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Based on reviews of clinical records, review of hospital policies and procedures, and staff interviews, it was determined that the hospital failed to enforce policies and procedures that comply with the requirements of 42CFR 489.20 and 42 CFR 489.24, the responsibilities of Medicare participating hospitals in emergency cases as evidenced by:

A2405: The hospital failed to ensure a patient who was brought to the Intake Area by ambulance was entered into the dedicated Intake Log. (Patient #6).

A-2406 Medical Screening Examination: The hospital failed to provide a Medical Screening Examination (MSE) to a patient who was taken to the Intake Department by ambulance (Patient #6). Staff declined to accept the patient when the ambulance arrived with the patient (Patient #6) from the transferring hospital.


Findings include:

A2405
Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)," revealed "...Documentation: Springstone Hospitals will maintain a log of patients presenting to the hospital for treatment along with documentation indicating whether he or she refused treatment, was denied treatment or whether he or she was treated, admitted, stabilized, and/or transferred or was discharged...."

Review of the Intake Area EMTALA Log dated 04/22/2022 revealed no evidence of Patient #6 was entered into the EMTALA log upon presentation by ambulance on 04/22/2022 at approximately 2220 pm in the Intake area.

Patient #6 [Social Work] Case Management note from Hospital #2 dated 04/23/2022 at 0017 revealed: "...Patient was discharged and transported to [Copper Springs] via Maricopa Ambulance. Upon arriving to intake, they refused to accept [him] stating they do not have any beds and [he] was declined for admission earlier today. This is a contradiction to what had been discussed previously when the dispo plan was established per previous notes. Regardless, patient returned to MGMC (Hospital #2) ED from intake at [Copper Springs] and referrals were re-faxed to all appropriate level one psych facilities for consideration. Awaiting acceptance. [SW] following...."

Patient #6 Transfer Form form Hospital #2 dated 04/22/2022 at 2000 revealed: "...Benefits/reason for transfer: Availability of a higher specialized level of Psychiatry care; receiving facility: [Copper Springs], accepting [physician Dr Amani], time contacted at 1900, staff person name: [Copper Springs], Time contacted at 1900; Transported by: BLS ambulance...."

The EMS run sheet dated 04/22/2022 revealed "...At scene 2201, Transport 2213, Arrival at destination 2219...Narrative: Dispatched to [Gilbert Mercy] (Hospital #2) for a 55 y/o male for SI transporting to behavioral facility...On arrival to behavioral facility receiving [RN] refused to take over patient care due to not being notified of patient arrival and no available bed for patient. [Gilbert Mercy] (hospital #2) was contacted and authorized returning patient to [Gilbert Mercy] (Hospital #2)...."

Employee #2 confirmed during an interview on 12/15/2022 that there is no documentation that Patient #6 was brought in by ambulance on 04/22/2022 approximately between 2200-2230. Employee #2 further confirmed that if a patient arrives via ambulance or walk-in, the facility is obligated to enter the patient into the Intake Area EMTALA log including the documentation of the performed MSE.

A2406

The hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)," revealed "...All persons presenting to a Springstone Hospital will be provided a medical screening examination to determine id they have an emergency medical condition...Capacity means the ability of the Springstone Hospital to accommodate the individual requesting or being referred for examination or treatment of the transferred individual. Capacity encompasses things as numbers and availability of qualified staff, beds and equipment and the hospital's past practices in accommodating additional patients in excess of its occupancy limits...Comes to the hospital means an individual has presented on Springstone Hospital property, as defined in this sections, and requests examination or treatment for what may be an emergency medical condition, or has such a request made on his or her behalf...Hospital Property means the entire Springstone Hospital campus, including the parking lot, sidewalk, and driveway, but excluding other areas or structures of the Hospital's main building that are not part of the hospital or are nonmedical facilities...Treatment: A person who comes to a Springtime Hospital will receive a medical screening exam (MSE) conducted by a qualified medical person (QMP) to determine if an emergency medical (including psychiatric) condition (EMC) exists. An appropriate medical screening examination should address the presenting symptoms and comply with current policies and procedures for assessment of those presenting symptoms...."

A review of Patient #6 medical records revealed that no evidence of a medical screening examination was completed or performed upon arrival to Hospital #1 via ambulance on 04/22/2022 at approximately 2220.

Employee #4 confirmed during an interview on 12/12/2022 that when patients arrive either as a walk-in or via ambulance they are taken directly to the intake assessment area for triage and an assessment. Employee #4 further confirmed that there was no evidence that a medical screening examination was conducted or performed on Patient #6 upon arrival to Hospital #1 via ambulance on 04/22/2022 at approximately 2220.

Based on review of records, policies and procedures, hospital logs/documents, and staff interviews, it was determined the hospital failed to ensure a patient who was brought to the Intake Area by ambulance was entered into the dedicated Intake Log. (Patient #6).

Findings include:

Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)", revealed: "...Documentation: Springstone Hospitals will maintain a log of patients presenting to the hospital for treatment along with documentation indicating whether he or she refused treatment, was denied treatment or whether he or she was treated, admitted, stabilized, and/or transferred or was discharged...."

Hospital document titled ,"EMTALA Intake Area Log, April 2022", revealed no evidence of Patient #6 being entered into the EMTALA Intake Area Log after being brought into the facility by ambulance on 04/22/2022 at approximately 2220 pm.

Patient #6 [Social Work] Case Management note from Hospital #2 dated 04/23/2022 at 0017 revealed: "...Patient was discharged and transported to [Copper Springs] via Maricopa Ambulance. Upon arriving to intake, they refused to accept him stating they do not have any beds and he was declined for admission earlier today. This is a contradiction to what had been discussed previously when the dispo plan was established per previous notes. Regardless, patient returned to MGMC (Hospital #2) ED from intake at [Copper Springs] and referrals were re-faxed to all appropriate level one psych facilities for consideration. Awaiting acceptance. [SW] following...."

Patient #6 Transfer Form form Hospital #2 dated 04/22/2022 at 2000 revealed, "...Benefits/reason for transfer: Availability of a higher specialized level of Psychiatry care; receiving facility: [Copper Springs], accepting [physician Dr Amani], time contacted 1900, staff person name: [Copper Springs], Time contacted 1900; Transported by:BLS ambulance...."

The EMS run sheet dated 04/22/2022 revealed, "...At scene 2201, Transport 2213, Arrival at destination 2219...Narrative: Dispatched to [Gilbert Mercy] (hospital #2) for a 55 y/o male for SI transporting to behavioral facility...On arrival to behavioral facility receiving RN refused to take over patient care due to not being notified of patient arrival and no available bed for patient. [Gilbert Mercy] (hospital #2) was contacted and authorized returning patient to [Gilbert Mercy] (hospital #2)...."

Employee #2 confirmed during an interview on 12/15/2022 that there is no documentation that Patient #6 was brought in by ambulance on 04/22/2022 at approximately 2200-2230. Employee #2 further confirmed that if a patient arrives via ambulance or walk-in, the facility is obligated to enter the patient into the Intake Area EMTALA log along with the performance of the MSE.

Based on review of policies and procedures, hospital documents, medical records and staff interviews, it was determined that the hospital failed to ensure a patient who presented to the intake area by ambulance was provided a medical screening examination. (Patient #6).

Findings include:

Hospital policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA)", revealed: "...All persons presenting to a Springstone Hospital will be provided a medical screening examination to determine id they have an emergency medical condition...Capacity means the ability of the Springstone Hospital to accommodate the individual requesting or being referred for examination or treatment of the transferred individual. Capacity encompasses things as numbers and availability of qualified staff, beds and equipment and the hospital's past practices in accommodating additional patients in excess of its occupancy limits...Comes to the hospital means an individual has presented on Springstone Hospital property, as defined in this sections, and requests examination or treatment for what may be an emergency medical condition, or has such a request made on his or her behalf...Hospital Property means the entire Springstone Hospital campus, including the parking lot, sidewalk, and driveway, but excluding other areas or structures of the Hospital's main building that are not part of the hospital or are nonmedical facilities...Treatment: A person who comes to a Springtime Hospital will receive a medical screening exam (MSE) conducted by a qualified medical person (QMP) to determine if an emergency medical (including psychiatric) condition (EMC) exists. An appropriate medical screening examination should address the presenting symptoms and comply with current policies and procedures for assessment of those presenting symptoms...."

A review of Patient #6 medical record revealed no evidence of a medical screening examination was completed when the patient was presented to the Intake Area via ambulance personnel on 04/22/2022 at approximately 2220 pm.

Employee #4 confirmed during an interview on 12/12/2022 that when patients arrive either as a walk in or by ambulance they are taken directly to the intake assessment area for triage and an assessment. Employee #4 further confirmed that no evidence of a medical screening examination was conducted for Patient #6 when [s/he] presented in the Intake Area via ambulance on 04/22/2022 at approximately 2220.