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Based on interview, and record review, the facility failed to ensure that emergency medical services were provided in accordance with CFR 489.24, the regulations for the Emergency Medical Treatment and Active Labor Act (EMTALA) when:

1. There was no medical screening evaluation provided for one of 22 sampled patients (Patient 2) (Refer to A 2406).

Based on interview, and record review, the facility failed to comply with the Emergency Medical Treatment and Active Labor Act (EMTALA) when one of 22 sampled patients (Patient 2), was not provided with a Medical Screening Examination (MSE) upon presenting to the Emergency Department (ED).

This failure had the potential to delay necessary medical care which could cause negative clinical outcomes to occur.

Findings:


A review, of the facility's policy titled, "Emergency Medical Treatment and Labor Act (EMTALA)," effective date 12/11/24, indicated that the emergency medical screening and stabilizing treatment will be provided to all individuals requesting, or requiring examination or treatment of a medical condition, and to individuals presenting on the hospital property including parking lots, sidewalks, driveways within 250-yards of the hospital.

A review, of the facility's policy titled, "Ambulance Diversion (the redirection of an ambulance to a different medical facility than the one originally intended)," effective date 10/8/20, which defined diversion as the closure of a hospital's emergency department (ED) from receiving patients arriving by ambulance including any specialty services. The policy outlines the procedure for STEMI (ST-Elevated Myocardial Infarction, a severe type of heart attack) diversion: EMResource is to be updated with the status "Advisory," and indicate that STEMI services are unavailable, and completion of the Ambulance Patient Diversion Form 508-A.

A review, the facility's policy titled, "Code STEMI," effective date 11/19/24, and lists the policy "Ambulance Diversion," as an associated document. The policy indicates that when emergency medical services (EMS) calls with a field identified (a term indicating EMS services, before a patient arrives to a hospital) STEMI, the EKG (electrocardiogram, a diagnostic test of the electrical activity of the heart) will be transmitted to the ED from the field, and the ED physician will confirm the diagnosis. If an EKG cannot be transmitted but it is called a STEMI by EMS, the cardiac catheterization lab (CCL, a specialized unit or department in a hospital where cardiologists [a medical doctor specializing in diagnosing and treating diseases of the heart and blood vessels] and specialized staff perform cardiac procedures) team will be activated; the patient will not go to the CCL until the EKG has been reviewed by the ED physician and the cardiologist and STEMI has been confirmed. If there is an unavoidable delay in patient care, for example simultaneous STEMI patients, or the cardiologist is in another case already in progress in the CCL, the ED physician will collaborate with the cardiologist to determine if thrombolytic therapy (medications that dissolve blood clots blocking blood vessels) should be administered.

Patient 2's medical record was reviewed. An ambulance trip report, incident # 206857, indicated that emergency medical services (EMS) responded to Patient 2's private residence for a complaint of chest pain on 7/2/25 at 11:36 am. In the narrative, documented by Paramedic (a trained healthcare professional that provides emergency medical care outside of the hospital setting) A, Patient 2 stated he was having difficulty breathing and stated, "I'm going to have a heart attack, I'm going to die," and that he had had MI's (myocardial infarctions, or heart attacks) twice this year with a total of 4 stents placed (a reference to a cardiac procedure in which stents, or tubes, are inserted into narrowed or blocked arteries in order to keep blood flowing to the heart). An EKG performed indicated Patient 2 had a STEMI. EMS contacted Facility A's ED and activated a STEMI alert (a process that informs staff that the incoming patient has a STEMI and requires specialized medical care). Upon arriving to Facility A's ambulance bay at 12:20 pm, Paramedic A documented being met by ED Medical Doctor (ED MD) B and being informed Patient 2 needed to be diverted to Facility B due to, "no cardiologist in house." EMS contacted Facility B and issued the STEMI alert, and diverted Patient 2 to Facility B.

A review, was made of a compilation of Patient 2's encounters at Facility A (document untitled). There was an encounter documented on 7/2/25 between 11:17 am to 12:20 pm, with Patient 2 arriving via ambulance.

A review, was made of Facility A's Cardiology call schedule for the month of July, 2025. Dr Cardiologist C was on call on 7/2/25.

A review, was made of Facility A's list of cardiac catheterization procedures performed on 7/2/25. Cardiologist C performed procedures from 9:20 am to 10:06 am, and 11:38 pm to 2:43 am.

A review, was made of Facility A's Ambulance Patient Diversion Form 508-A, from 2/1/25 through 7/29/25. In a total of nine diversions, there were none listed for 7/2/25.

During a concurrent observation, and interview, on 7/29/25 from 10:15 to 11:15 am, the Chief Nursing Officer (CNO) was asked for information on the processing of STEMI patients in the ED. The CNO stated, that EMS usually sends an EKG which the provider looks at. If there is a confirmed STEMI, the STEMI crew is called in, consisting of the cardiac catheterization lab crew, and one of two interventional cardiologists (a cardiologist who specializes in using catheter-based procedures to diagnose and treat heart and blood vessel conditions), and the house supervisor is contacted. The CNO indicated that STEMI (along with two other specialty treatment areas) are never diverted.

During a concurrent interview, and record review, on 7/31/25 at 12:21 pm, of a Radio/audio recording with the Manager of Emergency Preparedness (MEP). EMS was heard to inform Facility A's ED staff of Patient 2's impending arrival, his current heart rate and blood pressure, the EKG findings, medications given, signs and symptoms, and some background information. Hospital staff asked for transmission of EKGs; EMS stated they "will attempt to, but monitor is having some issues." At this time, MEP confirmed that the Patient Diversion Forms 508-A provided were complete, containing all diversions in the previous six months.

During an interview, on 7/31/25 at 3:25 pm, Cardiovascular Nurse Coordinator (CNC) was asked for the process involving incoming STEMI patients, in particular if more than one patient arrives. CNC stated, I'm not sure of the policy, so I don't want to speak out of turn. When asked how this situation would be managed, the CNC stated there was one interventional cardiologist on duty at a time, and when a second patient needing their services arrives to the facility, the cardiologist would speak with the ED provider, decide if the patient can be accommodated, see if the patient is stable and give TNK (Tenecteplase, a medication used to treat blood clots in cases of acute myocardial infarction) if needed. CNC stated, if a STEMI was identified in the field, we would try to stop them in the field before they arrive. When asked for more information, CNC stated, all EMS services call ahead to notify of STEMI in the field. We are a primary receiving center for outlying counties in this area. Our process should be if we are busy, they would divert the ambulance before they arrive here. If patients are diverted, we place an advisory. The ED handles those notifications. CNC stated, "one concern we had, we had a patient called a STEMI in the field, they arrived to the ambulance bay." CNC identified Patient 2 by surname, and stated the facility started an investigation because the case was unusual in that Patient 2 was diverted without a diversion notification being placed, there was miscommunication between the ED provider and the cardiologist, and the ambulance trip report indicated the cardiologist wasn't present when they actually were present. The fault was that they were diverted without a diversion being in place.

During an interview, on 7/31/25 at 4:18 pm, ED MD B stated, that Patient 2 came in as a STEMI-alert on 7/2/25, and the EKG could not be transmitted from the ambulance. The cardiologist was in a complicated procedure; when ED MD B spoke with the cardiologist, ED MD B was told "it would be OK to give TNK," but the cardiologist could not accommodate the patient at this time and suggested diverting. ED MD B stated, that while speaking with EMS, "the radio died, and I couldn't reach the ambulance to divert. I took 10 to 15 minutes to trying to reach them and then the ambulance arrived." ED MD B informed Patient 2 and EMS they had been trying to divert but could not reach them, that if Patient 2 needed a cardiac catheterization the facility could not provide that due to the lack of provider. ED MD B gave Patient 2 the options that he could remain in the ED and wait for a cardiac catheterization procedure, or go to Facility B, and Patient 2 opted to go to facility B. ED MD B stated, that she did not speak with Facility B about the transfer and was told by her superiors that she should have registered the patient and should have spoken with Facility B to assure their cardiologist was available. When asked if communication was the issue, ED MD B stated, other than the equipment failure when the radio died, yes, that was the issue.