Based on interviews, record review and observation, the hospital failed to provide a medical screening exam on each individual who presented at the emergency department seeking medical attention. This deficient practice results in the potential for the hospital to overlook an emergency medical condition and fail to provide necessary stabilizing treatment or an appropriate transfer. The findings are: A. On 11/15/16 at 4:00 pm during a telephonic interview, Patient #1 stated she presented at the hospital ED on 11/07/16 and asked if there was a doctor who specialized in kidney failure. Patient #1 stated she was told to go next door to see a doctor as a walk-in as the ED is only for emergencies. Patient #1 informed the surveyor that if a video recording was available of her visit to the hospital ED on 11/07/16, she would appear as a slender woman with dark brown wavy hair of mid-back length, wearing boots, jeans, a jacket, and carrying a zebra-print hand bag. B. On 11/16/16 at 9:57 am during interview, Staff #1 stated she remembers Patient #1 asking for a kidney doctor. Staff #1 then stated she told Patient #1 to go next door (to a medical clinic) to see a doctor because Staff #1 did not know where to refer Patient #1. C. Record review of the video recording dated 11/07/16 revealed Patient #1 entering the ED at approximately (due to faulty time stamp) 8:30 am, appearing exactly as self-described in the interview with the surveyor on 11/15/16 at 4:00 pm. Video recording further revealed Patient #1 speaking with Staff #1 in the registration area. Patient #1 is then seen leaving the ED shortly after.

Based on interviews, record review and observation, the hospital failed to maintain a central log on each individual who comes to the Emergency Department seeking medical attention. This deficient practice produces the potential for the hospital to fail to process and thereby miss identifying an emergency medical condition when a patient presents at the Emergency Department (ED). The findings are: A. On 11/15/16 at 4:00 pm during a telephonic interview, Patient #1 stated she presented at the hospital ED on 11/07/16 and asked if there was a doctor who specialized in kidney failure. Patient #1 stated she was told to go next door to see a doctor as a walk-in as the ED is only for emergencies. Patient #1 informed the surveyor that if a video recording was available of her visit to the hospital ED on 11/07/16, she would appear as a slender woman with dark brown wavy hair of mid-back length, wearing boots, jeans, a jacket, and carrying a zebra-print hand bag. B. On 11/16/16 at 9:00 am during interview, the Quality Assurance (QA) Director stated that he received a call from the complainant a day or two later to report what happened in the ED registration (the QA Director did not provide a date or time when the complainant called). The QA Director stated he told the complainant to come back and get checked and he further asked if she needed an ambulance for transportation to the hospital. The QA Director then stated that the patient did not return to the hospital. However, the QA Director stated that the complainant informed him she had gone to a different hospital for treatment. C. On 11/16/16 at 9:57 am during interview, Staff #1 stated that she never writes anything down when patients leave the ED without being seen. Staff #1 further stated that in October 2016, approximately 3 patients left without being seen from the ED who weren't registered. Staff #1 stated she remembers Patient #1 asking for a kidney doctor. Staff #1 then stated she told Patient #1 to go next door (to a medical clinic) to see a doctor because Staff #1 did not know where to refer Patient #1. Staff #1 confirmed that Patient #1 did not get registered, but Staff #1 stated that she suggested to Patient #1 that the problem she was experiencing might be different than what Patient #1 thought (giving the patient "hints" that lower back problems could possibly be a urinary tract infection), and told the patient that the medical staff would evaluate the problem and help her if they could. However, Patient #1 reiterated that she wanted to see a kidney specialist (nephrologist), and left the ED. D. On 11/16/16 at 10:05 am during interview, the QA director was present during the interview conducted with Staff #1 and confirmed that Staff #1 appeared to have been diagnosing patients in the registration department. E. On 11/16/16 at 1:02 pm during interview, Staff #2 stated she may inform her supervisor if a patient leaves without registering. Staff #2 further stated she would not document a patient's departure because there is no place to document when a patient leaves without registering in the ED. F. On 11/16/16 at 1:20 pm during interview, Staff #3 stated that all patients presenting in the ED get registered per her protocol. G. On 11/16/16 at 1:35 pm during interview, Staff #4 she would contact her supervisor if a patient leaves and doesn't provide information for registration when presenting in the ED. Staff #4 further stated that she would leave notes on an email document this type of event and would ensure a date and time was provided to the supervisor. H. On 11/16/16 at 9:09 am, the Chief Nursing Officer provided a registration list from the ED dated 11/07/16 which revealed that Patient #1's name was not on the list. I. Record review of the video recording dated 11/07/16 revealed Patient #1 entering the ED at approximately (due to faulty time stamp) 8:30 am, appearing exactly as self-described in the interview with the surveyor on 11/15/16 at 4:00 pm. Video recording further revealed Patient #1 speaking with Staff #1 in the registration area. Patient #1 is then seen leaving the ED shortly after.