Based on observation, review of the hospital's self-disclosure report, review of patient records, hospital policies and procedures and staff interviews, the hospital failed to comply with all requirements of 489.24. Refer to citations and examples at: A 2406 (489.24(a)) Medical Screening Exam - Failure to provide a medical screening exam; and failure to have language in by-laws, approved by the Governing Body that specified which medically qualified personnel had been determined qualified to conduct emergency medical exams (MSEs).

Based on review of the hospital's self-disclosure report, review of hospital policy and procedure, and staff interview, the hospital failed to provide a medical screening exam to rule out an emergency medical condition for a patient who came to the Emergency Department (ED) to be seen for a medical condition for 1 of 25 patient records reviewed (Patient #1); and failed to have signed Governing Body authorization with identification of which qualified medical professionals were approved to provide medical screening exams in hospital by-laws or regulations. Failure to provide a medical screening exam risked patient health and safety, and is a violation of the federal "anti-dumping" regulations. Item #1--Provide a Medical Screening Exam Findings include: Patient #1: Per review of the hospital's report, the ED Log, the patient ED record, and staff interview, Patient #1 came to the ED to have an abscess drained when she was unable to secure an appointment with her primary medical provider, an Advanced Registered Nurse Practitioner (ARNP A) at the Medical Clinic located next door to the ED. Patient #1 arrived at the Emergency Department on 01/30/18 at approximately 3:12 P.M. Staff logged her arrival in the ED Log, and provided a triage which included vital signs, pain assessment, medical/surgical history, medication and allergy history, description of symptoms, staff actions, and discharge details. Interview with administrative hospital staff on 02/6/18 revealed the patient had previously received care for the abscess from the same ARNP A in the Clinic who was on-call for the ED on 01/30/18. When she was unable to secure an appointment at the Clinic, she came to the ED. Following Triage, staff contacted ARNP A who, per the patient record, "...advised to send patient to the Clinic." Staff completed the ED Log entry for Patient #1 as "left without being seen." Interview with ARNP A on 02/6/18 at 3:15 P.M. revealed she had time to see Patient #1 at the Clinic, but for some undetermined reason, the schedulers at the Clinic (not employed by the hospital) did not release an appointment time for the patient to be seen. Per the interview, Patient #1 was seen and treated at the Clinic. There was no negative outcome due to the delay in treatment from the hospital ED to the Clinic. Record review of hospital policy titled, "EMTALA Policy and Procedure" last dated 01/24/18, directed that a physician, ARNP or PA (Physician's Assistant) provides an appropriate medical screening examination to all individuals seeking emergency services. The hospital failed to provide an appropriate medical screening exam to rule out an emergency medical condition for the patient as required by hospital policy and federal regulation. Item #2--Governing Body designation to perform Medical Screening Exams Based on review of the hospital documents and staff interview, the hospital failed to have language in hospital regulations or by-laws, approved by the Governing Body, that specified which medically qualified personnel had been approved to conduct emergency medical screening exams (MSEs) for their hospital. Findings: Interview with administrative staff on 02/6 and 7/18 and review of hospital policy showed that a physician, ARNP or PA were allowed to provide an appropriate medical screening examination to all individuals seeking emergency services. Review of the hospital's regulations and by-laws failed to evidence that the Governing Body had identified and approved which qualified medical personnel were approved to conduct Medical Screening Exams. Staff interview on 02/7/18 verified that comparable language did not exist in current hospital regulations or bylaws.