HospitalInspections.org

Based on interviews and document reviews, the facility failed to comply with the Medicare provider agreement as defined in §489.20 and §489.24 related to Emergency Medical Treatment and Labor Act (EMTALA) requirements.

FINDINGS

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

Tag 2408: (4) Delay in Examination or Treatment. Based on document reviews and interviews, the facility failed to comply with the Emergency Treatment and Labor Act (EMTALA). Specifically, the facility failed to ensure the registration process did not delay examination and treatment in seven of twenty patients who sought emergency care. (Patient #4, #5, #6, #7, #10, #15, and #19)

Based on document reviews and interviews, the facility failed to comply with the Emergency Treatment and Labor Act (EMTALA). Specifically, the facility failed to ensure the registration process did not delay examination and treatment in seven of twenty patients who sought emergency care. (Patient #4, #5, #6, #7, #10, #15, and #19)

Findings include:

Facility policy:

According to the EMTALA policy, this policy applies to all clinical and administrative staff working in the facility's Emergency Department (ED) and/or location where EMTALA applies. This includes, without limitation, Adult ED, Pediatric ED and UC (PEDUC), Psychiatric ED (PES), Obstetrics Emergency Department (OBED).

Once the medical screening examination is completed and the patient's condition has been determined not to be an emergency medical condition, or once an emergency medical condition has been stabilized, personnel may require the individual or the individual's legal representative execute an agreement to pay or otherwise supply insurance information.

1. The facility failed to ensure the registration process did not delay examination and treatment for seven patients who sought emergency care.

A. Document Review

i. On 7/23/25 at 11:06 a.m., the agreement to pay, referred to in the EMTALA policy, was requested. The Hospital General Consent for Treatment and Terms Relating to Payment document was provided. Review of the Hospital General Consent for Treatment and Terms Relating to Payment revealed patients agreed to make a payment of all healthcare expenses, and were subject to the remedies provided in the delinquent accounts section if payment was not made.

According to the delinquent accounts section, the facility could refuse to provide care to patients until a payment had been made, unless not allowed by law such as an emergency. Interest could be charged at the highest rate allowed by law. The facility could file a lawsuit to sue patients to collect the bill. Patients agreed to pay the facility's lawyer fees, court costs, and expenses of collection. Additionally, the facility could obtain copies of the patients' credit bureau reports, and any information about them that was reasonably necessary for collection purposes.

ii. Medical record review revealed Patient #4 presented to the PES on 5/29/25 at 9:26 p.m. for suicidal ideations, and signed the agreement to pay at 10:25 p.m. Patient #4 was examined by the provider on 5/29/25 at 10:30 p.m.

iii. Medical record review revealed Patient #5, who was 36 weeks and 6 days pregnant, presented to the OBED on 6/3/25 at 1:20 p.m. for contractions and decreased fetal movement. Patient #5 signed the agreement to pay on 6/3/25 at 1:40 p.m. and was examined by the provider at 2:37 p.m.

iv. Medical record review revealed Patient #6 presented to the PES on 1/26/25 at 6:14 p.m. on a 72 hour involuntary mental health hold for suicidal ideations. Patient #6 verbally signed the agreement to pay on 1/26/25 at 6:49 p.m. and was examined by the provider at 9:20 p.m.

v. Medical record review revealed Patient #7 presented to the ED on 5/31/25 at 1:20 a.m. for a medical screening examination. Patient #7 signed the agreement to pay on 5/31/25 at 1:44 a.m. and was examined by the provider at 1:54 a.m.

vi. Medical record review revealed Patient #10 presented to the PES on 7/15/25 at 6:22 p.m. for violent ideations. Patient #10 signed the agreement to pay on 7/15/25 at 7:01 p.m. and was examined by the provider on 7/16/25 at 7:46 a.m.

vii. Medical record review revealed Patient #15 presented to the ED on 5/19/25 at 4:38 p.m. for dizziness, headache, nausea and vomiting. Patient #15 signed the agreement to pay on 5/19/25 at 5:02 p.m. and was examined by the provider at 5:24 p.m.

viii. Medical record review revealed Patient #19 presented to the ED on 3/8/25 at 10:43 p.m. for a psychiatric evaluation and chest pain. Patient #19 signed the agreement to pay on 3/9/25 at 12:17 a.m. and was examined by the provider at 12:31 a.m.

This was in contrast to the EMTALA policy which read, personnel should have required the individual to execute an agreement to pay after the provider had completed the medical screening examination and the patient's condition had been determined not to be an emergency medical condition, or once an emergency medical condition has been stabilized.

B. Interviews

i. On 7/23/25 at 3:22 p.m., an interview was conducted with the lead patient access representative (PAR) #1. PAR #1 stated patients signed the consent to treat (agreement to pay) once they were placed in a room, before they were seen by the provider and treated. PAR #1 stated they preferred to register patients as soon as they were roomed, and in most cases, PARs went into the patients' rooms before the provider to collect their insurance information. PAR #1 also stated they occasionally collected patients' insurance cards in triage and asked for insurance cards in the room, if they had not been obtained in triage.

This was in contrast to the EMTALA policy which read, personnel should have required the individual to execute an agreement to pay, or supply insurance information, after the provider had completed the medical screening examination and the patient's condition had been determined not to be an emergency medical condition, or once an emergency medical condition has been stabilized.

Additionally, PAR #1 stated patients occasionally refused to sign the agreement to pay and were deterred from seeking care. PAR #1 stated the provider could dismiss the patient if they had not been examined by the provider. PAR #1 stated if the patient had been examined by the provider and needed to stay for treatment, enrollment could speak with the patient about Medicaid. PAR #1 also stated patients in the OBED did not sign consents until after they had been seen by the provider.

This was in contrast to medical record review for Patient #5 which revealed their agreement to pay had been signed before they were examined by the provider.

Furthermore, PAR #1 stated they did not know what EMTALA requirements were.

ii. On 7/24/25 at 7:15 a.m., an interview was conducted with the director of patient safety, quality, and regulatory compliance (Director) #3. Director #3 stated there was a risk patients could leave and not be examined by a provider when their insurance and payment information was addressed prior to the medical screening examination.