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Based on observation, interview, and record review the hospital failed to abide by the provider's agreement that required a hospital to comply with 42 CFR 489.20. The hospital was not in compliance with the EMTALA (Emergency Medical Treatment and Labor Act) requirements, in that the hospital failed to ensure EMTALA signage was posted in all areas of the hospital's Emergency Department (ED) and was visible to all individuals from any vantage point.

Cross Refer to Tag A2402-489.20 (q) (1) and (2).

Based on observation, interview, and record review the hospital failed to ensure EMTALA (Emergency Medical Treatment and Labor Act) signage was posted in all areas of the ED (Emergency Department) and was visible to all individuals from any vantage point. The signage was to specify the rights of individuals with respect to examination and treatment for emergency medical conditions and for women in labor. The signage was to include whether or not the hospital participated in the Medicaid program.

Findings included:

A tour was conducted on 7/30/19 at approximately 9:45 AM in the hospital's ED (emergency department). The surveyor observed the lobby, check-in desk, triage area (1 triage room, 4 exam rooms), and all forty-five (45) patient rooms. There were 2 signs observed during the tour that specified the rights of individuals with emergency medical conditions and women in labor. The signs also indicated the hospital participated in the Medicaid program. Upon entry into the ED's vestibule between the first set of automatic patient entry doors and the second set of automatic patient entry doors, one sign was located on the right wall among other sign postings. The sign's frame measured 9"X 13.5". The sign within the frame measured approximately 8" X 12." Wheelchairs were placed in front of the signs making it difficult to walk up close to the signage to read. The second observed sign was on the right wall in the vestibule between the ED's first set of automatic ambulance bay entry doors and the second set of automatic ambulance bay entry doors. The frame was slightly larger than the first sign, but the sign reflected both English and Spanish information on one sign. These signs were not posted in a conspicuous place. The small size of the framed signage prevented it from being noticeable or easily read among the other posted signs on the wall. No other similar signage was observed in the ED's lobby, check-in desk, triage area, or in the 45 patient rooms. As a result, individuals awaiting treatment, were not able to see or read about their rights pertaining to emergency medical conditions, women in labor, or the hospital's participation in the Medicaid program. The surveyor was accompanied on the ED tour by Personnel #2 and Personnel #1.

During an interview on the morning of 7/29/19 during the ED tour, Personnel #2 and Personnel #1 confirmed all ED observations.

A review of the Hospital's Emergency Medical Treatment and Labor Evaluation policy with an effective date of 3/22/16 reflected, " ...Each [hospital acronym] facility covered by this policy shall post signs in prominent and conspicuous locations likely to be noticed by all individuals entering ED, L&D, and any other areas where patients are screened (such as entrances, admitting areas, waiting rooms, and/or treatment areas) which, at a minimum, must specify the rights of individuals in accordance with EMTALA ... The signs must indicate whether the facility participates in the Medicaid program ..."