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Based on staff interviews and review of medical records and policies and procedures, the facility failed to comply with the Medicare provider agreement as defined in 489.20 and 489.24 related to EMTALA (Emergency Medical Labor and Treatment Act) requirements.

The facility failed to meet the following requirements under the EMTALA regulations.

Reference Tag A2406 Appropriate Medical Screening Examination. The facility's Bylaws and Medical Staff Rules/Regulations did not state that Physician Assistants were Qualified Medical Personnel appropriate to conduct Medical Screening Exams.

Based on review of facility documents, credential files, and staff interviews, the facility failed to ensure that each individual who conducted Medical Screening Exams within the facility was determined qualified by hospital Bylaws or Rules and Regulations. Specifically, the facility's Bylaws and Medical Staff Rules/Regulations did not state that Physician Assistants were Qualified Medical Personnel appropriate to conduct Medical Screening Exams. This failure created the potential for a negative outcome.

The findings were:

The facility's Medical Staff Bylaws were reviewed on 7/5/11 and stated the following, in pertinent part: "Qualified Medical Person or Personnel: In addition to a Physician, Qualified Medical Person may perform a medical screening examination. Individuals in the following professional categories who have demonstrated current competence in the performance of medical screening examinations, and who are functioning within the scope of his or her license and policies of the Hospital, have been approved by the Board as Qualified Medical Personnel: Registered Nurse in Perinatal Services, Psychiatric Social Worker, Registered Nurse in Psychiatric Services, or Psychologist."

The facility provided the policy titled "EMTALA- Definitions and General Requirements," which was labeled as their corporate policy and not a policy adopted and approved by the facility. Although the policy stated that a Physician Assistant was an "example" of a professional that "may be approved by the hospital's governing board as qualified to administer one or more types of initial MSEs," the policy was not facility specific. Regardless, the facility's governing board did not state in its Bylaws or Rules and Regulations that Physician Assistants had been approved to perform MSEs.

Two Physician Assistant Credential files (samples #1 & #2) were reviewed on 7/5/11. The privileging section stated that each were approved to "perform medical screening exams..." and that additional documentation related to such included "...physician must contemporaneously review and co-sign ED record (by end of shift.)" Review of twenty medical records revealed that, in the cases where Physician Assistants were utilized to provide Medical Screening Exams, the documentation was co-signed by a physician.

An interview with the interim Chief Nursing Officer was conducted, on 7/5/11 at approximately 1:40 p.m. S/he referenced the above excerpt from the Medical Staff Bylaws and stated, "This is the only place in the bylaws that says who can do the MSE..." S/he stated that with Physician Assistants, it would be "part of the credentialing process. It wouldn't be in a specific policy and procedure." On 7/5/11 at approximately 3:15 p.m., the Assistant Vice President of Quality and Performance Improvement confirmed that the Medical Staff Bylaws/Rules and Regulations stated other License Independent Practitioners could perform Medical Screenings Exams, but did not state that Physician Assistants were approved to do so.

Based on staff interviews and review of medical records and policies and procedures, the facility failed to comply with the Medicare provider agreement as defined in 489.20 and 489.24 related to EMTALA (Emergency Medical Labor and Treatment Act) requirements.

The facility failed to meet the following requirements under the EMTALA regulations.

Reference Tag A2406 Appropriate Medical Screening Examination. The facility's Bylaws and Medical Staff Rules/Regulations did not state that Physician Assistants were Qualified Medical Personnel appropriate to conduct Medical Screening Exams.

Based on review of facility documents, credential files, and staff interviews, the facility failed to ensure that each individual who conducted Medical Screening Exams within the facility was determined qualified by hospital Bylaws or Rules and Regulations. Specifically, the facility's Bylaws and Medical Staff Rules/Regulations did not state that Physician Assistants were Qualified Medical Personnel appropriate to conduct Medical Screening Exams. This failure created the potential for a negative outcome.

The findings were:

The facility's Medical Staff Bylaws were reviewed on 7/5/11 and stated the following, in pertinent part: "Qualified Medical Person or Personnel: In addition to a Physician, Qualified Medical Person may perform a medical screening examination. Individuals in the following professional categories who have demonstrated current competence in the performance of medical screening examinations, and who are functioning within the scope of his or her license and policies of the Hospital, have been approved by the Board as Qualified Medical Personnel: Registered Nurse in Perinatal Services, Psychiatric Social Worker, Registered Nurse in Psychiatric Services, or Psychologist."

The facility provided the policy titled "EMTALA- Definitions and General Requirements," which was labeled as their corporate policy and not a policy adopted and approved by the facility. Although the policy stated that a Physician Assistant was an "example" of a professional that "may be approved by the hospital's governing board as qualified to administer one or more types of initial MSEs," the policy was not facility specific. Regardless, the facility's governing board did not state in its Bylaws or Rules and Regulations that Physician Assistants had been approved to perform MSEs.

Two Physician Assistant Credential files (samples #1 & #2) were reviewed on 7/5/11. The privileging section stated that each were approved to "perform medical screening exams..." and that additional documentation related to such included "...physician must contemporaneously review and co-sign ED record (by end of shift.)" Review of twenty medical records revealed that, in the cases where Physician Assistants were utilized to provide Medical Screening Exams, the documentation was co-signed by a physician.

An interview with the interim Chief Nursing Officer was conducted, on 7/5/11 at approximately 1:40 p.m. S/he referenced the above excerpt from the Medical Staff Bylaws and stated, "This is the only place in the bylaws that says who can do the MSE..." S/he stated that with Physician Assistants, it would be "part of the credentialing process. It wouldn't be in a specific policy and procedure." On 7/5/11 at approximately 3:15 p.m., the Assistant Vice President of Quality and Performance Improvement confirmed that the Medical Staff Bylaws/Rules and Regulations stated other License Independent Practitioners could perform Medical Screenings Exams, but did not state that Physician Assistants were approved to do so.