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Based on reviews of clinical records, review of hospital policies and procedures, and staff interviews, it was determined the hospital failed to enforce policies and procedures that comply with the requirements of 42CFR 489.20 and 42 CFR 489.24, responsibilities of Medicare participating hospitals in emergency cases when a patient arrived at the hospital emergency department by ambulance for evaluation and treatment (Patient #1).

Findings include:

Hospital policy titled, "Emergency Services", revealed: "...Purpose: To provide emergency care necessary to meet the needs of the community and surrounding area...A chronological log of emergency services provided to patients is kept which includes: Patient name; date and time of arrival; disposition of patient...All emergency patients will be assessed and triage according to the Triage policy...The Emergency Department has clinical laboratory, diagnostic radiology, and respiratory services available 24 hours a day...."

Hospital policy titled, "EMTALA", revealed: "...The Governing Board delegates authority and accountability for compliance with this policy to the Medical Staff...Coming to the Emergency Department means, with respect to an individual who is not a patient, the individual has presented to a hospital's dedicated emergency department and requests examination or treatment for a medical condition...An individual is in a non-hospital owned ambulance and the ambulance is on hospital property for presentation of the individual for examination and treatment of a medical condition...Hospital property means the entire main hospital campus including the parking lot, sidewalk, and driveway...Medical Screening Evaluation: All individuals requesting care must receive a medical screening examination...The medical screening examination must be performed and documented by the ER physician...."

Hospital policy titled, "Triage", revealed: "...The purpose of this policy is to expedite and prioritize patient care to patients that present to the Emergency Department (ED); and to expedite patient flow and care while in the department...All patients presenting to the ED will be triaged by a registered nurse (RN) or a higher level provider...."

The hospital failed to ensure a patient who was brought to the ED by ambulance was entered into the dedicated ED log. (Patient #1)

The hospital failed to provide a Medical Screening Examination (MSE) to a patient who was taken to the ED by ambulance. (Patient #1) The ambulance was "diverted" by an ED medical provider in the ambulance bay to a different hospital. (Hospital #2)

Employee #2 and #3 confirmed during interviews on 12/20/2023 that the facility did not follow hospital policies and procedures when Patient #1 was "diverted" to another facility for evaluation and treatment.

Based on review of records, policies and procedures, hospital logs/documents, and staffing interviews, it was determined the hospital failed to ensure a patient who was brought to the Emergency Department (ED) by ambulance was entered into the dedicated ED Log. (Patient #1).

Findings include:

Hospital policy titled, "Emergency Services", revealed: "...Purpose: To provide emergency care necessary to meet the needs of the community and surrounding area...A chronological log of emergency services provided to patients is kept which includes: Patient name; date and time of arrival; disposition of patient...."

A review of the ED log for 09/12/2023 revealed no documentation that Patient #1 presented there by ambulance and that the ambulance left with the patient prior to the patient receiving a Medical Screening Examination.

Employee #2 confirmed during an interview on 12/20/2023 that Patient #1 was not entered into the dedicated ED log.

Based on review of policies and procedures, hospital documents and staff interviews, it was determined that the hospital failed to provide a Medical Screening Examination to a patient who presented to the ED for examination and treatment. (Patient #1)

Findings include:

Patient #1 presented to the Emergency Department of Hospital #1 on 09/12/2023 via ambulance after calling EMS (emergency medical services) for transport to Hospital #1 for complaints of migraine, weakness and high blood pressure. EMS had made a patch call to Hospital #1 informing hospital of patient's chief complaint, condition and estimated arrival time. Upon arrival to the ambulance bay the EMS began offloading the patient from the ambulance and were met by an ED medical provider. The ED medical provider informed the EMS crew that the hospital could not accept Patient #1 as the CT scanner was not operating correctly. The ED medical provider informed the EMS crew that Patient #1 needed to be transported to another facility, Hospital #2. EMS left Hospital #1 with Patient #1 without Patient #1 having a medical screening exam performed at Hospital #1 and proceeded to Hospital #2 approximately 35 miles away.

Hospital policy titled, "Emergency Services", revealed: "...Purpose: To provide emergency care necessary to meet the needs of the community and surrounding area...A chronological log of emergency services provided to patients is kept which includes: Patient name; date and time of arrival; disposition of patient...All emergency patients will be assessed and triage according to the Triage policy...The Emergency Department has clinical laboratory, diagnostic radiology, and respiratory services available 24 hours a day...."

Hospital policy titled, "EMTALA", revealed: "...The Governing Board delegates authority and accountability for compliance with this policy to the Medical Staff...Coming to the Emergency Department means, with respect to an individual who is not a patient, the individual has presented to a hospital's dedicated emergency department and requests examination or treatment for a medical condition...An individual is in a non-hospital owned ambulance and the ambulance is on hospital property for presentation of the individual for examination and treatment of a medical condition...Hospital property means the entire main hospital campus including the parking lot, sidewalk, and driveway...Medical Screening Evaluation: All individuals requesting care must receive a medical screening examination...The medical screening examination must be performed and documented by the ER physician...."

Hospital policy titled, "Triage", revealed: "...The purpose of this policy is to expedite and prioritize patient care to patients that present to the Emergency Department (ED); and to expedite patient flow and care while in the department...All patients presenting to the ED will be triaged by a registered nurse (RN) or a higher level provider...."

Review of the EMS Runsheet dated 09/12/2023 1857 for Patient #1 revealed: "...Narrative: (EMS crew number) dispatched to a sick person at the above address...Upon entering the structure a [woman] appeared with an unsteady gait and holding [herself] up on the wall inside the front door...[87 year old female] patient who is CAOX4 and complains of dizziness/headache/sickness over the last 48 hours. Answers questions appropriately. Stroke scale is performed with normal range of motion in extremities, normal speech and equal facial symmetry. Headache pain is 9/10 which is common on a daily basis according to the patient...No chest pains, no complications with breathing...Treating and transporting the patient to Benson Hospital at the patient's request...The patient's chronic history mixed with possible complications from the hypertension poses a potential life risk...Verbal report was called into Benson Hospital X4 attempts were made before staff answered and took report...arrived at Benson Hospital and backed into the emergency department ambulance bay...while opening the rear ambulance door, the on-duty physician came out of the emergency department, where [he] made contact with the crew and patient. The physician advised crew and patient that we could be seen at this facility because radiology went down. Our patient would have to go to another facility which is approximately a 35 minute delay in care or longer...Crews obtained consent from patient to transport to (Hospital #2) despite [her] reservations to be seen at that facility...Trying to advocate for the patient, (company officer) took over patient care and paramedic followed the physician into the hospital...(paramedic) requested baseline assessment by provider since [he] made contact with patient to begin with...Inquiring as to the specific problem with radiology, its's transmitting of results was malfunctioning...The provider was informed the patient may or may not have needed this intervention and it should have been considered at that point as to what is happening currently...Departed at 2021 for (Hospital #2)...Report called to Hospital #2 at 2022...Arrived at Hospital #2 at 2113...."

Review of the hospital ED log revealed no entry for Patient #1 on the ED log for 09/12/2023.

Review of the hospital electronic medical records revealed no ED medical record for 09/12/2023 for Patient #1.

Review of Patient #1 medical record from Hospital #2 dated 09/12/2023 revealed: "...arrival 09/12/2023 time: 2113...presents to the ED via EMS with complaints of General Weakness...The patient presents with generalized weakness...past medical history of diabetes, not on insulin, and chronic migraines coming in today for worsening headache, weakness and slight dizziness describing lightheadedness...patient initially transported to Benson emergency department/hospital but apparently their CT scanner is down in the around bypass so was diverted to our facility...The patient had not been evaluated by the physician...Patient's laboratory results came back reassuring. CT head negative for bleed or tumor, no evidence of urinary tract infection, EKG and troponin reassuring as well...."

Review of 20 ED records randomly selected for review included patients who were transferred, admitted, or discharged home revealed no documentation that there were any delays in assessments and/or treatments based on patient ability to pay for medical services.

Employee #2 confirmed during an interview on 12/20/2023 that the patient was turned away in the ED ambulance bay by an ED medical provider and the ambulance was sent to Hospital #2 for evaluation and treatment. Employee #2 confirmed that the medical provider should have performed a medical screening examination before sending the patient to another facility.