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Based on document reviews and interviews, the hospital failed to follow their policy and provide a medical screening examination with the capability of the hospital's Emergency Department for a patient who was seeking care on 5/16/2025. (Patient #1)

Findings:

The NL Sebasticook Valley Hospital policy titled, 'Emergency Treatment and Transfer Rules Policy', last revised 4/1/2024, stated in part..."POLICY AND PROCEDURE I. HOSPITAL DUTY WITH RESPECT TO EMERGENCY MEDICAL CONDITION If an individual Comes to the Emergency Department, then the hospital must provide a Medical Screening Examination..."

On 05/16/2025, Northern Light Sebasticook Valley Hospital self-reported a possible EMTALA violation stating,in part, "[Patient #1] brought to NL Sebasticook Valley Hospital ("SVH") Emergency Department by SVH ambulance and Pittsfield police department for psychiatric evaluation. Individual was transported in handcuffs via ambulance. Upon entry to the hospital, Emergency Medical Services ("EMS") and police explained to Emergency Department RN that the individual needed to be in handcuffs and supervised one-to-one. RN informed EMS and police that there was not sufficient staff to care for this individual, no beds available, and that the emergency department was unable to provide the requested one-to-one supervision services."

On 6/3/2025 at 6:30 AM a telephone interview was conducted with RN #1, ED Staff Nurse, regarding her involvement in the alleged EMTALA issue. She was asked if she worked 5/16/2025 when a policeman came into the ED and talked wither about a patient that was arriving. She stated yes. She explained that the ED was extremely busy that night, that there were 4 psych patients and patients being housed in the ASU area. She stated that the policeman told her a very disruptive patient was arriving and would need 1;1 and be restrained in a bed. She stated that she was overwhelmed and was not really thinking when she told the policeman that the ED did not have the capacity to take that patient."

Northern Light Sebasticook Valley Hospital identified the potential violation, self-reported the event, and put in measures to ensure that the Emergency Department staff would not deter a patient in the future from seeking care. These measures included a review of facility Emergency Medical Treatment and Active Labor Act ("EMTALA") policies, online EMTALA training for staff, and in-person EMTALA reviews with Emergency Department staff. At the time of the on-site survey, surveyors determined, through observation, document reviews, and interviews, that Northern Light Sebasticook Valley Hospital was in compliance, but previously out of compliance with 42 CFR, Part 489, Responsibilities of Medicare Participating Hospitals in Emergency Cases.

On 6/2/2025 at 1:00 PM, the VP of Nursing was interviewed. She stated in part..."all ED staff have a mandatory reeducation of EMTALA via HealthStream that needs to be completed by 6/14/2025. She stated the providers are included even though no provider was aware of the situation. She stated that the EMS crew will complete the EMTALA training as well. She stated that she has met with the new police chief in town and she is planning an Inservice for the entire police force in June...she said as soon as she knew the situation she called the ED and spoke to the[RN #1]. She said the nurse was very upset and didn't realize that once the patient arrived they needed a medical screening exam. She was confused by the police being involved. She said that she counseled her on the phone."

Based on review of documentation and interviews, the facility failed to provide an appropriate medical screening examination at the facility's Emergency Department ("ED") on 05/16/2025. (Patient #1)

Findings:

The Northern Light Sebasticook Valley Hospital policy titled, 'Emergency Treatment and Transfer Rules Policy', last revised 4/1/2024, stated in part..."POLICY AND PROCEDURE I. HOSPITAL DUTY WITH RESPECT TO EMERGENCY MEDICAL CONDITION If an individual Comes to the Emergency Department, then the hospital must provide a Medical Screening Examination..."

On 05/16/2025, Northern Light Sebasticook Valley Hospital self-reported a possible EMTALA violation stating,in part, ..."[Patient #1] brought to NL Sebasticook Valley Hospital ("SVH") Emergency Department by SVH ambulance and Pittsfield police department for psychiatric evaluation. Individual was transported in handcuffs via ambulance. Upon entry to the hospital, Emergency Medical Services ("EMS") and police explained to Emergency Department RN that the individual needed to be in handcuffs and supervised one-to-one. RN informed EMS and police that there was not sufficient staff to care for this individual, no beds available, and that the Emergency Department was unable to provide the requested one-to-one supervision services."

On 6/3/2025 at 6:30 AM a telephone interview was conducted with RN #1, ED Staff Nurse, regarding her involvement in the alleged EMTALA issue. She was asked if she worked 5/16/2025 when a policeman came into the ED and talked wither about a patient that was arriving. She stated yes. She explained that the ED was extremely busy that night, that there were 4 psych patients and patients being housed in the ASU area. She stated that the policeman told her a very disruptive patient was arriving and would need 1;1 and be restrained in a bed. She stated that she was overwhelmed and was not really thinking when she told the policeman that the ED did not have the capacity to take that patient."

Northern Light Sebasticook Valley Hospital identified the potential violation, self-reported the event, and put in measures to ensure that the Emergency Department staff would not deter a patient in the future from seeking care. These measures included a review of facility Emergency Medical Treatment and Active Labor Act ("EMTALA") policies, online EMTALA training for staff, and in-person EMTALA reviews with Emergency Department staff. At the time of the on-site survey, surveyors determined, through observation, document reviews, and interviews, that Northern Light Sebasticook Valley Hospital was in compliance, but previously out of compliance with 42 CFR, Part 489, Responsibilities of Medicare Participating Hospitals in Emergency Cases.

On 6/2/2025 at 1:00 PM, the VP of Nursing was interviewed. She stated in part..." all ED staff have a mandatory reeducation of EMTALA via HealthStream that needs to be completed by 6/14/2025. She stated the providers are included even though no provider was aware of the situation. She stated that the EMS crew will complete the EMTALA training as well. She stated that she has met with the new police chief in town and she is planning an Inservice for the entire police force in June...she said as soon as she knew the situation she called the ED and spoke to the[RN #1]. She said the nurse was very upset and didn't realize that once the patient arrived they needed a medical screening exam. She was confused by the police being involved. She said that she counseled her on the phone."

Based on review of documentation and interviews, the facility failed to provide an appropriate transfer at the facility's Emergency Department ("ED") on 05/16/2025. (Patient #1)

Findings:

The NL Sebasticook Valley Hospital policy titled, 'Emergency Treatment and Transfer Rules Policy', last revised 4/1/2024, stated in part..."POLICY AND PROCEDURE... Before transfer, the ED (or Labor & Delivery Department) must, except as noted below, provide either: 1. Treatment within the abilities of the staff and facilities available at the hospital to Stabilize the medical condition and documentation thereof on the Interhospital Transfer Form; or 2. Transfer to another medical facility in accordance with specified rules. An individual who has been Stabilized may be transferred as provided by departmental policy. An individual who has not been Stabilized may be transferred only if one of the following three (3) requirements is met and documented on the Interhospital Transfer Form at the time of transfer: (a) The individual or a legally responsible person acting on the individual's behalf, after being informed of the hospital's obligations under this section to Stabilize the individual and also after being informed of the risks and benefits of transfer, versus admission to the hospital, requests, in writing, the transfer to another medical facility..."

On 05/16/2025, Northern Light Sebasticook Valley Hospital self-reported a possible EMTALA violation stating,in part, "Patient #1 brought to NL Sebasticook Valley Hospital ("SVH") Emergency Department by SVH ambulance and Pittsfield police department for psychiatric evaluation. Individual was transported in handcuffs via ambulance. Upon entry to the hospital, Emergency Medical Services ("EMS") and police explained to Emergency Department RN that the individual needed to be in handcuffs and supervised one-to-one. RN informed EMS and police that there was not sufficient staff to care for this individual, no beds available, and that the emergency department was unable to provide the requested one-to-one supervision services."

On 6/3/2025 at 6:30 AM a telephone interview was conducted with RN #1, ED Staff Nurse, regarding her involvement in the alleged EMTALA issue. She was asked if she worked 5/16/2025 when a policeman came into the ED and talked wither about a patient that was arriving. She stated yes. She explained that the ED was extremely busy that night, that there were 4 psych patients and patients being housed in the ASU area. She stated that the policeman told her a very disruptive patient was arriving and would need 1;1 and be restrained in a bed. She stated that she was overwhelmed and was not really thinking when she told the policeman that the ED did not have the capacity to take that patient."

Northern Light Sebasticook Valley Hospital identified the potential violation, self-reported the event, and put in measures to ensure that the Emergency Department staff would not deter a patient in the future from seeking care. These measures included a review of facility Emergency Medical Treatment and Active Labor Act ("EMTALA") policies, online EMTALA training for staff, and in-person EMTALA reviews with Emergency Department staff. At the time of the on-site survey, surveyors determined, through observation, document reviews, and interviews, that Northern Light Sebasticook Valley Hospital was in compliance, but previously out of compliance with 42 CFR, Part 489, Responsibilities of Medicare Participating Hospitals in Emergency Cases.

On 6/2/2025 at 1:00 PM, the VP of Nursing was interviewed. She stated in part..." all ED staff have a mandatory reeducation of EMTALA via HealthStream that needs to be completed by 6/14/2025. She stated the providers are included even though no provider was aware of the situation. She stated that the EMS crew will complete the EMTALA training as well. She stated that she has met with the new police chief in town and she is planning an Inservice for the entire police force in June...she said as soon as she knew the situation she called the ED and spoke to the[RN #1]. She said the nurse was very upset and didn't realize that once the patient arrived they needed a medical screening exam. She was confused by the police being involved. She said that she counseled her on the phone."