Springhill Medical Center

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 54319 Based on hospital policies and procedure, Emergency Department (ED) video footage, ED Assessment Flowsheet, ED bed census, and staff interview it was determined the hospital failed to provide an appropriate Medical Screening Exam (MSE) within the capability of the hospital to determine whether or not an emergency medical condition existed for all patients who presented for emergency services or document a description of the MSE which was attempted and refused by the patient and the patient was informed of the risks and benefits of leaving prior to the completion of the MSE. This deficient practice affected one of six patients reviewed who left without being seen, including Patient Identifier (PI) # 1, and had the potential to affect all patients served by the hospital’s ED. Findings include: Cross Refer to A2406 for findings.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 54319 Based on hospital policies and procedure, Emergency Department (ED) video footage, ED Assessment Flowsheet, ED bed census, and staff interview it was determined the hospital failed to provide an appropriate Medical Screening Exam (MSE) within the capability of the hospital to determine whether or not an emergency medical condition (EMC) existed for all patients who presented for emergency services or document a description of the MSE which was attempted and refused by the patient and the patient was informed of the risks and benefits of leaving prior to the completion of the MSE. This deficient practice affected one of six patients reviewed who left without being seen (LWBS), including Patient Identifier (PI) # 1, and had the potential to affect all patients served by the hospital’s ED. Findings include: Hospital Policy: Cobra Policy on Responsibilities of Medicare Hospitals in Emergency Cases...Pursuant to the Emergency Medical Treatment and Labor Act (EMTALA) Effective date: 7/24 Policy: If any individual...comes by himself or herself or with another person to the ED and request is made on the individual’s behalf for examination or treatment of a medical condition...the hospital must provide for an appropriate MSE within the capability of the hospital’s ED... An EMTALA screening obligation on the part of the hospital is triggered... when the individual presents at a hospital’s ED and requests examination or treatment for a medical condition... Medical Screening Examination Procedure: Hospitals are obligated to screen patients to determine if an EMC exits. It is not appropriate to merely “log in” a patient and not provide a MSE... EMC means a medical condition manifesting itself by acute symptoms of sufficient severity...such as the absence of immediate medical attention could reasonably be expected to result in: ...Serious impairment to any bodily functions; Serious dysfunctions of any bodily organ or part... Hospital Policy: LWBS [left without being seen] Effective Date: 7/24 Purpose: To ensure appropriate medical screening is provided when notified of a patient’s intent to leave without being seen and risks and benefits are explained. Process: I. LWBS prior to triage...educate patient on risks of leaving without being seen and encourage them to come back to the facility. Documents patient’s response... II. If hospital staff witness a patient attempting to leave after being triaged but before being placed in a room. A. Notify the physician immediately when patient expressing intent to leave without being seen and document notification. B. Document why patient is leaving. C. Urge the patient to stay then educate them on risks of leaving without being seen and record reason given by patient for leaving without being seen. D. If possible, have the patient sign the AMA (Against Medical Advice) form... 1. Patient Identifier (PI) # 1 presented to the ED on 4/9/26 at 7:25 PM with a chief complaint of blood in urine. Review of the ED video footage dated 4/9/26 revealed at 7:28 PM, PI # 1 entered the ED with a caregiver. An armband was placed on the patient then the patient and caregiver sat down in the ED waiting room. At 8:03 PM the patient and caregiver exited the ED after speaking with staff at reception desk. Review of the ED Assessment Flowsheet dated 4/9/26 at 8:12 PM revealed the patient left before triage. Review of the ED bed census dated 4/9/26 at 7:15 PM and 8:00 PM revealed the ED had three of the 27 ED beds available. There was no documentation a triage was attempted, the patient or representative were encouraged to stay to complete the MSE, a MSE was attempted, of a description of the MSE which was refused by the patient or on the patient’s behalf, and the patient or patient’s representative was informed of the risks and benefits of leaving prior to the completion of the MSE. An interview was conducted, via phone, on 8/19/26 at 8:10 am with Employee Identifier (EI) # 1, ED Director. EI # 1 verbalized the hospital ED was not on diversion when the patient presented and was not aware of a specific emergency going on at the time. The hospital failed to provide an appropriate MSE within the capability of the hospital to determine whether or not an EMC existed for PI # 1 who presented to the hospital ED on 4/9/26 for emergency services or document a description of the MSE which was attempted and refused by the patient or on the patients behalf and the patient or patient representative was informed of the risks and benefits of leaving prior to the completion of the MSE.”