Based on observation, staff and patient interview and record review, the facility failed to comply with the requirements of 489.24 with stabilizing treatment (See A-2407).

Based on observation and staff interview the hospital failed to ensure the posting of a sign specifying the rights of individuals under the EMTALA requirements within the emergency area entrance or waiting area. This has the potential to affect all individuals seeking treatment at the hospital emergency department. The emergency department has an average of 3,112 individuals seeking emergency services per month. Findings include: Tour of the hospital emergency department was conducted on 12/17/15 at 3:30 PM. Hospital Staff A and Staff D who accompanied the surveyor on tour confirmed the EMTALA posting was not visible to all patients seeking care in the emergency department. The emergency department entry and waiting areas were currently under construction. Staff F confirmed on 12/17/15 at 3:50 PM that the EMTALA posting had been covered up since the construction began on 11/30/15.

Based on medical record review and staff interview the hospital failed to provide an appropriate stabilizing treatment for two (Patient #'s 2 and 6) of 20 patients reviewed who presented to the emergency department for care. The total sample size was 20. The emergency department logs an average of 3,112 patients per month. Findings include: 1. Patient #2 (MDS) dated [DATE] at 9:40 PM with a chief complaint listed as "closed head injury, face laceration". At 9:42 PM the RN triage nurse triaged the [AGE] year old patient by asking the patient's mother to describe the reason for seeking care in the emergency department. The patient's mother stated, "he fell against the fireplace and cut his head, less than an hour ago." As part of the triage assessment, the triage nurse assigned the patient a 15 on the Glascow Coma Scale and documented, "appears in no apparent distress, behavior is appropriate for age, cooperative." At 9:54 PM the emergency department technician assessed the patient's vital signs including oxygen saturation and recorded the patient's weight in kilograms. At 10:44 PM the triage nurse documented, "Updated on and apologized for delays at this time. Mother states, "I think I'll just take him to Bluffton. Will I get charged a co-pay at both places if I leave?" Inquired about billing and advised mother that if not seen by ED MD, will not be charged for co-pay. Voiced knowledge." At 10:47 PM the triage nurse documented, "patient eloped, patient left the ED." The medical record does not contain documentation the patient was provided a medical screening exam by a physician after the triage assessment by the RN. 2. Patient #6 (MDS) dated [DATE] at 9:08 PM with a chief complaint listed as "lips swelling, sore throat". At 9:10 PM the RN triage nurse triaged the patient documenting that the patient's significant other reported, "He's been having swelling in his lips, loss of voice and sore throat for no apparent reason." As part of the triage assessment, the triage nurse assigned the patient a 15 on the Glascow Coma Scale and documented, "appears in no apparent distress, behavior is appropriate for age, cooperative." At 9:07 PM the emergency department technician assessed the patient's vital signs including oxygen saturation and respiratory rate. At 9:22 PM the emergency technician assessed the patient's vital signs again including oxygen saturation, respiratory rate and recorded the patient's current pain level a "5" on a 1-10 pain scale. At 10:07 PM the triage nurse documented, "Updated on wait time with voiced knowledge. Voices no further complaints, no signs/symptoms of acute distress noted." At 10:39 PM the triage nurse documented, "Informed of delays and apologized for delays again at this time. Wife states, "We are going to Bluffton, this is ridiculous....." At 10:43 PM the triage nurse documented, "patient eloped, patient left the ED." The medical record does not contain documentation the patient was provided a medical screening exam by a physician after the triage assessment by the RN. These findings were confirmed during interview with Staff A on 12/17/15 at 3:00 PM.