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Based on record reviews, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider's agreement which requires hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by the hospital failing to ensure a medical screening examination was provided to each patient presenting to the emergency department (ED) to determine whether or not an emergency medical condition existed. This deficient practice was evidenced by failing to provide an appropriate medical screening exam for 1 (#3) of 20 (#1 - #20) patients who presented to the emergency department (see findings tag A-2406).

Based on record reviews, the hospital failed to ensure all patients who presented to emergency department (ED) had an appropriate medical screening exam. This deficient practice was evidenced by failing to provide an appropriate medical screening exam for 1 (#3) of 20 (#1 - #20) patients who presented to the emergency department.

Findings:

Review of the hospital's policy titled "Medical Screening Exam" revised date 07/24/2006, revealed in part, "1.) No patient who presents himself for treatment at the Emergency Room who requests screening shall be refused a medical screening evaluation or emergency treatment. The hospital will not delay providing an appropriate medical screening examination and treatment in order to inquire about the patient's method of payment or insurance status, or to seek authorization from the insurance company."
"3.) Medical Screening Exams should include at a minimum the following:
-Emergency Department Log entry including disposition of patient;
-Patient's triage record;
-Vital Signs;
-History;
-Physical exam of affected systems and potentially affected systems;
-Exam of known chronic conditions, if pertinent/available;
-Necessary testing to rule out emergency medical conditions;
-Notification and use of the on-call personnel to provide all necessary testing and on-call services within the capability of the hospital to reach a diagnosis.
-Notification and use of on-call physicians to diagnose and/or stabilize the patient as necessary;
-Vital Signs;
-Documentation of medical screening examination."

Review of Patient #3's emergency department record dated 05/31/2024 revealed Patient #3 presented with a chief complaint of back pain. Review of the provider note dated 05/31/2024 revealed in part, Patient has had back pain x 2 months, states the pain radiates to her right hip and leg. States it has had acute worsening over the last 2 days. She took robaxin, tramadol, prednisone at 2:00 a.m. prior to arrival. States she first noticed the pain getting worse on Monday this past week. She called her primary care doctor but had acute worsening of the pain today. States she has had difficulty walking the last couple days. She denies any saddle paresthesias, bladder/bowel incontinence. Denies any dysuria, hematuria. Denies chest pain, shortness of breath, nausea, vomiting, abdominal pain, headache, lightheadedness, dizziness. Further review revealed in part, Patient #3 was given Norco and a Lidoderm patch and a CT lumbar spine was obtained in the emergency department. Review of the CT lumbar spine revealed in part, Impression: 1.) Osteopenia and mild scoliosis with significant multilevel lumbar degenerative changes (lumbar spondylosis) and associated spinal stenosis. There is significant central canal stenosis at several levels, greatest at L4-L5. 2.) Left-sided L4 Schmorl node. 3.) No acute lumbar findings. No fracture. Age-related and other chronic findings are noted above. Review of the provider note dated 05/31/2024 revealed in part, Patient #3 was discharged home on 05/31/2024 with a diagnosis of pain in the lower back. The hospital failed to provide an appropriate medical screening examination to determine the presence or absence of the emergency medical conditions of spinal cord compression, conus meduallaris syndrome and/or cauda equina syndrome.

Review of Patient #3's emergency department record dated 06/01/2024 revealed Patient #3 presented with a chief complaint of back pain. Review of the provider note dated 06/01/2024 revealed in part, Patient was here on the day prior to presentation for similar symptoms. States she was discharged when she went home she had no relief in her pain. States never had relief in her pain while she was in the hospital. She states the medication she was given do not work. States that she has been unable to walk to the bathroom all day. Of note, she has not covered in feces or urine while in the emergency department. States she is also having right leg numbness which is new on the day of presentation. States she continues to not be able to lay down as she is in too much pain. States she sitting recliner. However, she still denies saddle paresthesias, urinary and bowel incontinence. Denies fever, chills, chest pain, shortness of breath, headache, lightheadedness, dizziness. Further review revealed in part, Patient #3 was given Robaxin, acetaminophen, and Neurontin in the emergency department. Patient #3 was discharged home on 06/01/2024 with a diagnosis of pain in the lower back. The hospital failed to provide an appropriate medical screening examination to fully evaluate for the emergency medical conditions of spinal cord compression due to spinal stenosis, conus medullaris syndrome, and/or cauda equina syndrome.