Based on record review and interview this hospital failed to ensure they were in compliance with all EMTALA requirements under 42 CFR 489.20 and 42 CFR 489.24. This occurred in 1 of 20 sampled patients (Patient #1), who presented to the Emergency Department seeking emergency medical care. Failure to maintain compliance with EMTALA requirements has the potential to affect all patients seeking care in this facilities Emergency Department. Findings include: Patient #1 came to the hospital at 8:08 AM on 8/25/17 via ambulance. The hospital failed to include Patient #1 on their Emergency Department Central Log. (Reference 2405) Patient #1 was in the hospital ambulance bay for approximately 12 minutes and did not receive a Medical Screening Exam before Patient #1 was transported to another hospital. (Reference 2406)

Based on record review and interview, the facility failed to maintain a log of all patients presenting to the Emergency Department in 1 of 20 patients reviewed (Patient #1). This has the potential to affect all patients presenting to the facility seeking Emergency Services. Findings include: The policy titled "EMTALA: Medical Screening and Stabilizing Treatment" dated December 1, 2015 was reviewed on 9/6/2017 at 11:26 AM. This document states in part "Log. The hospital will maintain a centralized log on each person who comes to any and all areas of the Hospital seeking emergency medical screening and treatment. The log must include: whether the individual refused treatment or was refused treatment including explanatory details..." Reviewed Patient #1's Medical Record dated 8/25/2017 at 11:30 AM. Patient #1 was admitted to St. Francis Emergency Department (ED) with altered mental status at 1:19 AM and was discharged with a diagnosis of intoxication and alcohol abuse at 7:19 AM. Patient #1 returned to St. Francis at 8:08 AM via ambulance. There is no record of Patient #1 returning to St. Francis on 8/25/17 at 8:08 AM on the Emergency Department Centralized log. An interview was conducted with Director of Emergency Department (ED) B on 9/6/17 at 10:31 AM. Director of ED B stated the hospital reviewed security footage and noted the ambulance arrived into the ambulance bay on 8/25/17 at 8:08 AM and nurses went to see the patient in the ambulance bay at 8:10 AM, a police officer spoke with the patient at 8:16 AM and at 8:20 AM the ambulance was seen leaving. A second interview was conducted with Director of ED B on 9/6/17 at 1:11 PM. Director of ED B was asked if Patient #1 was on the ED log for the 8:08 AM encounter. ED B stated Patient #1 was not on the log for the 8:08 AM encounter.

Based on record review and interview, the facility failed to provide a Medical Screening Exam (MSE) for 1 of 20 Emergency Department Patients reviewed (Patient #1). This has the potential to affect all patients presenting to the facility seeking Emergency Services. Findings include: The policy titled "EMTALA: Medical Screening and Stabilizing Treatment" dated December 1, 2015 was reviewed on 9/6/2017 at 11:26 AM. This document states in part "1. Medical Screening Examination - Any patient who comes to the Hospital's dedicated emergency department and requests or has a request made on his or her behalf for emergency examination and treatment or who a prudent layperson would believe, on the basis of the individual's appearance or behavior, requires examination or treatment for a medical condition, will be provided an appropriate medical screening examination within the capabilities of the dedicated emergency department including ancillary services routinely available to the emergency department to determine whether an emergency medical condition exists regardless of their ability to pay for medical care." Reviewed Patient #1's Emergency Department Medical Record dated 8/25/2017. Patient #1 was admitted to St. Francis ER with altered mental status at 1:19 AM and was discharged with a diagnosis of intoxication and alcohol abuse at 7:19 AM. Patient #1 was escorted off hospital property for wandering the halls and reportedly drinking hand sanitizer from the dispenser. Per ambulance report Patient #1 returned to the facility via ambulance at 8:08 AM with complaints of inability to walk. This return visit was not documented by the facility. An interview was conducted with Director of Emergency Department (ED) B on 9/6/17 at 10:31 AM. Director of ED B stated the hospital reviewed security footage and noted the ambulance arrived into the ambulance bay at 8:08 AM and nurses went to see the patient in the ambulance bay at 8:10 AM, a police officer spoke with the patient at 8:16 AM and at 8:20 AM the ambulance was seen leaving. An interview was conducted with Registered Nurse (RN) C on 9/6/2016 at 12:10 PM via phone. RN C stated RN D and RN C went out to get the patient. RN C stated "The EMT refused to open the door because the patient was aggressive. I asked the police officer that was here to go talk to the EMT and the patient." RN C stated RN C did not know what happened to the patient after that. An interview was conducted with Registered Nurse (RN) D on 9/7/2017 at 10:00 AM via phone. RN D stated RN D was sitting at the nurses station when the Bell ambulance EMT came to the desk to give report for Patient #1. RN D stated Patient #1 was still in the ambulance. RN D stated "me and (RN C went out to evaluate (Patient #1) in the ambulance bay. The EMT refused to open the door because the patient was hostile." RN D stated "the police were asked to go out and talk to the patient and that was the last thing I heard." RN D stated RN D had no further contact with Patient #1 after that. An interview was conducted with Emergency Medical Technician (EMT) G on 9/12/17 at 2:30 PM via phone. EMT G stated Patient #1 was picked up. Patient #1 was asked which hospital Patient #1 wanted to go to and Patient #1 stated the closest. EMT G informed Patient #1 that St. Francis was the closest and the patient agreed to go there. EMT G called the nurse at St. Francis to give report but stated by the time they answered the ambulance was on site so EMT G informed the nurse EMT G would come in and give report. EMT G stated G went to the nursing station to give report and when G "gave the patient name they said they would not see the patient as (Patient #1) was just discharged and escorted from the property." Staff refused to see the patient and a police officer was sent out. The police officer came out and talked to the patient. The police officer asked Patient #1 why Patient #1 wanted to be seen and Patient #1 stated "So I don't die." Patient #1 stated Patient #1 wanted to go to Sinai. ED staff was aware that Patient #1 was on hospital property when Patient #1 requested to go to Sinai. Reviewed Patient #1's Medical Record from Aurora Sinai dated 8/25/2017 at 8:43 AM. Patient #1 was treated in the ED at Sinai for intoxication with a blood alcohol level greater than when the patient was discharged from St. Francis on 8/25/17 at 7:19 AM. An interview was conducted with Director of ED B on 9/6/2017 at 1:11 PM. Director B stated there is not a record of Patient #1 being at St. Francis at 8:08 AM. Patient #1 was not on the ED log and does not have a documented MSE on 8/25/17 at 8:08 AM.