Based on a review of facility policy and documentation, and staff interviews (EMP), it was determined that the facility failed to provide an appropriate medical screening examination (MSE) to evaluate for an emergency medical condition within the capabilities of the facility for one patient who was transported to the facility by ambulance and subsequently diverted to another facility without being screened by a physician or qualified medical professional. Findings include: 1) Review of facility policy "Emergency Medical Treatment and Active Labor Act (EMTALA) " last revised on September 22, 2014, revealed "...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...B. When a Medical Screening Examination is required 1. If an individual arrives on the Hospital Property or Premises or an off-campus dedicated Emergency Department and is not technically in the Hospital Emergency Department, and requires emergency care, he or she must receive a Medical Screening Examination within the Capacity and Capabilities of the Hospital. Movement of the patient to the Hospital's Emergency Department may be necessary for screening. However, common sense and individual judgment should prevail. In exercising such..." 2) Review of Ambulance Trip Sheet dated January 21, 2016 revealed at 20:39 "...Contacted [the facility] requested activation of cath lab from bedside, advised [the facility] 12 lead would be sent when crew arrives at truck...20:42...12 lead transmitted to [the facility]...20:44...[ambulance] went reroute to [the facility], upon turning into parking area of ER (emergency room ) [ambulance)] was notified by dispatch to divert because [the facility] could not handle the patient at this time. [The facility] contacted for clarification. Crew was advised that they had only one cath lab team and it was in use and [ambulance] would need to divert to another facility, while on the line with [the facility] they assured pt (patient) could be taken to [another facility]with cath lab available...[ambulance]diverted to [another facility]..." 3) Review of radio wave transmission recording dated January 21, 2016 at 20:56 between the ambulance service and the facility's Med Command revealed that the paramedics informed the facility's Med Command that the ambulance was present in the facility parking lot at which time EMP5 revealed "...The guy is sitting in the parking lot..." 4) During interview on February 1, 2016 at approximately 12:50 PM, EMP2 confirmed the above findings and when asked if Med Command EMP4 and EMP5 understood that diverting a patient on hospital property without receiving a MSE was potentially a violation of EMTALA Law revealed " ...it was crystal clear, they did not want to override the physicians authority... "

Based on a review of facility documentation and medical records (MR) and staff interviews (EMP), it was determined that the facility failed to report to CMS (Center for Medicare Services) or the State within 72 hours of a patient whom the facility believed to be improperly transferred for one of 24 medical records reviewed (MR1). Findings include: Review of Facility policy "EMTALA" reviewed September 22, 2014, revealed ".. The Hospital has a duty to report an EMTALA violation within 72 hours to the Centers for Medicare and Medicaid Services and/or the State survey agency any time it has a reason to believe it may have received an individual who has been transferred in an Emergency Medical Condition from another hospital in violation of the requirements." 1) Review of ambulance trip sheet dated July 9, 2015, at 06:45 revealed "...at [transferring hospital] Medical Command saw patient and request that patient be transferred directly to a trauma. Patient being transported to [receiving hospital]. ...07:40 No change in patient status. Out at [receiving hospital]. ...07:45 Patient care transferred to trauma team. Patient placed in ER bed t17 via board lift. Patient care report given to team at bedside... ." 2) Review of MR1 dated July 9, 2015, revealed no documentation accompanied the patient from the transferring hospital to the receiving hospital. Further review of MR1 also revealed no documentation by physician or nurse that indicated the pateint was seen or treated at another hospital or that pateint was transferred with physician certification or other medical documentation. 3) During interview on September 21, 2015, at approximately 10:00 EMP1 revealed "...The first time we thought we had a problem [EMTALA] was September 1, 2015... ." EMP1 revealed being notified by EMP10 by email on September 1, 2015 that the transferring hospital physician never contacted the receiving hospitals of the imminent transfer. 3) During interview conducted on September 21, 2015, at approximately 13:40 EMP4 confirmed the above findings and revealed when asked if EMP1 knew that the patient was not a direct transfer and was transferred from another hospital EMP1 revealed "yes." When asked if EMP1 suspected the transferring hospital may have improperly transferred the patient according to EMTALA requirements, EMP1 revealed "yes." When asked if EMP1 notified anyone of the potential EMTALA violation EMP1 revealed "yes, physician and trauma folks... ." When asked if she knew whether they reported it to CMS or the State within 72 hours of receiving the patient EMP1 revealed "...it never went anywhere after that... ."