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Based on medical record reviews, interviews and document reviews, the facility failed to provide a Medical Screening Examination (MSE) to one (1) [Patient #2] out of twenty (20) [Patients #1 - #20] records reviewed of Springfield HealthPlex Emergency Department patients. At the time of this survey, the facility was in complaince, but was previously out of compliance, with the EMTALA requirements at 42 CFR §489 (Rev. 02-21-20)) regarding Responsibilities of Medicare Participating Hospitals in Emergency Cases.

The findings:

The facility's policy entitled, "IHS EMTALA - Compliance with the Emergency Medical Treatment and Active Labor Act Policy," PolicyStat ID 17200541, effective date January 14, 2025, reads in part:
... "I. Policy
Any individual who comes to an Inova Dedicated Emergency Department requesting, or for whom a request is made, examination or treatment for a medical condition, shall be given an appropriate medical screening.
... II. Purpose
To provide guidelines to ensure compliance with EMTALA - Emergency Medical Treatment and Active Labor Act - which requires that (i) a medical screening must be done to determine if an emergency medical condition exists for anyone who comes to an Emergency Department seeking an evaluation or treatment ....
... III. Applies to
All hospitals, hospital property areas, including any building owned by the hospital that are within 250 yards of the hospital, and provider-based facilities, and off-campus dedicated Emergency Departments.
... V. Expected Outcomes
2. All hospitals and dedicated emergency departments will meet the guidelines required by the Emergency Medical Treatment and Active Labor Act."

The facility's policy entitled, "EMTALA - Compliance with the Emergency Medical Treatment and Active Labor Act, Addendum Title: Medical Screening Procedure, Addendum Letter: A," effective date November 2024, reads in part:
"A. Medical Screening Examination
b. Medical Screening Exam Required
ii. An appropriate Medical Screening Examination, within the capability and capacity of the facility, shall be provided to any individual who (i) comes to an Inova Dedicated Emergency Department requesting, or for whom a request is made for, examination or treatment for a medical condition ...."

A review of the medical record revealed that Patient #2 was taken to the Springfield HealthPlex Emergency Department [ED] with an accidental self-inflicted gunshot wound [GSW] to the left leg on December 21, 2024, at 11:36 P.M. Patient #2 was transported by a friend and entered the main entrance of the facility's ED through a metal detector monitored by a security guard.. During triage, Patient #2 denied having any weapons or hazardous materials with them. Patient #2 was provided with a MSE and stabilizing treatment before transfer to another Inova facility at 00:39 A.M. on December 22, 2024.

During an interview on February 4, 2025, at 10:57 A.M., Staff Member #4 indicated that the HealthPlex ED was shut down from 11:40 P.M. on December 21, 2024, until 12:20 A.M. on December 22, 2024, approximately forty (40) minutes total, by Staff Member #6. Staff Member #6 notified security to lock the ED down shortly after Patient #2 arrived. Staff Member #6 did not seek approval from an appropriate administrator prior to the lockdown. Staff Member #4 indicated that it was totally inappropriate for Staff Member #6 to lock the HealthPlex ED down. Staff Member #4 was aware of two (2) patients that were turned away at the main entrance by security during the lockdown. Staff Member #4 indicated that the two (2) patients that were turned away required MSEs, per EMTALA requirements and facility policy.

During an interview on February 5, 2025, at 8:57 A.M., Staff Member #8 indicated they received a text from Staff Member #6 on December 22, 2024, at approximately 12:20 A.M., notifying Staff Member #8 that they [Staff Member #6] had put the ED on lockdown. The lockdown had already been underway for thirty-five to forty (35-40) minutes. Staff Member #8 indicated that two (2) patients had been turned away by security from the main entrance to the ED during the lockdown. A patient presenting with chest pain was allowed to enter the ED during the lockdown. Staff Member #8 indicated that Staff Member #6 did not have the authority to lockdown the ED and should have called Staff Member #8, the administrator at Inova Alexandria Hospital or Staff Member #4. Staff Member #8 indicated that there were no EMS calls during the lockdown. Staff Member #8 d that indicatethe two (2) patients that were turned away required MSEs per EMTALA regulations.

During an interview on February 5 2025, at 9:56 A.M., Staff Member #7 indicated during the lockdown, two (2) patients were turned away, a toddler and a young boy.

On February 5, 2025, the surveyor reviewed all education and changes implemented as a result of the reported incident. EMP1, EMP4 and EMP6 reported reeducation was provided to the ED and security staff. Attendance rosters were provided and reviewed by this surveyor to include: diversion and lockdown protocols, a tabletop drill to assess and review restricted access and lockdown procedures, and the"escalation tree" document detailing procedures and step-by-step instructions posted at the ED charge nurse's desk.