Orlando Health South Lake Hospital

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 49777 Based on video review, interview, emergency room logs, record review, policy and procedure review, the facility failed to ensure all individuals presenting to the hospital’s off-site free-standing emergency department for care received an appropriate medical screening examination within the off-site free-standing emergency department’s capabilities (including but not limited to mental health services routinely available to an emergency department) to determine whether an emergency medical condition existed for one (1) of 20 sampled patients, Patients #1, who presented to the hospital’s off-site free-standing emergency department with dehydration and nausea related conditions. On September 22, 2025, Patient #1, presented to the hospital’s off-site free-standing emergency department with a chief complaint of dehydration and nausea. The hospital’s off-site free-standing emergency department had the capability and capacity to conduct medical screening examinations to determine if an emergency medical health condition existed, however, the patient was not provided an examination and/or treatment. Findings: Cross Refer to A2406: Medical Screening Examination.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 49777 Based on video review, interview, emergency room logs, record review, policy and procedure review, police report and Medical Staff Rules and Regulations, the facility failed to ensure all individuals presenting to the hospital’s off-site free-standing emergency department for care received an appropriate medical screening examination within the off-site free-standing emergency department’s capabilities to determine whether an emergency medical condition existed for one (1) of 20 sampled patients, Patients #1, who presented to the hospital’s off-site free-standing emergency department with dehydration and nausea related conditions. The hospital’s off-site free-standing emergency department had the capacity and capability to conduct medical screening examinations to determine if an emergency medical condition existed when Patient #1 presented to the emergency department. Patient #1 was removed from the emergency department without treatment or being seen. Findings include: Review of the Emergency Department Log OH (Orlando Health) Emergency Room and Medical Pavillion Blue Cedar dated 09/22/2025 at 2:28 PM documented, “[Patient #1’s name] CC [chief complaint] dehydration; ED [Emergency Department] Disposition: LWBS [left without being seen] after Triage. During an interview on 10/7/2025 at 10:31 AM with the Operations Manager and the Corporate Risk Manager a request was made to view the video and provide a copy of the ED activity on 09/22/2025 beginning at 2:00 PM. The RM stated they would not be able to provide a copy, and a review of the video began at 15:22 (3:22 PM). A request was made to back the video footage back to 2:00 PM. Attempts were made to back up the video without success. (This did not allow for the observation video footage of Patient #1 entering the ED). Review of the video footage, no audio, dated 09/22/2025 beginning at 15:22:42 (3:22 and 42 seconds PM) The video footage of Patient #1 shows Patient #1 sitting in a chair with an older female sitting in a chair to the left of Patient #1 observing facing the receptionist desk. Patient #1’s chair was directly across from the receptionist desk, approximately 25 feet away. The receptionist desk cannot be viewed, except for the left side while facing the desk, due to the area having a decorative slanted covering that is suspended from the ceiling that obstructs the view of the receptionist desk. At 15:22:42 Patient #1 is seen standing up and rushing toward the receptionist work area followed by the female. Due to the decorative slanted covering the view of what occurred in that area cannot be observed on the footage. At 15:22:52 a security guard was observed rushing toward the receptionist desk. The older female was observed walking Patient #1 back to where they were sitting in the chairs. At 15:33:53 Patient #1 was seen standing and moving her arms in rapid motion as if in animated conversation “talking with her hands” but was not seen approaching other patients in the waiting room. Patient #1 sat down. The charge nurse is seen in the area between the receptionist and Patient #1 and has a telephone to her ear and her lips were moving. At 15:39:00 [name of City] Police officer arrives. At 15:46:34 a second Police Officer arrived on scene and apply handcuffs to Patient #1’s wrists. This resulted in an approximate time lapse of 16 minutes from time Patient #1 was observed going toward the receptionist desk and the arrival of law enforcement on the scene. Review of the ED in Orlando Health Emergency Room and Medical Pavilion Blue Cedar Encounter Information form dated 09/22/2025 for Patient #1 read, “Admission Information: Date of Admission: 09/22/2025 at 1428 (2:28 PM). Admission Type: Emergency. Means of Arrival: Personal Own Vehicle. Discharge Information: Discharge Date/Time: 09/22/2025 1600 [4:00 PM]. Discharge Disposition: Left Against Medical Advice Or Discontinued Care. Discharge Destination: None. Discharge Provider: None. Admission diagnoses/Reasons for Visit: Description: Procedure and treatment not carried out due to patient leaving prior to being seen by health care provider. Final Diagnoses: Description: Procedure and treatment not carried out due to patient leaving prior to being seen by health care provider... Date/Time: Tue [Tuesday] Sep [September] 23, 2025 10:54 AM. Comment: Pt. [Patient] was removed from facility/trespassed by [Name of local law enforcement] after physically attacking a team member in registration and attempting to physically assault several patients in the lobby. Discharge Information: Date/Time: 09/22/2025 1600 [4:00 PM] Disposition: Left Against Medical Advice Or Discontinued Care. Reason for Visit: Chief complaint: Dehydration. Medication List: Prior to Admission: None. Discharge Medication List: None. ED Care Timeline: 09/22/2025. 14:28 [2:28 PM] - Patient arrived in ED. 14:28 - Arrival Complaint: Nausea... 1454 - Triage Started. Chief Complaints Updated: Dehydration (Pt. family stated she has not been eating for 2 weeks and not drinking very nausea {sic} thinks she is dehydrated). 14:58 - Patient Location - Is the patient currently in the ED?: Yes. Section 1 - Is the patient cognitively impaired? Does the patient have a new diagnosis or history of dementia, Alzheimer’s, or is there concern the patient lacks capacity to make their own medical decisions?: No. 1550 [3:50 PM] Departure Condition: Stable. Mobility at Departure: Restrained. Departure Mode: In police custody.” Review of the Arrest Affidavit/First Appearance From for Patient #1 dated 09/22/2025 at 1941 (7:41 PM) read, “On September 22, 2025, at approximately 1526 [3:26 PM] hours, officers responded to South Lake Hospital [address for the hospital], in reference to a battery that had just occurred in the lobby area between a female subject and the receptionist. Upon arrival, contact was made with the victim, who identified herself as the hospital receptionist. The victim advised that as she was walking back to her desk, a female later identified as [Patient #1’s name] (hereinafter referred to as the defendant) followed her behind the desk. The victim stated the defendant then grabbed her by the hair and pulled her to the ground. While on the floor, the defendant struck the victim multiple times on the left side of her face, causing visible bruising and bleeding to the victim’s upper left lip. The victim reported that the striking to the face lasted only a few seconds before the defendant’s family members pulled her away. The victim confirmed she recognized the defendant from the check-in process and identified her as [Patient #1’s name]. The defendant was present and identified at the scene by her family members. After being advised of her Miranda Rights, the defendant declined to provide a statement.” During an interview on 10/6/2025 at 11:30 AM the Main Emergency Department Clinical Assistant Nurse (MEDCAN) stated, “All patients need to receive a medical screening examination [MSE] prior to discharge. From reviewing the timeline, the patient [Patient #1] was never placed in a room, and the patient was discharged from the registration area/triage area via law enforcement who arrested her for attacking the receptionist.” A request was made to review the documentation of the physician being notified Patient #1 was leaving without an MSE. The MEDCAN stated, “There is no documentation that the physician was notified that the patient was leaving without a MSE.” During an interview on 10/6/2025 at 12:25 PM, the Chief of Emergency Medicine stated, “All patients need to have a MSE completed and the provider should be notified if the patient wants to leave AMA [against medical advice]. Staff should have them sign the AMA form and if they refuse, document the patient’s refusal.” During an interview on 10/6/25 at 12:45 PM the Orlando Health South Lake Hospital Emergency Room Physician stated, “If someone was in the lobby waiting to be seem and the police came in to arrest them, they would have to see them before they were escorted out by the police. I’m not going to get shot over it but they do need to have an examination.” During an interview on 10/7/2025 at 1:16 PM via telephone the Vice Chair of the Emergency Room stated, “I cannot recall who informed me of the Blue Cedar patient [Patient #1] not receiving an MSE, I heard by word of mouth. Everyone without failure is to receive an MSE. If a patient wants to leave after triage and before an MSE, the provider needs to be notified.” During an interview on 10/7/2025 at 2:40 PM, the Emergency Department Physician at Blue Cedar ED on duty at the time of the 9/22/2025 incident stated, “I had heard yelling out in the front lobby. I went out there and saw the charge nurse and security and saw the situation was under control. I returned to care for patients. I was not informed by anyone that the patient [Patient #1] left without an MSE. All patients must have an MSE.” During an interview on 10/7/2025 at 4:04 PM the Registered Nurse at Orlando Health South Lake Hospital Blue Cedar Emergency Room stated, “Everyone who comes in should have a medical screening. We usually have a very good relationship with law enforcement, and they will let us do the medical screening. If we know someone is leaving, we will alert the physicians so that we can do the examination Review of the policy and procedure titled, “Compliance and Ethics Program” Policy #5706-0301 read, “Purpose: This policy outlines Orlando Health’s Compliance and Ethics Program (CEP) and its commitment to conducting business in full compliance with laws and regulations, rules, the Orlando Health Code of Conduct (Code of Conduct) and policies and procedures. 4.2 EMERGENCY TREATMENT AND PATIENT TRANSFERS: We comply with the Emergency Medical Treatment and Active Labor Act (EMTALA) in providing emergency medical treatment to patients regardless of ability to pay. Anyone with an emergency medical condition or requesting emergency services is given an appropriate medical screening examination and treatment based on medical necessity. Prompt and effective delivery of emergency care will not be delayed for any reason. Each patient who presents to any Orlando Health Emergency Department must receive an appropriate medical screening examination. References: Florida Statute §395.1041, Access to Emergency Services and Care. Review of the Medical Staff Rules and Regulations read, Article 9 Emergency Services: 9.A General: Emergency services care will be provided to any person in danger of loss of life or serious injury or illness whenever there are appropriate facilities and qualified personnel available to provide such services or care. Such emergency services and care will be provided without regard to the patient’s race, ethnicity, religion, national origin, citizenship, age, sex, pre-existing medical conditions, physical or mental handicap, insurance status, economic status, sexual orientation, or ability to pay for medical services except to the extent such circumstance is medically significant to the provision of appropriate care to the patient. 9.B Medical Screening Examinations: (1) Medical Screening Examinations, within the capacity of the hospital will be performed on all individuals who come to the hospital requesting examination or treatment to determine the presence of an emergency medical condition. Qualified medical personnel who can perform medical screening examinations within applicable hospital policies and procedures are defined as: (a) Emergency Department: (i) Members of the medical staff with clinical privileges and emergency medicine (ii) other Active Staff Members (iii) appropriately credentialed Advanced Practice Providers. (2) The results of medical screening examination must be documented upon completion of the examination in the Emergency Department.””

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 41334 Based on video review, interview, emergency room logs, record review, policy and procedure review, the facility failed to ensure all individuals presenting to the hospital’s off-site free-standing emergency department for care received an appropriate medical screening examination within the off-site free-standing emergency department’s capabilities (including but not limited to the ancillary obstetrical services routinely available to an emergency department) to determine whether an emergency medical condition existed for two (2) of 20 sampled patients, Patients #1 and #2, who presented to the hospital’s off-site free-standing emergency department with pregnancy related conditions. On June 24, 2025, Patient #1, presented to the hospital’s off-site free-standing emergency department at 10:18 PM with a chief complaint of abdominal pain; gestational age of 16 weeks. On May 19, 2025, Patient #2 presented to the hospital’s off-site free-standing emergency department at 5:16 PM with a chief complaint of pelvic pain; gestational age of 20 weeks. The hospital’s off-site free-standing emergency department had the capability and capacity to conduct medical screening examinations to determine if an emergency medical condition existed, however, the patients were not provided an examination and/or treatment. The facility failed to secure each patients’ informed consent and failed to document the patients leaving without being seen. Findings: Cross Refer to A2406: Medical Screening Examination.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 41334 Based on video review, interview, emergency room logs, record review, policy and procedure review, the facility failed to ensure all individuals presenting to the hospital’s off-site free-standing emergency department for care received an appropriate medical screening examination within the off-site free-standing emergency department’s capabilities (including but not limited to the ancillary obstetrical services routinely available to an emergency department) to determine whether an emergency medical condition existed for two (2) of 20 sampled patients, Patients #1 and #2, who presented to the hospital’s off-site free-standing emergency department with pregnancy related conditions. The hospital’s off-site free-standing emergency department had the capacity and capability to conduct medical screening examinations to determine if an emergency medical condition existed when Patient #1 and Patient #2 presented to the emergency department. Patient #1 and Patient #2 were dismissed without treatment or being seen. The facility failed to secure each patients’ informed consent and failed to document the patients leaving without being seen. Findings include: 1. Review of the “Emergency Department Log OH [Orlando Health] Emergency Room and Medical Pavilion Blue Cedar” dated 6/24/2025 at 10:20 PM documented, “[Patient #1’s name] CC [chief complaint] abd pain; 16wks preg [abdominal pain; 16 weeks pregnant]. ED [Emergency Department] Disposition” was blank. Review of Part 1 of the video footage, no audio, of the ED parking lot dated 6/24/2025, showed Patient #1 walked into the ED on 6/24/2025 at 22:18 09 seconds (10:18 PM) Review of Part 2 of the video footage, no audio, dated 6/24/2025 at 22:18 45 seconds Patient #1 was observed at Registration window. At 22:22 (10:22 PM) and an individual is observed coming out of a door and speaks with Patient #1 until 22:24 23 seconds (10:24 PM). At 22:24 23 seconds Patient #1 sits down in a chair and is observed texting on a cellular telephone. At 22:28 30 seconds (10:28 PM) Patient #1 gets up and exits the emergency department. The outside video view has Patient #1 getting into a private car. Review of Patient #1’s medical record read, “Discharge date and time of 6/24/2025 at 2234 [10:34 PM]. Discharge information: Disposition: ED dismiss-diverted elsewhere.” Review of Patient #1’s medical record, no triage was completed, no vital signs were obtained, and no medical screening examination was completed. During an interview on 6 /30/2025 at 11:19 AM via telephone Patient #1 stated, “I guess I got there [to the emergency department] somewhere about 10 o’clock at night. I went in and they took all my information. I waited maybe five minutes, then the doctor told me I needed to go somewhere else. They said all they could do was an ultrasound, but they couldn’t do anything else and told me to go to the main emergency room because they could do more for me there. She told me something like they didn’t have the proper stuff, some kind of paper to see if my water broke, but they had it at the main emergency room. I did not get an examination or anything else, they didn’t take any vital signs on me. I did not sign any discharge paperwork at all. They did not do anything for me. I was not feeling very good about that at all. I wasn’t feeling very good and then I had to get a ride to another hospital. It was a pain to have to go there, and I wasn’t feeling very good. I thought I was losing the baby and maybe my water broke, so I thought I needed to be seen right away. I got care at [Name of another local hospital], they did an ultrasound and some other stuff and told me I had to have a stitch put in my cervix to make sure I don’t go into labor and lose the baby. I don’t know why they are an emergency room [off-site free-standing ED] if they can’t give me the care I need. I think they should be able to do that. They did not offer to give me an examination or to transfer me, they never offered me that, they just told me to go to the main hospital.” During an interview on 7/1/2025 at 1:17 PM the Vice Chief of Emergency Medicine stated, “We should not be telling any patients that we don’t have the equipment or capability to treat them. We can cover all emergency treatment here at any ED, Main or free standing. If needed, we can transfer to [Name of Hospital]. The free standing ED’s are an extension, we should be able to evaluate and send patients to OB [obstetrics] and any higher risk OB patients can be transferred to [Name of Hospital]. Typically, we see all pre 20-week patients, screen and medically treat in the ED, or we will consult OB or send the patient to OB to be seen. If a patient is above 20 weeks, they can be seen in the Main ED and the OB team will come downstairs and see them. If they were in a free-standing ED we could transfer them to the main hospital, or to OB to be evaluated as needed. I would expect complete and accurate documentation of any patient entering the ED. The patients [Patients #1 and #2] should have been seen and a medical screening examination done.” During an interview on /1/2025 at 12:39 PM the Nursing Operations Manager of Emergency Services, stated, “We are a fully equipped ED, have ultrasounds, dopplers, inhouse labs. Each patient encounter should have the appropriate documentation. I would expect that both nurses and the ED doctor would document that a patient left without being seen. Each patient was logged, but they did not get triaged before they left. Each patient should have been brought back, vitals taken and charting completed. The ED Doctor spoke with the patient [Patient #1]. Each patient should have received a medical screening examination. If they didn’t want to be seen, we should have followed our policies for left without being seen.” During an interview on 7/1/2025 at 3:05 PM the Medical Doctor A stated, “I believe that I saw her [Patient #1]. She [Patient #1] was worried her water had broken. I explained that we do not have the testing available, we can’t do the test to determine that, to do nitrazine [paper to detect ruptured membranes during pregnancy] testing. I did tell her that our main campus was a better alternative, they had the proper equipment to provide that testing. I told her we could do an ultrasound and check fetal heart tones. I don’t think we have the specific nitrazine testing strips to have addressed her specific concern. I told her I was happy to see her, but we don’t have the capability. I felt that I should give her the option to go where she would get the answer she needed and so she would not have an unnecessary ED visit. In this exact situation I knew I couldn’t give her the answer she wanted, and I wanted to do what was best for her. I do now see how this could be an EMTALA [Emergency Medical Treatment and Labor Act] violation. We should have seen her [Patient #1] and evaluated her when she [Patient #1] presented to us. She [Patient #1] did not get a medical screening examination. I could have provided one within our capabilities. If she needed additional testing we could have transferred her, but I thought that I would refer her to the right place. We do have a process for patients who leave without being seen or AMA [against medical advice]. I did not have her sign anything. She [Patient #1] left after I spoke to her, so none of the nurses saw her.” During an interview on 7/2/2025 at 7:08 AM Staff A, Financial Counselor I, ED Registration stated, “She [Patient #1] was not seen, the doctor came out and talked to her and she left after that, no one did vitals. I don’t know what she said to her. I just know that the doctor talked to her, and she left.” During an interview on 7/2/2025 at 7:26 AM Staff B, Registered Nurse (RN) stated, “ The physician [MD A] walked up to me and told me she [Patient #1] chose to go somewhere else.” 2. Review of the “Emergency Department Log OH Emergency Room and Medical Pavilion Blue Cedar” dated 5/19/2025 at 5:21 PM documented, [Patient #2’s name] CC pelvic pain-20 weeks pregnant. ED disposition” was blank. Review of Part 1 of the video footage, no audio, of the ED parking lot dated 5/19/2025, showed Patient #2 walked into the ED on 5/19/2025 at 1716 (5:16 PM). Review of Part 2 of the video footage dated 5/19/2025 at 17:19 (5:19 PM) Patient #2 was observed at the registration window. On 5/19/2025 at 1733 (5:33 PM) the charge nurse enters from the back into the waiting room and spoke with Patient #2 until 1736 (5:36 PM). Patient #2 is observed getting up and exits the emergency department. Review of Patient #2 ‘s medical record read, “Discharge date and time 5/19/2025 at 1736 [5:36 PM]. Discharge information: Disposition: ED dismiss-never arrived.” Review of Patient #2 medical record, no triage was completed, no vital signs were obtained, and no medical screening examination was completed.” During an interview via telephone on 7/1/2025 at 11:35 AM Patient #2 stated, “I did go to their [South Lake Hospital’s] off site emergency room. I did register and then someone came out. I can’t remember who and told me that they didn’t have what I needed, and I should go to the main Emergency Room. They told me they could do an ultrasound, but they didn’t have any OB equipment there and I would need to go to the main ED, so I did. I was not examined; they really didn’t do anything except for telling me to go to the main ED. They did not take vital signs. They didn’t offer to treat me or take me there. They just told me they couldn’t help and where for me to go. I was a little upset; it’s a pain to go to another place when you don’t feel good and are in pain.” During an interview on 7/1/2025 at 12:39 PM the Nursing Operations Manager Emergency Services, stated, “We are a fully equipped ED, have ultrasounds, dopplers, inhouse labs. We cannot do fetal monitoring, if they need to have continuous fetal monitoring, we can transfer the patient to either South Lake or Winnie Palmer as a physician would determine. We have determined, the nurse acknowledged what she said, that my charge nurse on 5/19/2025 [RN C’s name] stated that we did not have the capacity to do fetal monitoring. She stated that she did offer to have her come back and be evaluated. It should be documented. Each patient encounter should have the appropriate documentation. I would expect that both nurses and the ED doctor would document that a patient left without being seen. Each patient was logged but they did not get triaged before they left. Each patient should have been brought back, vitals taken and had charting completed. In one case the charge nurse spoke to the patient; in the other the ED Doctor spoke with the patient. Each patient should have received a screening examination. If they didn’t want to be seen, we should have followed our policies for left without being seen.” During an interview via telephone on 7/1/2025 at 6:00 PM Staff C, RN stated, “I really can’t remember whether or not I saw this patient. I was told I was seen on video as speaking with her [Patient #2] and then she left. I would not tell a patient we can’t provide care to them, but I would explain to them what would happen and let them know if they had problems they would be transferred to either South Lake or Winnie Palmer if they were high risk with complications. I understand that I need to offer patients the opportunity to be seen and evaluated. I can’t say that I offered her [Patient #2] that, I can’t remember. But historically when anyone has a question about their care I will speak with them and explain that if there is a problem, they will go to the main ED, L&D [labor and delivery] or [Name of Hospital] if there are high risk and have complications. We don’t document on them, we would have just entered that they have left AMA. I can’t say why I didn’t document. I should have documented that conversation.” Review of the policy and procedure titled “Compliance and Ethics Program” read, “4.2 Emergency Treatment and Patient Transfers: we comply with the emergency medical treatment and labor act (EMTALA) in providing emergency medical treatment to patients regardless of ability to pay. Anyone with an emergency medical condition or requesting emergency services is given an appropriate medical screening examination and treatment based on medical necessity. Prompt and effective delivery of emergency care will not be delayed for any reason. ... Each patient who presents at any Orlando Health emergency department must receive an appropriate medical screening examination. Patients with emergency medical conditions, including patients in active labor, will be provided ongoing care until final disposition (admission or transfer). An “emergency medical condition” means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual (or with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy, serious impairment bodily functions, or serious dysfunction of any bodily organ or part or with respect to a pregnant woman who is having contractions that there is inadequate time to effect a safe transfer to another hospital before delivery, or that transfer may pose a threat to the health or safety of the woman or the unborn child. Additionally, an emergency may include psychiatric disturbances and symptoms of substance abuse when the patient is considered a threat to themselves or to others. Patients will be transferred to a non Orlando health facility if a patient’s medical needs cannot be met at Orlando Health and appropriate care is known to be available at the non Orlando health facility. Prior to transfer the patient must be stable....All organizational emergency departments maintain an encore roster and a log documenting each individual who comes to the emergency department seeking assistance. The log must contain the patients chief complaint, diagnosis and disposition (e.g. Discharge, admission, transfer, left without treatment (LWT), left against medical advice (AMA).” Review of the policy and procedure titled, “AMA/Elopement/CODE ECHO [a security treat or a security incident]/Left without treatment” read, I. Purpose: this policy outlines the responsibilities related to patient elopement, leaving against medical advice, or leaving without treatment with the organizational goal of the patient’s safe return to their assigned medical treatment area using the minimal amount of force and or law enforcement intervention. II. Definitions: When used in this policy, these terms have the following meanings. A. Against medical advice (AMA) any patient or outpatient leaving against medical advice in which the nurse or physician has awareness of their wish to leave. I. Left without treatment (LWT) a patient who registers into the emergency department ED and who decides to leave the ED before the physician’s medical screening examination has been completed. III. Policy: It is the policy of Orlando Health that: g. Data regarding the volume of left without treatment events shall be maintained by the respective Emergency Department. IV. Procedure: D. Left without treatment: (Emergency Department and Free standing EDs); 1. If possible educate the individual regarding the importance of the medical exam benefit/risk if not completed. 2. if possible complete one set of vital signs and reassess the patient’s condition. 3. have the patient or legal representatives signed the refusal for screening examination section of the informed refusal consent form. 4. document the education, vital signs, assessment, date/time of departure, reason for leaving, and the ability to return as needed or follow up with their primary care physician or clinic. Review of the policy and procedure titled, “Patients’ Rights and Responsibilities” read, “1. Purpose: This policy describes the rights and responsibilities of patients of Orlando Health. IV. Procedure: A. Patients’ Rights:1. Access to Care: b. A patient has the right to a medical screening to determine if an emergency medical condition exists and the right to treatment for any emergency medical condition that will deteriorate from a failure to provide treatment.” Review of the policy and procedure titled, “Patient Acuity and Nursing Assessment in the Emergency Department” read, “I. Purpose: This policy provides a. standardized means for assessing patient acuity of all patients presenting for evaluation in Orlando Health Emergency Departments and Free-Standing Emergency Departments. III. Policy: It is the policy of Orlando Health that all: A. Presenting patients will be offered a medical screening exam. B. Emergency Department (ED) patients are assessed promptly after arrival.””