HospitalInspections.org

Based on observations, interviews, and review of the hospital's Emergency Medical Treatment And Labor Act (EMTALA) policies and procedures, the hospital failed to ensure a sign with a monetary amount for services was not posted in the hospital's adult emergency waiting room.

The findings are:

Hospital policy, entitled, "EMTALA-Medical Emergencies, Screening and Transfer", revealed, "MUSC (Medical University South Carolina) Health will provide emergency services to all patients, without discrimination and without regard to whether a patient may be eligible for assistance under MUSC Health's Financial Assistance Policy. MUSC Health prohibits any actions that would discourage individuals from seeking emergency medical care, such demanding that individuals pay before receiving treatment for emergency medical conditions or permitting debt collection activities that interfere with the provision of emergency services..."

Observations on 08/15/22 at 1:00 PM in the hospital's Emergency Department waiting room revealed a standing sign in the Emergency Room waiting area by the front door entrance that stated "Virtual Urgent Care, E-Visits (electronic visits) online services that connect patients with (hospital) providers for common urgent care and primary care conditions, $25 (twenty-five dollars) out-of-pocket" with a list of conditions and a link for the visits.

On 08/16/22 at 3:19 PM, during an interview with Emergency Department Technician (EDT) #1, he/she stated, "E-Visits for ($25)twenty-five dollars was started for "my charts" patient portal. My Chart shows any visits and labs(laboratory studies). There is a tele visit which you can use without having to come into the ER (Emergency Room). The list gives what the visits can be for. Any patients coming to the ER will be seen. All staff are aware of the sign. The patients will ask what it is about, and we will explain it to them. We don't recommend them to do the E-Visits, but recommend that for future visits. It's up to the patients for doing it later."

On 08/16/22 at 3:43 PM, during an interview with Registered Nurse (RN) #1, he/she stated, "The E-Visit sign is if the patient wants to schedule a visit. I think of it as more of a next time thing."

On 08/17/22 at 8:53 AM, during an interview with EDT #2, he/she stated, "The quick visit sign is if they want to use it. Some patients ask questions about it, and if they still want to check in here (emergency room), then I tell them we can see them here. I'm not sure if it's an ED (Emergency Department) physician or not, but it has to be an attending. I think the visit is done online, and they don't have to come to the ED at all. The sign for E-Visits has been in the ER for about 3 1/2 (three and a half) years. The sign was in the old ER area as well."

On 08/17/22 at 9:23 AM, during an interview with RN #2, he/she stated, "E-Visit sign is just about other resources for the patient. The E-Visit is not offered by the ED. I think it's an (hospital) poster for resources. I've never been educated on it. You can see a person during the visit. I think it's (the hospital) urgent care because we don't have one."

On 08/18/22 at 9:08 AM, during an interview with the main ED Nurse Manager, he/she stated, "The E-Visit sign was the organization's thought it would be an additional resource to do primary care. It came in handy during COVID. That (the sign) was an initiative by Senior Leadership when we were expanding our telehealth. It is not a service of the ED. The sign has been there since pre-COVID. We have been in this location within the last two years. Currently, no urgent care by the hospital."

On 08/18/22 at 1:49 PM, during an interview with the Chief Nursing Officer (CNO), he/she stated, "The E-Visit sign. I'm not sure who made the decision for it to be posted. Talking with staff, I was told that it's like a type of follow up for patients leaving the ED, mainly as a resource. Unsure if staff has been educated about it. Our E-Visit goes to the telehealth nursing team. It's PA's (Physician Assistants), APP (Advanced Practice Practitioners) some physicians, and they are not associated with the ER."

On 08/18/22 at 2:24 PM, during an interview with the Director of Occupational Health, he/she stated, "I didn't realize it (the sign) was in the new ED. We had it up at one point in the old ED. It was like another avenue for care and was promoting our telehealth. It was another advertisement for it. No one in the ED would be responsible for the E-Visits. Approval of the sign? I don't remember (who gave it). The former chair of the ED and the former compliance person would have been the ones to approve the sign. After their approval, the sign stayed in place after that. I'm surprised it's over there. It wasn't there during the weeks prior to me leaving."