HospitalInspections.org

Based on document review and interview, it was determined that the Hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The hospital failed to ensure a medical screening examination was completed to determine if a medical emergency existed. Refer to A- 2406

Based on document review and interview, for 1 of 1 (Pt. #1) patient who arrived on Hospital' A's property and was diverted (change course) to Hospital B, the hospital failed to ensure a medical screening examination was completed to determine if a medical emergency existed.

Findings include:

1. The hospital's policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA) Policy" (1/30/2024) was reviewed on 8/13/2025 and included, "Comes to the Emergency Department means an individual: ... Has presented on the Hospital property. ... "Hospital Property" means entire main campus of the Hospital, including the sidewalks, parking lots and driveways. ... Patients who come to a dedicated emergency department requesting examination and treatment will be triaged and receive a medical screening examination by a QMP [qualified medical professional]."

2. The EMS (emergency medical services) calls to Hospital A were reviewed on 8/12/2025. The first call was unremarkable. A second EMS call was placed to Hospital A due to Pt. #1's heart rate being 28 - 30 (reference range 60-100 beats per minutes) . Hospital A questioned whether Pt. #1 was in complete heart block on the heart monitor. The ambulance stated that was unable to be identified on the monitor. The ambulance was 2-3 minutes away. Hospital A voiced a concern that they did not have an interventional cardiologist (specialty that focuses on minimally invasive procedures of the heart) in the case that Pt. #1 required a pacemaker (artificial device for stimulating the heart and regulating its contractions). Hospital A asked if EMS felt that Pt. #1 was stable enough and could be diverted (change course) to Hospital B. Ambulance responded 'yes'. Ambulance informed Hospital A that they were pulling onto the hospital grounds. Hospital A still requested to divert to Hospital B otherwise would need to transfer anyway if pacemaker needed. The ambulance went onto Hospital B from the grounds of Hospital A.

3. The ED charge nurse (E#5), involved with Pt. #1 was interviewed on 8/13/2025 at 8:30 AM. E#5 stated, "[Pt. #1] had become bradycardia and I was concerned we couldn't provide the service [Pt. #1] needed in case of the need for a pacemaker. We did not have interventional cardiology available. I was unclear on the type of cardiac diversion we were on. I made the decision to divert to [Hospital B] based on our capabilities. I believe the ambulance had stated that it had just arrived on our campus, so the ambulance did not stop and continued on to [Hospital B]. [Pt. #1] should have been accepted by us because the heart condition was unknown. There was not a confirmed STEMI (severe type of heart attack). Since this event, I have been personally counseled about the diversion policy."

4. The ED medical director (MD#1) was interviewed on 8/13/2025 at 12:30 PM. MD#1 stated that an ECRN (emergency communications registered nurse) answers all EMS radio calls. MD#1 stated, "The ECRN makes most of the decisions related to patients coming to our hospital via ambulance. They make the decisions on diversion based on policy. They only consult a physician when there is a concern about patient stability." ... MD#1 stated, "Once any patient arrives on hospital grounds, that patient must be seen and have a medical screening exam completed." MD#1 stated that Pt. #1 should have been evaluated in the ED and not diverted.