HospitalInspections.org

Based on interview and record review, the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to provide triage and medical screening exam (MSE) for 1 (#12) of 25 patients reviewed, resulting in the potential for less than optimal outcomes for all patients seeking emergent care. Findings include:

See tag A-2406 -Failure to provide MSE

Based on record review and interview, the facility failed to document information on the Emergency Department (ED) central log or Obstetric Department (OB) central log for 1 (#12) of 25 patients reviewed for fulfillment of Emergency Medical Treatment and Labor Act (EMTALA) requirements, resulting in the potential for unmet patient needs and poor patient outcomes. Findings include:

On 6/2/25 at approximately 1230, review of the ED log for the past 6 months (12/1/24-5/31/25) revealed no evidence of patient #12 being registered. Interview with ED Manager (Staff C), on 6/2/25 at approximately 1330, verified that the patient had not been registered in the ED Log. On 6/3/25 at approximately 1130, review of the OB log for the same past 6 months also revealed no evidence of patient #12 being registered. Interview with the OB Manager (Staff L), on 6/3/25 at 1130, verified that the patient should have been examined and placed on the OB log.

Review of the facility policy titled "Emergency Medical Treatment and Active Labor Act (EMTALA) last revised 4/4/2022, (page 11 of 13)" documented "L. Centralized Log: 1. All applicable [affiliated] hospital Emergency Centers and Labor and Delivery, shall maintain logs that identify the individuals who have presented for such services. 2. The logs shall include whether the individual refused treatment, were refused treatment, were treated, were admitted, were stabilized, were transferred or were discharged."

Based on interview and record review, the facility failed to conduct a medical screening exam (MSE) for 1 (#12) of 25 patients presenting to the emergency room, resulting in delayed care and the potential for less than optimal patient outcomes. Findings include:

On 6/2/25 at approximately 1000, interview with ED Nurse Manager (Staff C) revealed that pregnant women 20 weeks or more gestation were to be examined by the Obstetrics physician when they presented to the ED. The patient is usually taken up to the OB floor, at times OB staff come down to the ED.

On 6/2/25 at approximately 1130, interview with OB Manager (Staff L) and OB Charge Nurse (Staff N) on 6/2/25 at 1500, revealed that patient #12 was a 28-year-old female transferred to the ED by ambulance from the doctor's office on 4/24/25 at approximately 1620 for possible ruptured uterus or placental abruption at approximately 36 weeks gestation. Patient #12 was not examined by an OB physician but rather was met in the ED by two OB physicians and sent to another hospital by the OB physicians and a nurse anesthetist.

Interview with the Nurse Anesthetist (Staff P), on 6/3/25 at 1000, revealed that she consulted the anesthesiologist and it was determined that facility resources could not care appropriately for this patient. The facility did not have a neonatal intensive care unit and the patient would probably require massive transfusions. She stated it was for the safety of the patient.

On 6/3/25 at 1030, interview with ED Nurse (Staff R) revealed that she took the EMS radio call that the patient was on the way. When she went up to triage two minutes later, patient #12 was already at the triage desk area. (Note: patient walk-in and ambulance entrance were the same entrance) OB physicians and Anesthesia Staff P came down to the ED and insisted the patient go to another hospital.

Interview with OB physician (Staff U), on 6/3/25 at 1145, revealed that anesthesia concerns were the main reason that she requested the EMS ambulance take the patient to a higher level of care hospital. The patient's office attending OB physician was called and he and the patient agreed to the other hospital. There was no medical record documentation on this patient. OB physician U verified that a medical screening exam (MSE) was not done. She stated that she had completed EMTALA training and a MSE should have been done and if needed, an appropriate transfer.

Interview with the second OB physician (Staff V), on 6/3/25 at 1200, revealed that she also met the patient in the ED and thought the patient was fine because she was arguing with staff. The patient remained on the EMS gurney and was sent to another hospital by ambulance. This OB physician stated that she had completed EMTALA training and verified that a MSE should have been done before a transfer to another hospital.

Review of the facility policy titled "Emergency Medical Treatment and Active Labor Act ('EMTALA'), last revised 4/4/2022" documented, "A. Medical Screening Examination ... hospital will provide a medical screening examination (MSE) to any individual regardless of diagnosis (e.g. labor, AIDS) financial status (e.g. uninsured, Medicaid), age, gender, color, race, national origin (e.g. Hispanic or Native American), religion, sexual orientation, marital status, or disability, or in a manner that would violate federal or state anti-discrimination laws."