [DATE]. Review of the central log for the ED from 2/20/16-2/25/16 was conducted. P22 was not listed on the central ED log. Review of Examination and Transfer of Emergency Patients (EMTALA) policy, last revised 5/10, was completed. The policy noted: "I. Central Log. A central log shall be maintained as to each individual who comes to the Emergency Department, recording whether he or she refused treatment, was refused treatment-and the reason for the refusal, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged . "An interview was conducted on 3/10/16 at 11:00 a.m. with the chief nursing officer and she said the EMTALA process included noting the individual in the ED central log when the individual presented to the ED.

Based on documentation review and interviews, the hospital failed to provide a medical screening examination for 1 of 22 patient medical records (P22) reviewed for patients who presented to the Emergency Department (ED). Findings include:Review of a police report, dated 2/22/16 at 10:09 p.m., noted law enforcement transported P22 to the hospital, met with a staff member who advised an ambulance be called to transport P22 to a second hospital. Review of the Ambulance Patient Care Report, dated 2/22/16 at 11:00 p.m., noted " Police brought (sic) male to Tracy Hospital. Ambulance paged to hospital for transfer of male to Marshall. " Review of the second hospital documentation, dated 2/22/16, noted P22 was intoxicated, had a malformed arm, and complained of chest pain while in their ED. The chest pain was found to be likely non-cardiac related. P22 was found to have a seven month old arm fracture which was not previously repaired. P22 was found to be acutely intoxicated. The hospital kept the patient overnight for observation. P22 was discharged home to next day. On 3/10/16 at 3:45 p.m. the hospital had no documentation that P22 received a medical screening exam on 2/22/16. Employee C-Quality Risk Manager verified there was no documentation for P22 related an ED visit, which included no documentation of a medical screening exam by a provider. An interview was conducted with Nursing Assistant (NA)-J on 3/11/16 at 7:30 a.m. and she stated she met law enforcement in the parking lot of the hospital and determined P22 needed to go by ambulance to another hospital. NA-J stated she did not notify the other staff specifically to tell them P22 was in the parking lot. P22 did not receive a medical screen exam by a physician at the hospital because staff did not notify the physician that P22 presented for an emergent medical condition. An interview was conducted with Nurse K on 3/11/16 at 9:10 a.m. and she said received a telephone call that P22 would be brought to the hospital by law enforcement. Nurse K was not alerted when P22 presented to the hospital parking lot so did not assess P22 or call the physician to conduct a medical screening evaluation. An interview was conducted with the chief nursing officer on 3/11/16 at 10:25 a.m. who stated NA-J works as a nursing assistant but also as a paramedic in the ED when delegated by the RN or physician to do so. The chief nursing officer said paramedics do not provide a medical screening evaluation for ED patients. A paramedic may greet and escort the individual to the ED. The paramedic may then log the individual into the computer and provide cares as directed by the nurse or physician. Review of the information received from Nursing Assistant-J after the incident revealed the hospital EMTALA process was not followed. NA-J was working as a nursing assistant on 2/22/16 when P22 presented on hospital property. The physician was not notified and P22 was not provided with a medical screening exam before taken by ambulance to another hospital. Review of the Examination and Transfer of Emergency Patients policy and procedure, revised last 5/10, noted " Procedures: A. Medical Screening Examination. For any individual presenting to the Sanford Tracy Medical Center campus, and for those on whose behalf a request for examination or treatment for a medical condition is made, an appropriate medical screening examination will be provided by qualified medical personnel within the capabilities of the Emergency Department ...to determine whether or not am emergency medical condition exists. Sanford Tracy Medical Center campus defines qualified medical personnel as being physicians, physician assistants, and nurse practitioners. " An interview was conducted with the chief nursing officer on 3/11/16 at 10:25 a.m. who stated NA-J works as a nursing assistant but also as a paramedic in the ED when delegated by the RN or physician to do so. The chief nursing officer said paramedics do not provide a medical screening evaluation for ED patients. A paramedic may greet and escort the individual to the ED. The paramedic may then log the individual into the computer and provide cares as directed by the nurse or physician. Review of the information received from Nursing Assistant-C after the incident revealed the hospital EMTALA process was not followed. NA-J was working as a nursing assistant on 2/22/16 when P22 presented on hospital property. The physician was not notified and P22 was not provided with a medical screening exam before taken by ambulance to another hospital.