Based on a review of facility documentation and staff interview (EMP), it was determined that the facility failed to ensure each individual who came to the emergency department seeking assistance, whether he or she refused treatment, was refused treatment or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged , was placed on a central log. Findings include: A review of the facility's emergency room central log failed to include the name of an individual that presented on November 5, 2017. Interview with EMP1 on November 21, 2017, at 9:00 AM, confirmed the above findings. EMP1 stated, "no, [the individual] would not be on the log ... never registered [the individual]."

Based on a review of facility policies and documentation, and staff interviews (EMP), it was determined the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department. Findings Include: Review of facility policy and procedure "Emergency Medical Treatment and Active Labor Act (EMTALA)" last approved January 2017, revealed, "... E. Comes to the Dedicated Emergency Department with respect to an individual requesting examination and treatment for what may be an Emergency Medical Condition means that the individual is at the dedicated emergency department or outpatient provider based entity operated to treat emergency medical conditions without an appointment. An individual in an emergency vehicle on Hospital Property or premises is considered to have come to the Hospital's emergency department. ... Medical Screening Examination A. General Requirements. In general, when an individual comes by him or herself or with another person to the hospital Property or Premises, and appears to be suffering from an Emergency Medical Condition or expresses a complaint which could reasonably be construed as an Emergency Medical Condition, or who comes to the Dedicated Emergency Department requesting examination or treatment of a medical condition, the Hospital or a department thereof must provide for an appropriate medical Screening Examination with the Capacity and Capability of the hospital's emergency department or department to which the individual has presented to determine whether or not an Emergency medical Condition exists, or with respect to pregnant woman having contractions, whether the woman is in Labor. ... All such patients shall be recorded in the central log." Review of facility documentation revealed, "....hospital personnel received a call on Friday, 11/10, from a patient that had come to the ED (Emergency Department) on Sunday November 5th for a bee sting. [Patient] was concerned [he/she] was having an allergic reaction. The patient was seen in triage by the Advance Life Support (ALS) Tech. Per the patient, the ALS Tech informed [patient] that it did not appear that [he/she] was having an allergic reaction. Patient stated that the ALS Tech did not offer to sign [him/her] in and then left the ED without being seen by an MD. The ED Manager spoke with the ALS Tech. The Tech confirmed that the patient came to the ED and that he told the patient it did not appear as if [he/she] was having an allergic reaction (the site was approximately the size of a quarter and reddened)." A request was made to review the medical record of the individual that presented to the emergency department. The facility was not able to provide any record of the individual. Interview with EMP3 on November 20, 2017, at approximately 9:30 AM, confirmed the above findings. EMP3 stated, "the patient did come into the waiting area to check in. [ALS Tech] was at the window, he did not pre register [the individual]. There was no medical screening. There is no medical record." Interview with EMP4 on November 20, 2017, at approximately 11:15 AM, confirmed the above findings. EMP4 stated, "I took the phone call in the ED and [patient] said [he/she] wanted to bring it to the attention of someone. [Patient's] nephew dropped [him/her] off and left. When [patient] went to the window the gentleman at the window said [patient] obviously wasn't allergic to bees and didn't need to be seen by a doctor. After leaving that day [patient] went to [his/her] doctor and was started on pills." Interview with EMP5 on November 21, 2017, at approximately 9:30 AM revealed " She got stung by a bee and didn't want to die from it. She showed me her arm and there was a red spot about quarter size. I told her it looks pretty good for happening six hours ago. She wanted to know if she was going to die from it. Then she said I guess if I ' m not going to die, I don ' t need to be here."