Chi St. Vincent Hospital Hot Springs

“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: 44854 Based on medical record review, policy review, interview and video recording review it was determined that the facility failed to provide a Medical Screening Exam for 1 of 25 patients seen in the Emergency Department. The failed practice did not ensure the patient had an emergency medical condition or not. The failed practice had the likelihood of affecting all patients seen in the Emergency Department. See tag A2406”

“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: 44854 Based on clinical record review, policy review, and interview, the facility failed to ensure one of one (#1) patient received an appropriate medical screening exam (MSE) before Patient # 1 was the discharged. The failed practice did not ensure Patient #1 was examined to determine if an emergency medical condition existed. The failed practice affected Patient #1 and had the likelihood to affect all patients presenting to the Emergency Department (ED). Findings follow: A. Review of the Policy and Procedure titled “EMTALA-Medical Screening and Treatment of Emergency Medical Conditions” reviewed date of 10/2025, showed the following: 1. The policy process was required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an EMC existed. 2. The hospital must provide an appropriate MSE (Medical Screening Examination) conducted by a physician or other QMP (Qualified Medical Professional, including to the extent necessary ancillary services within the Hospital’s capabilities and on-call physicians services, to determine whether or not an EMC existed. B. Review of policy titled “Emergency Medical Treatment and Labor Act (EMTALA) Procedure” (last reviewed 12/11/2024) showed, “All individuals who come to the OED and all individuals who present on Hospital Property requesting or requiring examination or treatment of an Emergency Medical Condition (EMC) shall receive an appropriate Medical Screening Examination (MSE). Additionally, the hospital shall not delay in providing the MSE or necessary stabilizing treatment in order to inquire about an individual’s ability to pay or to inquire about eligibility for financial assistance under CommonSpirit Governance Policy, Finance G-003, Financial Assistance Program.” C. Review of policy titled “Workplace Violence Prevention-CHI St. Vincent Hot Springs” (last review date 12/12/2022) showed, “Workplace Prevention Plan: Develop and provide a system for responding to and investigating violent incidents and situations involving violence or the risk of violence involving patients and/or family members. 1. An Emergency Management team meeting may be requested by any member of the medical team, employee and/or administrative team, risk management, security or designee on an ad hoc basis to evaluate threatening/ unsafe situations involving patients. The facility and outpatient care environments are to manage situations where disruptive behavior continues to escalate despite attempts at intervention. The team will continue to evaluate and develop a plan to address the behaviors. If no resolution, notify nurse manager (or designee) and security or designee to discuss further action needed (i.e. restriction of visitation and/ or discontinuation of care) in conjunction with the attending/ primary physician. 2. Medically stable patient and/or family/caregiver refusing discharge. Security and/or designee may be required to escort through the hospital or care center. Law enforcement may also be required.” D.During an interview on 08/12/2025 at 12:00 PM, the Emergency Room Director confirmed A-C. E. Review of Patient #1 Clinical record showed the following 1. On 07/03/2025 at 12:29 AM patient was admitted to ED, “ Right Great toe pain and bleeding at incision site. Was discharged earlier from evaulation” 2. On 07/03/25 at 1:28 AM, “Patient suddenly became aggressive, combative and yelling, saying he was in the wrong hospital ...Security called to assist with patient’s aggressive behavior, HSPD(Hot Springs Police Department) was called after patient refused to leave the premises.” The patient was removed from the premises by HSPD without being treated. F. Review of Clinical Record dated 07/03/2025 showed no evidence of an MSE to include History, Physical Exam, Laboratory Studies, Imaging, and Consultations as indicated. G. Review of Security Activity log for 07/03/2025 at 1:30 AM showed, “At about 00:30 (12:30 AM) the nurses in triage called Officer (Named) and myself up front to deal with a disruptive person. They were not a patient; he kept bad mouthing and treating (Named) and RN #4 very disrespectful (triage medical staff). They tried to explain to him the situation and he continued to talk over them. (Named) then tried to talk to him and the same thing happened to him. He was verbally aggressive to everyone. (Named) then called the police and they arrived shortly after. He was aggressive to them as well. They asked us if we wanted him trespassed and we said yes. He kept getting mouthy with the police, and so they arrested him. His name is (Patient #2).” H. During an interview on 07/22/2025 at 10:30 AM, Patient #1 stated, “I had surgery and when he got home, he had a psychotic breakdown.” ``I. An interview with ED RN #1 was conducted on 08/12/2025 at 10:50 AM regarding the standard process for working with agitated patients in the ED. ER RN #1 stated, “If the patient is verbally escalating, we call security to let them try to de-escalate the situation. If security can’t de-escalate, they call Hot Springs Police Department. It requires the city to say someone can’t come back.””