Based on a tour of the Emergency Department (ED), staff interview, and review of the Plan of Correction for the July 5, 2012 EMTALA survey, it was determined that the facility failed to conspicuously post signage specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment of emergency medical condition and women in labor or information indicating whether or not the hospital participates in the Medicaid program. Findings include: Reference: Plan of Correction, sent to CMS for the EMTALA survey conducted on July 5, 2012, page 3 of 9, number A2402, states, "Additional EMTALA signage is posted in the following areas: Emergency Department waiting area, Emergency Department Internal Triage, Emergency Department registration area, Emergency Department treatment/patient rooms ... Please see attached photos of existing signage." 1. Repeat deficiency from 7/05/2012: a. Observation of the patient treatment rooms in the Emergency Department (ED) on March 2, 2016 revealed signage was not posted conspicuously. The section of the sign regarding the rights of individuals under section 1867 of the Act, with respect to examination and treatment of emergency medical conditions and women in labor, and information indicating whether or not the hospital participates in the Medicaid program, was typed in a small font and covered only a very small portion of the paper, making it difficult to visualize. i. This paper sign was printed on a standard letter size paper that was approximately 8 ½ inches wide by 11 inches high. ii. The section of the paper concerning examination and treatment of emergency medical conditions and women in labor at the bottom of the paper was approximately 1-½ inches high and 5-¼ inches wide. This was not conspicuously posted. iii. The section of the paper concerning whether or not the hospital participates in the Medicaid program at the bottom of the paper was approximately 1/8 inch high and 5-1/2 inches wide. This was not conspicuously posted. b. Observation of the registration area in the ED on March 2, 2016 revealed signage was not posted conspicuously. The section of the sign regarding the rights of individuals under section 1867 of the Act, with respect to examination and treatment of emergency medical condition and women in labor and information indicating whether or not the hospital participates in the Medicaid program, was typed in a small font and covered only a very small portion of the paper, making it difficult to visualize. i. This laminated paper sign was printed on paper that was approximately 11 inches wide by 17 inches high. ii. The section of the paper concerning examination and treatment of emergency medical conditions and women in labor at the bottom of the paper was approximately 2 inches high and 7-1/2 inches wide. This was not conspicuously posted. iii. The section of the paper concerning whether or not the hospital participates in the Medicaid program at the bottom of the paper was approximately 1/4 inch high and 7-1/2 inches wide. This was not conspicuously posted. c. Signage in the registration area and the patient treatment rooms are not the same signs pictured in the plan of correction from the EMTALA survey conducted July 5, 2012.

Based on medical record review and staff interview it was determined that the facility failed to ensure all patients presenting to the ED are provided with a medical screening exam. Findings include: 1. Documentation in Medical Record #3 revealed the following: a. The patient presented on 1-2-16 at 22:21 PM with a complaint of a laceration to the upper lip. b. The patient was triaged at 22:31 PM and was moved to the waiting area. c. The patient left the ED on 1-3-16 at 03:28 AM, five hours and seven minutes after arrival. d. There was no documentation of a medical screening exam having been completed by a qualified medical professional for this patient. 2. Documentation in Medical Record #1 revealed the following: a. The patient presented on 9-6-14 at 15:15 PM for a crisis evaluation. b. The patient was triaged at 15:31 PM and was moved to the waiting area. c. The patient was screened by crisis at 17:35 PM. d. The patient left the ED on 9-6-14 at 19:16 PM, four hours and one minute after arrival. e. There was no documentation of a medical screening exam having been completed by a qualified medical professional for this patient. 3. Documentation in Medical Record #23 revealed the following: a. The patient presented on [DATE] at 17:45 PM with a complaint of left rib pain. b. The patient was triaged at 17:57 PM and was moved to the waiting area. c. The patient left the ED on 10-13-15 at 22:14 PM. Four hours and twenty nine minutes after arrival. d. There was no documentation of a medical screening exam having been completed by a qualified medical professional for this patient. 4. These findings were confirmed with Staff #6.