Based on findings from document review and interview, the facility failed to comply with the requirements for 489.24 and the related requirements of 489.20. Findings include: -- Please see specific findings under Tags A2403, A2406 and A2409.

Based on findings from document review, medical record (MR) review and interview, the hospital did not retain a complete and accurate MR for Patient A. Specifically, Patient A eloped from the emergency department (ED) and his/her electronic MR (EMR) was deleted then recreated. Findings include: -- On 6/2/15 at 9:30 am, review of the "Emergency Department Sign-In Log" revealed Patient A (MDS) dated [DATE] at 9:07 pm. Review of the EMR, for Patient A, supplied by the hospital on [DATE] at 10:25 am, revealed Patient A (MDS) dated [DATE] at 9:15 pm. The next EMR entry indicates that on 5/18/15 at 2:39 am the patient had eloped and at 2:45 am that the patient left the ED. This EMR contained no further documentation. -- During interview with Staff #1 on 6/2/15 at 10:20 am, when queried as to why information in Patient A's EMR was inconsistent, Staff #1 revealed Patient A's initial EMR was deleted so the EMR was recreated.

Based on findings from document review, medical record (MR) review and interview, the hospital failed to ensure that a patient (Patient A) had a medical screening exam (MSE) after he/she jumped from the 4th floor level of a parking garage on the hospital campus and sustained obvious injuries. Staff (Staff #3, #4, #5, #6), even though trained in EMTALA, lacked knowledge of EMTALA regulations and did not respond appropriately to this injured patient. Findings include: -- Per interview with Staff #3 on 6/3/15 at 8:00 am, Patient A jumped from the ledge on the 4th floor of the parking garage. Patient A was found on the ground with obvious deformity of a leg and arm and was talking/moaning in pain. -- Per interview of Staff #6 on 6/3/15 at 11:15 am, upon seeing Patient A sitting on the parking garage ledge, he/she called 911 and the Nursing Supervisor (Staff #4). -- Per interview with Staff #4 on 6/3/15 at 9:00 am, when he/she arrived to the injured patient (Patient A) he/she instructed staff not to touch the patient as they did not have the necessary training and the best way to care for the patient was for EMS to provide the care. Staff #4 also indicated (even though trained in EMTALA per review of education files) that the hospital campus is considered 250 feet from main entrance instead of 250 yards from hospital. -- Per interview with Staff #5 on 6/2/15 at 2:20 pm, someone called into the ED and asked the ED physician (Staff #5) to assess Patient A's wrist for vascular stability. Staff #5 indicated he/she performed a cursory assessment of Patient A in the ambulance. Staff #5 did not order blood tests, x-rays or other tests to determine if Patient A had additional injuries. Staff #5 did not document the assessment in a MR. -- Per review of the hospital's 2015 EMTALA mandatory education on 6/2/15 at 8:00 am, Staff #3, #4, #5, and #6, all completed 2015 EMTALA training on 1/11/15.

Based on findings from interview, the facility failed to effect an appropriate transfer to another medical facility. Findings include: -- Per interview with Staff #5 (emergency department physician) on 6/2/15 at 2:20 pm, when questioned, he/she indicated a certification, based upon the information available at the time of transfer, that the medical benefits of transfer to another medical facility outweighed the increased risks to Patient A was not signed. Staff #5 also acknowledged the hospital did not determine if the receiving facility had available space and qualified personnel for the treatment of the individual and that they agreed to accept transfer of the individual. Staff #5 also acknowledged the hospital did not send (to the receiving facility) any medical record information and the hospital did not obtain consent for transfer of Patient A from his/her legally responsible person acting on his/her behalf and inform them of the risk of transfer.