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Based on observation and interview, the facility failed to post conspicuously the required signage (per section 1867 of the Social Security Act) specifying the rights of individuals with respect to examination and treatment for emergency medical conditions (EMC) and women in labor and whether or not the hospital participated in the Medicaid program under a State plan (under Title XIX). The hospital failed to :

*Post signage in a manner that was noticeable and visible to individuals waiting for ER examination and treatment (waiting room of ER ).

Findings include:

TX 00374928

Walk- in lobby / ER Entrance:

Observation on 12/07/2021 at 10 AM in the waiting room of the facility ER showed a walk-up registration window.

Observation of the wall to the right of the registration window showed a fairly large printed sign with graphic circles that read: "It's the LAW", "patient bill of RIGHTS;" and "GRIEVANCE procedures."

This sign was hung fairly high on the wall ( approximately above 5 feet); the font size appeared small.

At the time of observation, surveyor was unable to read the printed words on the sign related to "It's the LAW" section ( EMTALA verbiage).

During an interview with Staff ID-H, ER nurse, at the time of observation, she was unable to read the words on the sign.

They were both standing directly underneath the sign an looking up toward the sign.

Record review of Medicare Provider Agreement [Code of Federal Regulations (CFR) 42 CFR 489.20(q) ] "requires a hospital to post conspicuously a sign(s) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor and to indicate whether or not the hospital participates in the Medicaid program. The letters within the signs must be clearly readable at a distance of 20 feet or the expected vantage point of the emergency departments clients..".

Based on interview and record review, the facility failed to:

a. maintain a usable and complete list of on-call physicians to provide further evaluation or stabilizing treatment, after a patient's initial exam;

b. develop written policies that address situations in which a particular specialty is not available or the on-call physician cannot respond due to circumstances beyond the physician's control.

Findings included :

TX 00374928

a. On-call list of physicians:

During an interview on 12/07/2021 at 10:15 AM with Staff ID- H, ER nurse- she was asked what medical specialties were on-call to provide further evaluation or treatment for the ER patients ? Staff H said she was not completely sure of all the specialties on-call. This RN was asked to provide the specialty physician on-call list for the current month, December 2021.

Record review in the ER of a form titled "Doctors on Call-December 2021" showed a calendar with two (2) last names listed for each day in December. There were telephone numbers listed for these physicians underneath the calendar grid. Staff ID-H said she was not aware of the practice speciality of these physicians. The specialties were not listed. There were "cardio" physicians listed on the lower portion of the page.

b. Policies that address unavailability of a certain specialty or on-call physician unable to respond:

Record review on 12/08/2021 of all facility policies related to EMTALA and emergency services failed to show any written policies and procedures related to the unavailability of certain specialties and non response of on-call physicians to the ER.

During an interview on 12/08/2021 at 2:30 PM with Staff ID-B, CNO, she stated the facility was in the process of trying to expand specialty physician coverage in the ER. The CNO said this effort also included developing needed policies related to physician coverage and unavailability. She acknowledged the facility did not have a policy that addressed lack of certain specialties or on-call physicians unable to respond.