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Based on a tour, review of facility documents and interview with staff (EMP), it was determined that the facility failed to post Emergency Medical Treatment and Labor Act (EMTALA) signage in the the public entrance and the ambulance entrance of the emergency department.


Findings include:


On October 31, 2023, a review of facility policy," POL-5195990: Emergency Medical Treatment and Labor Act (EMTALA)" (Last Revised: 9/1/2019; Last Approved: 5/31/2022) revealed the following: "Signage 1. Hospital signage must: ...d. Posted in a place or places likely to be noticed by all individuals entering the emergency department as well as those individuals waiting for examination and treatment (e.g., entrance, admitting area, waiting room, treatment area)."

On October 31, 2023, at 9:20am, during a tour of the emergency department, it was observed that there was no EMTALA signage at the public entrance to the emergency department. On October 31, 2023, at 9:20am, EMP5 confirmed that the public entrance door did not contain the required EMTALA signage.

On October 31. 2023, at 9:30am, during a tour of the emergency department ambulance entrance, it was observed there was no EMTALA signage displayed at the ambulance entrance. On October 31, 2023, at 9:35am, EMP4 and EMP5 confirmed that the ambulance entrance door did not contain the required EMTALA signage.

Based on a review of facility documents, and staff interview (EMP), it was determined that the facility failed to designate a substitute interventional cardiologist as required by the facility policy.

Findings include:

On November 1, 2023, a review of the "Allegheny Health Network-Medical Staff On Call Policy" (Last Approved: February 25, 2021) was completed and revealed the following: "A. On Call Schedule: 6. If a physician is unable to take call on his or her scheduled days, the physician must designate a substitute and notify the Medical Staff Office. If the Medical Staff Office is closed, the physician must notify the Emergency Department and the nursing supervisor of the identity of the substitute. B. Response to Call: 2. If the scheduled on call physician is unable to respond due to circumstances beyond the physician's control, the Emergency Department physician will determine whether to attempt to contact another physician on the Medical Staff or arrange for transfer pursuant to this policy. D. Concurrent Call/Elective Surgery: 1. Notwithstanding an on call physician's obligation to respond when on call, the on-call physician may also (i) be on call at another hospital, or (ii) perform elective surgery or other patient care services, provided: (a) the on-call physician has a designated backup physician with appropriate clinical privileges; (b) the on-call physician informs the Hospital's Emergency Department when the back up physicians is to be called ... "

During an interview on October 31, 2023, at 12:45pm, EMP13 explained the events of 10/27/2013. According to EMP13, on the morning of October 27,2023, EMP21 phoned EMP22 at 06:00am and indicated EMP21 would be unable to take call at the facility that day due to EMP21s work load at another facility. EMP22 agreed to cover call at the facility for EMP21. EMP21 and EMP22 failed to communicate the change in the on-call schedule to the facility cath lab, medical staff office or the emergency department, per policy.

On October 31, 2023, between 12:04pm and 12:26pm, EMP14 reviewed the facility's documented timeline of events in the cath lab. EMP14 explained that on 10/27/2023 at 11:02am, the ST-Elevation Myocardial Infarction (STEMI) pager for the facility was activated. On October 27, 2023, at11:04 am, the cath lab RN contacted Emp21. EMP21, the on-call physician of record, instructed the RN to send MR1 to AGH, as EMP21 could not come to the facility. At 11:05am, the cath lab RN phoned the charge RN at AGH. The AGH charge nurse indicated that EMP22 was performing a transcatheter aortic valve replacement (TAVR) and was not available. EMP22 failed to assure that EMP22 had secured and communicated a designated backup physician with appropriate clinical privileges while on-call and performing patient care services, per the facility policy.

These findings were confirmed during interview with EMP13 on October 31, 2023 at 12:45pm.

Based on a review of facility documents, medical record (MR), and employee interview (EMP), it was determined that the facility failed to provide a medical screening examination for a patient who arrived at the facility via ambulance for one of twenty medical records reviewed (MR1).
Findings include:
On October 31, 2023, a review of facility policy, "POL-5195990: Emergency Medical Treatment and Labor Act (EMTALA)" (Last Revised: 9/1/2019; Last Approved: 5/31/2022) revealed the following: "Overview Statement: ... It is the policy of Allegheny Health Network that any induvial who comes to the Hospital Property or Premises requesting examination or treatment and is suffering from an Emergency Medical Condition or expresses a complaint which could reasonably be construed as an Emergency medical Condition is entitled to and must be provided an appropriate Medical Screening Examination to determine whether or not an Emergency Medical Condition exists, stabilization to the extent the facility is able to do so, and an Appropriate Transfer if necessary."
On October 31, 2023, a review of MR1 revealed that an ambulance was dispatched to the patient's home on October 27, 2023, at 10:16am for "crushing chest pain radiating to back and left arm." Initial electrocardiogram (EKG) was obtained at 10:36am- normal sinus rhythm. A second EKG was obtained at 10:49am with elevation noted in leads V1-V5. ST- Elevation Myocardial Infarction (STEMI) was confirmed by medic command at 10:51am. Upon arrival to the facility, at 11:07am, "Two nurses from the ER came out and stated they could not accept the patient because they do not have an interventional cardiologist at the facility right now. Crew reloaded the patient into the ambulance and decided to transport to ... "
On October 31, 2023, at 8:33am, EMP1 confirmed that the patient had not undergone a medical screening examination upon arrival to the emergency department. On October 31, 2023, at approximately 9:30am, EMP4 and EMP 5 also confirmed that MR1 had not undergone a medical screening examination upon MR1s arrival to the emergency department on October 27, 2023 at 11:07am.