Based on interview and medical record review it was determined that the facility failed to provide a medical screening examination. The findings include: On January 17, 2017 a medical record review for Patient #20 revealed that Patient #20 arrived at the facility on December 21, 2016 at 10:45 p.m. Triage was started at 10:50 p.m. and completed at 10:55 p.m. Patient #20 was triaged as a level three (3). Patient #20 complained of right upper arm injury after opening a window and needing refill of a Xanax prescription. According to the Department of Health and Human Services Triage Levels are Level 1 resuscitation required and Physician assess immediately, Level 2 emergent and Physician assess within 15 minutes, Level 3 urgent and Physician assess within 30 minutes, Level 4 Less Urgent and Physician assess within hour, and Level 5 Non-urgent and Physician assess within two (2) hours. Interviews with Staff Members #10, #11 and #12 revealed that the Emergency Department was very busy on December 21, 2016; the night of the occurrence. There were no rooms available in the Emergency Department and at least nine or more patients were waiting in the waiting area to be seen by the Physician. All patients had been informed that they would be taken to a room in the Emergency Department as soon as a room was available. At 11:27 p.m. Patient #20 laid self on floor and began spitting on the floor in the waiting room. Interview with Staff Member #14 revealed that this was witnessed by Staff Member #14. Staff Member #14 communicated that Patient #20 had been yelling, cursing and pacing inside and outside of facility since approximately 11:00 p.m. before laying self on floor. Staff Members #10 and #11 assisted Patient #20 onto a stretcher and placed he/she in front of the nursing station in the emergency department so the patient could be observed until a room was available. Patient #20 was informed that a room would be available as soon as another patient was discharged . At 11:37 p.m. Patient #20 was placed in a room. At 11:55 p.m. Staff Member #10 stated that yelling of foul language and needing help was heard. Staff Member #10 went to room where Patient #20 was sitting up on stretcher screaming and cursing. The patient was informed that he/she was in a hospital and needed to keep it down and stop cursing due to other patients in the Emergency Department. Patient #20 then got louder and started holding breath until turning red and blue. Staff Member #10 informed the patient if he stopped breathing emergency procedures would be used to assist with breathing. Patient #20 then told Staff Member #10 " ...to get out of the room before he/she got hurt". Staff Member #12 entered and heard this conversation and encouraged Staff Member #10 to leave the room. Staff Member #14 called 911 and informed a dispatcher that staff members had been threatened and facility wanted the patient off the property. Staff Member #12 and #14 stated hearing the screaming and threats but did not enter the room. At 12:10 a.m. Patient #20 was escorted out of the emergency department by an area police officer without handcuffs. Patient #20 did not see a physician nor receive treatment during this time; one hour and 25 minutes. An interview with Staff Members #1, #2, #3 and #4 revealed " ...the Patient should have been seen by a physician and treated and before leaving the facility."