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Based on review of facility documents, non-hospital ambulance transport log, recipient hospital medical record (MR) review, and staff interviews (EMP), it was determined the facility failed to comply with 489.24 related to Medical Screening Examination.

Findings include:

The review of facility documentation, non-hospital ambulance transport log, recipient hospital medical record (MR) review, and staff interviews (EMP) revealed the facility failed to ensure an appropriate medical screening examination (MSE) to a patient who was on hospital property was completed in one (1) of twenty one (21) medical records reviewed..

Cross reference with:
489.24(a) and 489.24(c) - Medical Screening Exam

Based on review of facility documents, the non-hospital ambulance transport log, receiving hospital medical record (MR1) and staff (EMP) interview, it was determined the facility failed to provide an appropriate medical screening examination within the capability of the hospital's Emergency Department in one (1) of twenty-one (21) medical records reviewed (MR1).

Findings include:

Review on August 26, 2022, at 1130, of the non-hospital ambulance transport log revealed documentation on August 24, 2022, MR1 was transported from the patient ' s place of residence by a non-hospital ambulance for a chief complaint of abdominal pain and history that the patient was in the third trimester of pregnancy. At 1101, the ambulance crew was enroute to Geisinger Medical Center Muncy with ALS (advanced life support) on board. At 1110 the ambulance arrived at the facility. At 1111, ALS spoke with EMP8 via the ambulance cellphone, who stated that Geisinger Medical Center Muncy could not handle MR1 due to the patient being over 22 weeks gestation. EMP8 advised that the ambulance needed to divert to another hospital.


Review of the recipient/second hospital's medical record (MR1) on August 26, 2022, at 1200, revealed documentation on August 24, 2022, the patient had been transported by ambulance to the emergency department at the recipient/second hospital. MR1 was provided a medical screening examination and work up and determined to be stable for discharge and returned to place of residence with detailed discharge instructions and when to return for obstetrical concerns.


Review on August 30, 2022, of Geisinger Medical Center Muncy policy "EMTALA" Emergency Medical Treatment [and] Labor Act of 1986) "System Policy," last reviewed by the facility August 12, 2022, revealed POLICY Any person who comes to a facility requesting assistance for a potential emergency medical condition/emergency service will receive a medical screening performed by a qualified provider to determine whether an emergency medical condition exists. Persons with emergency conditions will be treated and their condition stabilized without regard to ability to pay for services. EMTALA does not apply to inpatients. ... DEFINITIONS ... Comes to Hospital refers to any individual requesting emergent examination and treatment arriving on any hospital property or premises. This includes sidewalks, driveways, parking lots and parking garages ... Emergency Medical Condition (which is determined by a qualified medical provider after conducting a medical screening examination) is defined as a medical condition manifesting itself by acute symptoms or sufficient severity ... such that the absence of medical attention could reasonably be expected to result in: Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy ... Emergency Medical Treatment and Labor Act EMTALA refers to Sections 1866 and 1867 of the Social Security Act, 42 U.S.C. and 1395dd, which obligates hospitals to provide medical screening, treatment and transfer of individuals with emergency medical conditions or women in labor. It is also referred to as the 'anti-dumping' statute and COBRA (Consolidated, Omnibus Budget and Reconciliation Act). Hospital includes any facility that is defined by state license as such an entity and/or covered with a unique Medicare provider number. Hospital Property or Premises includes the entire main hospital campus, including the parking lot, sidewalk, driveway, and any parts of the hospital that are within 250 yards of the main buildings. ... Qualified Medical Provider to perform a medical screening examination within Geisinger facilities are as follows: Doctor of Medicine or Osteopathy, Certified midwife with staff privileges at Geisinger ... Advanced practitioners as defined by the medical staff bylaws ... PROCEDURE A hospital must provide for an appropriate medical screening examination within the capability of the hospital emergency department to any individual who comes to the emergency department and requests examination or treatment. The purpose of this screening examination is to 'determine whether or not an emergency medical condition exists.' ... Requirements of a medical screening: The medical screening consists of an assessment and any ancillary testing or focused assessment based on the patient's chief complaint necessary to determine the presence or absence of an emergency medical condition. This may be a brief history and physical examination or may require complex ancillary studies and procedures such as, but not limited to, lab tests, fetal monitoring, EKG tracing or radiology exam. The medical screening is the process a provider must use to reach with reasonable clinical confidence whether a medical emergency does or does not exist. The medical screening must provide evaluation and stabilizing treatment within the scope of the hospital or facility's abilities and not consider a patient ' s ability to pay for services. The medical record will reflect the findings of the medical screening including results of any tests performed and analysis. ..."


Interview with EMP1 and EMP2 on August 30, 2022, at 0905 confirmed there was no medical record for the patient at Geisinger Medical Center Muncy (initial hospital).


Review on August 30, 2022, at 1105 with EMP2 of the Emergency Medical Services voice recording for notification of arrival from medics to Geisinger Medical Center Muncy Emergency Department (ED) to EMP9 dated on August 24, 2022. EMP9 answered the phone, the medic identified the unit and gave a report that they had a female, included age, with abdominal pain, vomiting and constipation. The patient was also COVID + and gave number of weeks gestation of pregnancy (in the third trimester). Medic gave report of current vital signs, oxygen saturation levels, explained intravenous fluids running, and gave an estimated time of arrival of 10 minutes. EMP9 responded we'll see you in about 10 minutes and put you in (and gave room number) they would put patient in.

Interview with EMP2 on August 30, 2022, at 1110 related there was no voice recording for when Geisinger Medical Center Muncy EMP8 spoke with the medics after the notification of arrival call as EMP8 had not used the medical command line which would have automatically recorded the conversation.

Interview with EMP8 on August 30, 2022, at 1130 confirmed receiving EMTALA training on hire. EMP8 related that the emergency department received a call from EMS (Emergency Medical Services) of a pregnant female with complaints of abdominal pain who was in the third trimester of pregnancy. Their expected time of arrival was 10 minutes. EMP8 related that anyone over 20 weeks pregnant was usually seen by an OB/GYN (obstetrics/gynecology) physician. The attending physician was busy on a phone call and this message was relayed to the attending physician. EMP8 related having called back the ambulance personnel (not on the recorded command line) with instructions to divert to the nearest hospital with OB/GN services, as they do not provide this service. EMP8 related he/she heard noises like a truck backing up through the phone but did not realize the ambulance was on-site at the hospital until after they pulled away. EMP8 was unable to get in touch with EMS after realizing this. EMP8 related EMS personnel did not announce they were on-site at the hospital. EMP8 confirmed he/she did not ask where the ambulance crew was before giving direction to divert to another hospital. EMP8 confirmed MR1 did not receive a medical screening examination in the Geisinger Medical Center Muncy ED.

Interview with EMP9 on August 30, 2022 at 1512 confirmed the ambulance was on-site on August 24, 2022, because EMP9 heard the back-up alarm of the ambulance into the ambulance bay and the ED was only expecting one incoming ambulance at the time which was the pregnant patient with the complaint of abdominal pain.

Interview with EMP11 on September 1, 2022, at 1005, confirmed he/she was the attending ED Physician in charge on August 24, 2022. EMP11 confirmed he/she completes EMTALA training yearly. EMP11 confirmed EMTALA applies to any patient who presents to the ED or is within 250 yards of the facility. If a patient is here in the ED, or within the 250 yards of the property, they are to have an evaluation completed. Asked EMP11 if he/she knew of what occurred in the case of the pregnant woman on August 24, 2022. EMP11 confirmed he/she was on the phone about another patient when the ED received a call from an ambulance with a brief report of a patient, 34-week gestation, was 10 minutes out. EMP11 requested the mid-level provider, EMP8, to respond to the call. EMP11 confirmed the facility does not have an OB Service and patients 20 weeks gestation, or over, are transferred to a facility with OB Services. EMP11 confirmed knowledge, at that time, was that the patient was 10 minutes out and not on the property. EMP11 stated if he/she had been aware the ambulance had been in the ambulance bay area, the ambulance crew would have been directed to bring the patient in for evaluation.