HospitalInspections.org

This standard is not met based on staff interview, review of facility's documents "Account Receivable Form" and "Standard Operating Procedure Emergency Department Registration," and policy and procedure review. The facility failed comply with the Emergency Medical Treatment and Labor Act (EMTALA) regulations by requesting payment before providing a test (computed tomography (CT) scan) ordered by the physician to determine if an emergent medical condition (EMC) existed on one (1) of 20 medical records reviewed, (Patient #1).


Findings Include:

Review of the medical record for Patient #1 revealed he arrived at the Emergency Department (ED) via private vehicle on 09/26/2024 at 8:45 p.m. with a complaint of syncope (fainting) and falling, hitting the back of his head on a door. Patient #1 reports he was unconscious for fifteen (15) minutes and now has pain at the base of his skull and nausea. During the medical screening examination, the provider ordered a CT scan of the cervical spine and head without contrast at 8:57 p.m.

Review of the facility's document, "Account Receivable Form," reveals on 09/26/2024 at 9:06 p.m. the facility documented collection of $642.38 from Patient #1 before a CT scan was performed at 9:17 p.m. and the medical screening exam (MSE) was completed.

An interview on 10/17/2024 at 10:45 a.m. with the Director of Patient Access, confirms the "Account Receivable Form" is correct and $642.38 was received from Patient #1 by Patient Access Registration (PAR) Staff #2 at 9:06 p.m. on 09/26/2024 before the MSE was completed.

Cross Refer to 2408 for additional findings.

This standard is not met based on facility staff interviews, record reviews, policy and procedure review, and review of facility documents "Standard Operating Procedure Emergency Department Registration", and the facility's "Account Receivable Form", the facility failed to provide a computed tomography (CT) scan, before the medical screening exam (MSE) was completed, necessary for the diagnosis of an emergent medical condition (EMC) on an individual presenting to the Emergency Department with a complaint of a head injury after a fall resulting in the loss of consciousness before payment for the CT scan was received for one (1) of 20 medical records reviewed, Patient #1.

Findings Include:

Review of the medical record for Patient #1 revealed he arrived at the ED via private vehicle on 09/26/2024 at 8:45 p.m. with a complaint of syncope (fainting) and falling, hitting the back of his head on a door and was unconscious for fifteen (15) minutes and now has pain and tenderness at the base of his skull and nausea. Patient reported dining at a restaurant and consuming six (6) and a half (1/2) ounces of alcohol (whiskey) during the meal lasting approximately one and a half (1½) to two (2) hours. Patient #1 reported standing up after the meal, became lightheaded, had tunneling vision and fainted, striking his head on the door and ultimately the tile. Medical record reveals a medical screening examination was started at 8:47 p.m. Triage Acuity Level 2, emergent, high risk. Electrocardiography (EKG), lab work, chest X-ray, and a computed tomography (CT) scan were ordered.

Review of the facility's document, "Account Receivable Form," reveals on 09/26/2024 at 9:06 p.m. the facility documented collection of $642.38 from Patient #1 before a CT scan was performed at 9:17 p.m. and the medical screening exam (MSE) was completed.

An interview on 10/17/2024 at 10:45 a.m. with the Director of Patient Access, confirms the "Account Receivable Form" is correct and $642.38 was received from Patient #1 by Patient Access Registration (PARs) staff #2 at 9:06 p.m. on 09/26/2024 before the MSE was completed.

An interview on 10/15/2024 at 4:17 p.m. with the Director of Patient Access confirms the Emergency Department (ED) Registration Clerks are not allowed to seek or ask for any payment or money at any time until a Medical Screening Exam (MSE) is completed, and the patient is stable.

Review of the Facility's document, "Standard Operating Procedures (SOP) ED Registration," effective date 06/01/2021, reveals " ...Quick Registration Process ...Full Registration Process ...This standard operating Procedure ...is intended to be used by the Patient Access Registration staff, hereon referred to as PARs(s), when working in the Emergency Department registration area ...expectations and processes that PARs are expected to adhere to when registering patients ...The Stat Reg ...process starts by obtaining and validating the patients information ...patients input their social security number using the keypad, verbally verify the correct spelling of their name and date of birth ...If this information is not gathered accurately, patient safety may be compromised...The full registration process starts after triage...Full registration process...the process below outlines the next steps to be used by PARs after a patient has already arrived, placed in a bed, triaged by a Nurse and medically screened by a Physician. This process is intended not only as a continuation of the STAT Reg process ...Patients will NOT be approached for money until a medical screening exam (MSE) has been conducted and the patient determined, by the physician or physician extender to be in stable condition ...if patients arrive to the ED via ambulance, the STAT Reg process is still utilized. If the patient's condition requires them to bypass STAT Reg, PARs will be required to execute the Arrival as well as the Full Registration for patient at the point of contact ...when patients are fully registered, PARs will attempt to collect the entire amount owed from the patient at bedside ...".

Review of the Facility's policy "EMTALA," dated 12/01/2023, reviewed or revised 11/21/2023, " ...The Emergency Medical Treatment and Active Labor Act is a statute which governs when and how a patient may be refused treatment or transferred from one hospital to another when he/she is in an unstable medical condition ...provide for an appropriate medical screening examination and necessary stabilizing treatment ...without regard of ...ability to pay for services ...will not engage in any action ...such as by demanding that emergency department patients pay before receiving treatment for emergency medical care ...No attempt at debt collection activities will be attempted until EMTALA ...requirements have been satisfied ...".

During exit conference on 10/18/2024 at 3:30 p.m. survey findings were discussed with Senior Director of Emergency Services, Regulatory and Accreditation, and Director of Accreditation. No further documentation was submitted for review.