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

Findings include:

Hospital policy titled. "EMTALA-Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination as required by the Emergency Medical Treatment and Labor Act (METAL)...If an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment within the Hospital's capabilities and /or are transferred if appropriate, all without regard to the patient's insurance coverage or ability to pay...Any individual who comes to the Hospital Property or Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exists...If an Emergency Medical Condition is found to exist, the Hospital will (without regard for the patient's insurance coverage or ability to pay) provide: (a) stabilizing treatment within the capabilities of the Hospital ad its staff (including on-call physicians and diagnostic services), and/or (b) an appropriate transfer to another medical facility (if required for the patient's treatment or requested by the patient)...A Hospital may communicate with ambulance staff or EMS that it is unable to accept patients in the ED because it is in "diversionary" status because it does not have the staff or facilities to accept any additional emergency patients at that time or lacks the capability or capacity to provide specific care needed as a patient (e.g. Cath lab is unavailable). However, if an ambulance disregards the Hospital's instructions regarding diversion and brings the individual to the Hospital, the individual has come to the Hospital, and the Hospital's METAL duties are triggered...."

Hospital policy titled, "EMTALA-Central Log", revealed: "...To identify and document each individual who either comes to the Dedicated Emergency Department seeking treatment for any medical condition or presents on Hospital Property or Premises seeking care for an emergency medical condition...VVMC will maintain a central log to identify each individual who either comes to the Dedicated Emergency Department seeking treatment for any medical condition or presents on Hospital Property or Premises seeking care for am emergency medical condition...A log entry should be made at the first point of contact...."

The hospital failed to proved a Medical Screening Examination (MSE) to a patient who presented to the Emergency Department by ambulance (Patient #1). The ambulance was diverted by a staff member in the ambulance bay to a different hospital.

The hospital failed to ensure a patient who was brought to the Emergency Department (ED) by ambulance was entered into the dedicated ED log (Patient #1).

Employee #2 confirmed Patient #1 did not receive a MSE and was not entered into the ED Log.

Based on review of hospital records and staff interview it was determined the hospital failed to ensure a patient who was brought in to the Emergency Department (ED) by ambulance was entered in the dedicated ED log (Patient #1).

Findings include:

Hospital policy titled, "EMTALA-Central Log", revealed: "...To identify and document each individual who either comes to the Dedicated Emergency Department seeking treatment for any medical condition or presents on Hospital Property or Premises seeking care for an emergency medical condition...VVMC will maintain a central log to identify each individual who either comes to the Dedicated Emergency Department seeking treatment for any medical condition or presents on Hospital Property or Premises seeking care for am emergency medical condition...A log entry should be made at the first point of contact...."

Review of the ED Log for August 2022 revealed no documentation that PAtient #1 presented to the ED by ambulance and that the ambulance left with the patient prior to the patient receiving a Medical Screening Examination.

Employee #2 confirmed on 09/19/2023 that Patient #1 was not entered in the dedicated central log for the ED.

Based on review of clinical records, policies and procedures, hospital documents, and staff interviews, it was determined the hospital failed to provide a Medical Screening Examination (MSE) to a patient who was taken to the Emergency Department by ambulance (Patient #1). The ambulance was "diverted" by a staff member in the ambulance bay to a different hospital.

Findings include:

On 08/14/2022, Emergency Medical Services (EMS) were called to Patient #1 (unidentified patient) to transport to hospital for complaint of chest pain. EMS made a PATCH call to the hospital and provided the hospital with patient complaint and sent an EKG to the hospital. Upon review of the EKG the medical provider determined the patient required cardiac cath lab intervention which was not available at the hospital at that time. The medical provider instructed the nursing staff to contact the EMS crew and have the EMS crew take the patient to hospital #2. Nursing staff were unable to contact the EMS crew. EMS arrived with Patient #1 and were met in the ambulance bay by nursing staff who instructed the EMS crew to take the patient to hospital #2.

Hospital policy titled. "EMTALA-Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination as required by the Emergency Medical Treatment and Labor Act (METAL)...If an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment within the Hospital's capabilities and /or are transferred if appropriate, all without regard to the patient's insurance coverage or ability to pay...Any individual who comes to the Hospital Property or Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exists...If an Emergency Medical Condition is found to exist, the Hospital will (without regard for the patient's insurance coverage or ability to pay) provide: (a) stabilizing treatment within the capabilities of the Hospital ad its staff (including on-call physicians and diagnostic services), and/or (b) an appropriate transfer to another medical facility (if required for the patient's treatment or requested by the patient)...A Hospital may communicate with ambulance staff or EMS that it is unable to accept patients in the ED because it is in "diversionary" status because it does not have the staff or facilities to accept any additional emergency patients at that time or lacks the capability or capacity to provide specific care needed as a patient (e.g. Cath lab is unavailable). However, if an ambulance disregards the Hospital's instructions regarding diversion and brings the individual to the Hospital, the individual has come to the Hospital, and the Hospital's METAL duties are triggered...."

Review of the hospital dedicated ED Log for August 2022 revealed no documentation for Patient #1.

Review of the PATCH log for Patient #1 dated 08/14/2022 revealed: "...[54 year old male] chief complaint SEMI, on oxygen...."

Review of Patient #1 EKG transmitted from EMS to the hospital revealed: "..abnormal findings, SEMI...."

No medical record was reviewed from Hospital #1 or the receiving Hospital #2, as no patient identification was provided in the complaint or by the complainant.

Employee #2 confirmed during an interview on 09/19/2023 that Patient #1 was brought in by EMS on 08/14/2022 for complaint of chest pain and upon arrival to the ambulance bay, EMS were instructed to take the patient to Hospital #2. Employee #2 confirmed that the medical provider had reviewed Patient #1 EKG prior to arrival and determined the patient needed cardiac cath lab which was not available at the hospital at that time. Employee #2 confirmed that the medical provider was unaware that staff had not been able to successfully divert the patient and the provider was unaware the patient had arrived in the ambulance bay.

Based on review of hospital records and staff interviews, it was determined the hospital failed to provide emergency stabilizing treatment and arrange a proper transfer for a higher level of care for one (1) patient who presented to the Emergency Department via ambulance and was diverted in the ambulance bay to another hospital (Patient #1).

Findings include:


Hospital policy titled, "EMTALA-Duty to Accept", revealed: " ...A hospital with specialized capabilities or facilities (such as burn units, shock-trauma units, neonatal intensive care units, or with respect to rural areas, regional referral centers) shall accept an appropriate transfer of an individual with an Emergency Medical Condition who requires specialized capabilities or facilities if the receiving hospital has the capacity to treat the individual...."

Hospital policy titled, "EMTALA-Medical Screening and Treatment of Emergency Medical Condition", revealed: "...A Hospital may communicate with ambulance staff or EMS that it is unable to accept patients in the ED because it is in "diversionary" status because it does not have the staff or facilities to accept any additional emergency patients at that time or lacks the capability or capacity to provide specific care needed as a patient (e.g. Cath lab is unavailable). However, if an ambulance disregards the Hospital's instructions regarding diversion and brings the individual to the Hospital, the individual has come to the Hospital, and the Hospital's METAL duties are triggered...."

Hospital policy titled, "EMTALA-Transfer Policy", revealed: "...Valley View Medical Center has written guidelines outlining the requirements for an appropriate transfer to another facility in accordance with federal and state laws. Any transfer of an individual with an Emergency Medical Condition must be initiated by a physician order with the appropriate physician certification...The transfer of a patient shall not be predicated upon arbitrary, capricious or unreasonable discrimination based upon race, religion, national origin, age, sex, physical condition or economic status...If a patient that comes to the emergency department or seeks emergency care on Hospital Property or Premises is determined through a Medical Screening Exam to have an Emergency Medical Condition, the hospital must provide either: (a) further medical examination and treatment, including hospitalization, if necessary, as required to stabilize the medical conditon within the capabilities of the staff and facilities available at the hospital; or (b) a transfer to another more appropriate or specialized facility...The four requirements of an appropriate transfer must be met before a patient can be transferred to a second facility: (a) The transferring hospital must, within its capability, provide treatment to minimize the risks to the health of the individula or unborn child; (b) The receiving hospital must have available space and qulaified personnel for the treatment of the individual, and must have agreed to accept the transfer and provide appropriate treatment;...."

On 08/14/2022, Emergency Medical Services (EMS) were called to Patient #1 (unidentified patient) to transport to hospital for complaint of chest pain. EMS made a PATCH call to the hospital and provided the hospital with patient complaint and sent an EKG to the hospital. Upon review of the EKG the medical provider determined the patient required cardiac cath lab intervention which was not available at the hospital at that time. The medical provider instructed the nursing staff to contact the EMS crew and have the EMS crew take the patient to hospital #2. Nursing staff were unable to contact the EMS crew. EMS arrived with Patient #1 and were met in the ambulance bay by nursing staff who instructed the EMS crew to take the patient to hospital #2.


Employee #7 confirmed on 09/18/2023 that Patient #1 was met by staff in the ambulance bay and sent to another hospital for treatment. Employee #7 confirmed that the hospital did not contact the receiving hospital regarding Patient #1. Employee #7 confirmed that Patient #1 did not receive a medical screening examination at the hospital.