Based on document review, the facility failed to provide Medical Screening Examinations in a non-discriminatory manner. Patients with VA benefits are all seen in the ER by a physician. These patients cannot be seen by Qualified Medical Personnel (QMP) to determine if a emergent or non-emergent condition exists. The facility encourages a practice and provide the exclusionary question to be asked of all patients that would reveal the patient's pay source or the patient's inability to pay as part of the Medical Screening. Exclusionary Criteria Question; Does the patient have VA benefits? A review of the document titled "Medical Screening Exam Policy" (MSE) revealed: Policy Statement: ...The MSE must be the same MSE that would be performed on any individual coming to the Emergency Department, regardless of the individual's ability to pay. No information regarding the patient's payer status, HMO/PPO membership, or insurance shall be asked prior to the completion of the MSE. VI. Exclusionary Criteria Questions: 7. Does the patient have VA benefits? This question is asked of patients by QMP. If the patient has VA benefits this patient is admitted to the ER and seen by a physician.

Based on document review and interview, the facility failed to provide a Medical Screening Examination by a doctor to 11 (Patients #5, 8, 10, 14, 15, 16, 18, 19, 23, 24, and #25) of 25 (Patients #1, 2, 3, 4, 6, 7, 9, 11, 12, 13, 17, 20, 21 and #22) patients presenting to the emergency room . A review of Patients' #5, 8, 10, 14, 15, 16, 18, 19, 23, 24, and #25 emergency room records revealed the patients presented to the facility's emergency room seeking treatment. The medical records provided no evidence of an examination or treatment by an ED physician or the Primary Care physician on-call. A review of the policy titled EMERGENCY MEDICAL TREATMENT AND LABOR ACT (EMTALA) revealed: "6.2. An ED physician or the Primary Care physician on-call are the only providers authorized to provide a medical screening exam to all patients who present to the ED, to determine the presence or absence of an emergency condition .... 7. An emergency medical condition is defined as: 7.1. An acute symptom that needs immediate medical attention, 7.2. A condition which could jeopardize health of patient or unborn, 7.3. A condition that might result in serious impairment of bodily function, organ, or body part if not immediately treated, 7.4. A condition which includes labor, severe pain, psychiatric disturbance, and substance abuse." An interview with the Chief Nursing Officer confirmed Patients #5, 8, 10, 14, 15, 16, 18, 19, 23, 24, and #25 did not receive examination or treatment by an ED physician or the Primary Care physician on-call.