Based on review of facility policies, video recording, facility documents and interviews with staff (EMP), it was determined the facility failed to ensure that the Emergency Medical Treatment and Labor Act (EMTALA) policies the facility adopted were followed. Findings include: A review of the facility policy "COBRA/EMTALA Policy Statement" last reviewed February 2016 revealed, "The hospital will provide a medical screening examination to any person presenting for treatment to determine whether an emergency medical condition exists. When there is no verbal request, a request for a Medical Screening Exam (MSE) will be considered to exist if a prudent layperson observer would conclude based on the person's appearance and/or behavior, that the person needs emergency examination and/or treatment. The person will be taken to the emergency department for an MSE. A medical screening exam is provided to any individual who presents - regardless of diagnosis, financial status, race, color, national origin, or handicap. An interview conducted on March 13, 2017, at 9:00 AM with EMP1 revealed that the facility had done an internal investigation. They determined that EMP4 was on duty at the ambulatory entrance of the Emergency Department (ED) on February 25, 2017, when the patient's spouse came into the ED to request assistance getting the patient out of the vehicle and into the ED. After a failed attempt by EMP4 to get the patient out of the van, EMP4 was not sure what to do and did not notify the ED clinical staff or the Security commander of the situation or ask for assistance. EMP4 instead directed the spouse to take the patient home and call 911 for ambulance transport to the ED, which the spouse did. EMP1 stated that, as a result of these findings, they realized that the EMP4 did not really understand EMTALA and that additional training was needed. An interview conducted on March 13, 2017, at 9:15 AM with EMP3 revealed that neither they nor any of the ED clinical staff were made aware on February 25, 2017, of the two attempts by the patient's spouse to get assistance to get the patient out of the car and into the ED for medical evaluation. Further interview confirmed that ED clinical staff should have been notified of the patient's presentation to the ED and the need for assistance into the ED as per their practice. An interview conducted on March 13, 2017, at 11:10 AM with EMP4 revealed they remembered that on February 25, 2017, while on duty at the ambulatory entrance to the ED, a individual parked a vehicle outside the entrance and entered the building. The individual asked EMP4 if they could assist getting the patient out of the vehicle and into the ED. EMP4 stated they went out and attempted to get the patient out of the vehicle, but the patient would not move, just stared and would not respond. EMP4 then suggested to the individual that they go home and call 911. The individual drove off and returned a few minutes later and asked EMP4 again if there was anything that could be done. EMP4 stated that they asked EMP5 if they could assist and was told by EMP5 that they were not allowed to go out of the ED and assist patients. EMP4 explained this to the individual who then drove off with the patient. EMP4 stated that they did not remember having EMTALA training, was not able to verbalize what EMTALA meant and did not know about the EMTALA policy. An interview conducted on March 13, 2017, at 3:15 PM with EMP1 and EMP3 confirmed that EMP4 and EMP5, while on duty in the ED on February 25, 2017, did not follow the facility's EMTALA policy. A viewing on March 15, 2017, at 11:15 AM with EMP11 of the ED video recording without audio for February 25, 2017, from 12:01 PM to 12:11 PM, revealed a vehicle pulled up outside the ambulatory entrance of the ED and the driver entered the ambulatory vestibule and took a wheelchair out to the opened front passenger door. After a few moments, the driver re-entered the ED and spoke with EMP4 at the metal detector station. EMP4 was seen going out to the vehicle with the driver and looked like they were trying to assist the patient in the front passenger seat for about three minutes without success. EMP4 then returned to the ED with the empty wheelchair. The vehicle left and returned about four minutes later. The driver re-entered the ED ambulatory entrance and was seen speaking with EMP4 briefly. EMP4 appeared to look momentarily in the direction of where EMP5 was stationed. The driver then left the ED and drove off with the patient still in the vehicle. There were four cameras that showed different views of what happened but EMP5 was not seen in the video. A review on March 15, 2017, at 11:30 AM with EMP11 of the EMS trip report for the patient turned away from the ED on February 25, 2017, revealed, "Arrival at dispatched location 12:49 PM to find a large frame white individual sitting in passenger seat of mini-van in rear residence with spouse in attendance. ... . the spouse helped the patient into the mini-van to go to Crozer e/r. The spouse got to the hospital and the pt became rigid which made it difficult to remove the patient from the car. The spouse asked staff and they said they couldn't get the patient out either and they said to "drive home and call 911". ... . Spouse wants patient to be brought to CCMC e/r for evaluation. ... . Pt is making arms and legs rigid and resisting EMS attempts to remove from car. EMS moved pt's legs out of car and got pt upright and sat on stretcher with straps in place... pt loaded in Medic Ridley - 7. ... . Arrival at CCMC e/r 1:20 PM. Pt secured in e/r bed #24 with verbal report to e/r rn at bedside. No incident." An interview conducted on March 15, 2017, at 11:45 AM with EMP11 confirmed that EMP4 AND EMP5 did not follow the "COBRA/EMTALA Policy Statement". Further interview confirmed that EMP4 AND EMP5 should have notified security or ED clinical staff to assist getting the patient out of the vehicle and into the ED for medical evaluation and stabilization. .

Based on observations, review of facility policy, and interviews with staff (EMP), it was determined the facility failed to follow their policy that required Emergency Medical Treatment and Active Labor Act (EMTALA) signage be posted conspicuously in the Emergency Department (ED) in places likely to be noticed by all individuals entering the ED and areas other than the traditional emergency department. Findings include: Review of the facility "COBRA/EMTALA Policy Statement" last reviewed February 2016 revealed, "Signage: Signs are posted in the Emergency Department at both the Ambulance and the walk-in entrances, Labor and Delivery, Admissions, Pre-Admission Testing, Information Desk, Registration Areas and Crisis, as appropriate, to notify patients and visitors of their rights under Federal law with respect to examination and treatment of emergency medical conditions and women in active labor. Additionally, it specifies that the hospital participates in the Medicare Program. ... ." 1) Tour of the facility ED on March 13, 2017, at 11:00 AM with EMP2 and EMP3 revealed one Emergency Medical Treatment and Active Labor Act (EMTALA) sign in the ED on a recessed, non-prominent wall behind and to the right of the patient greeter/mini-registration station. Further tour of the ED revealed no other EMTALA signage posted conspicuously in the ambulance and walk-in entrances or other areas where patients would likely see the signs. An interview conducted on March 13, 2017, at 11:30 AM with EMP2 and EMP3 confirmed there was only one Emergency Medical Treatment and Active Labor Act (EMTALA) sign in the entire ED AND IT was not prominently displayed. Further interview confirmed the facility did not follow their EMTALA policy with regard to EMTALA signage in specified areas of the ED. 2) Tour on March 13, 2017, at 3:00 PM with EMP2 of Labor & Delivery unit, Admissions, Pre-admission testing, Information desk, (secondary) registration areas, and Crisis revealed no EMTALA signage present in Labor & Delivery, Pre-admission testing, Information desk, (secondary) registration areas and Crisis. An interview conducted on March 13, 2017, at 3:30 PM with EMP2 confirmed no EMTALA signage present in Labor & Delivery, Pre-admission testing, Information desk, (secondary) registration areas and Crisis. An interview conducted on March 13, 2017, at 3:45 PM with EMP1 confirmed that the facility failed to follow their EMTALA policy with regard to EMTALA signage in specified areas of the facility.