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Based on hospital policy and procedure reviews, medical record reviews, hospital documents review and staff and physician interviews, the hospital failed to comply with 42 CFR §489.20 and §489.24.

The findings include:

Based on hospital policy and procedure review, medical record reviews, physician and staff interview and Emergency Service personnel interviews, the hospital's DED (Dedicated Emergency Department) physician failed to provide an appropriate medical screening examination (MSE) within the capability of the hospital's DED, including ancillary services routinely available to the DED, to determine whether or not an emergency medical condition (EMC) existed for 1 of 21 reviewed patients who presented to the DED. (Patient #21).

~ Cross refer to §489.24(a) and §489.24(c) Medical Screening Examination - Tag A2406.

Based policy and procedure review, DED central log review and staff interview, the hospital failed to maintain an accurate central log on each individual who present to the hospital's DED (dedicated emergency department) seeking assistance as to whether or not he or she refused treatment, or was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged for 1 of 20 sampled patients (Patient #21).

The findings include:

Review of facility policy "Treatment of Patients with Emergency Medical Conditions (EMTALA)", last revised 06/2021 revealed "....H. Additional Requirements: 1. (Named hospital) will maintain a central log that lists: i. Each individual presenting to (Named hospital) dedicated emergency department..."

Review of the hospital's central log revealed Patient #21 was not found on the central log.

Interview with ED Administration on 02/23/2022 at 1015 confirmed Patient #21 was not on the hospital's central log on 01/16/2022.



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Based on hospital policy and procedure review, medical record reviews, physician and staff interview, emergency department logs, Emergency Medical Services (EMS) report, and Emergency Service personnel interviews, the hospital's DED (Dedicated Emergency Department) physician failed to provide an appropriate medical screening examination (MSE) within the capability of the hospital's DED, including ancillary services routinely available to the DED, to determine whether or not an emergency medical condition (EMC) existed for 1 of 21 reviewed patients who presented to the DED. (Patient #21).

The findings include:

Review of facility policy "Treatment of Patients with Emergency Medical Conditions (EMTALA)" last revised 06/2021 revealed "...It is the policy of "(named hospital) that all individuals including women in labor, presenting to (named hospital's) property.... including (named hospital's) "dedicated emergency department" (as defined below) who: request examination or treatment for a medical condition, or have such a request made on his or her behalf... be given an appropriate medical screening examination by a qualified medical personnel to determine if an emergency medical condition exists..."

Review of Hospital A's DED logs revealed Patient #21 was not registered as a patient on 01/16/2022.

Review of "named EMS (Emergency medical services) ambulance report revealed on 01/16/2022 at 0203 EMS was dispatched to Patient #21 a 62-year-old female who was presenting with abdominal pain and pitting edema. Review of the report revealed "Responded non-emergency traffic to residence ref. (reference) sickness ... "Pt (patient) stated I just got out of "named hospital" this week, and they just sent me home with this medicine ...they pretty much have given up on me, said I probably need to call hospice and sent me home. I want to get a second opinion at "named Hospital A" ...Encoded (radio call to Hospital A) who advised they do not have a cardiologist and could not handle the patient due to her dobutamine infusion. EMS supervisor was contacted via cell phone who said adv [sic] to Hospital A that family request their facility, and we do not need to transfer further due to incoming inclement weather. Hospital A was advised of the same EMS was parked at the EMS Entrance at Hospital A when the charge nurse approached the rear door EMS opened the same and the charge RN stated "You do realize that we do not have a cardiologist or the capabilities to handle this patient? Our ICU is full. You need to transport her to a higher level of care." I responded she is here for an evaluation for abdominal pain and weeping edema in her leg she is usually seen at "named hospital" but she has requested a 2nd opinion here. The charge nurse stated, "well she can get a 2nd opinion at another hospital ...If she is stable you need to transport her to one of those places." At this time, I closed the ambulance door and ended the conversation and the patient stated, "it sounds like they don't want me here." Pt was advised that EMS would transport her to Hospital B ..."

Review of Hospital B's DED record revealed Patient #21 arrived on 01/16/2022 at 0356 via EMS and admitted to the facility at 1149. Review of the history and physical on 01/16/2022 revealed "Pt recently discharged from "named hospital" and sent home with a dobutamine drip and hospice referral. Patient states she wants to get a second opinion to see if there's anything more that can be done, saying she is "not ready to die ...." Review revealed patient died on 01/20/2022 while admitted at Hospital B.

Interview on 02/22/2022 at 1415 with the EDMD (Emergency Department Medical Doctor) on duty revealed she recalled the radio call of a patient being brought in with complaints of abdominal pain on a dobutamine drip (medication used to treat blood pressure). Interview revealed she recalled the person recommending going to another hospital due to no cardiology on call. Interview revealed the patient requested to come to Hospital A. Interview revealed she recalled the House Supervisor on duty stated to the EMS personnel say "My doctor her not to come" Per interview the House Supervisor stated the EMS personnel slammed the door of the ambulance and drove off.

Interview on 02/23/2022 at 0930 with the House Supervisor who was on duty on the night shift of 01/15/2022 and morning of 01/16/2022 revealed she does not recall any interaction or event with EMS or Patient #21 or a conversation with EDMD.

Interview on 02/25/22 at 1315 with the Paramedic who transported Patient #21 to Hospital A revealed he recalled the patient wanting a second opinion regarding hospice. Interview revealed Patient #21 requested to go to Hospital A. Interview revealed he called in report on the radio to let Hospital A know and the hospital did not want to accept Patient #21 due to there was no cardiology on call. Interview revealed the "charge nurse" came out to the ambulance and stated, "you do realize we do not have cardio and she can get a second opinion somewhere else." Interview revealed the nurse slammed the back of the ambulance door and walked off. Interview revealed they left with Patient #21 and transported her to Hospital B.