Conway Regional Medical Center, Inc.

“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: 40282 Based on policy review, record review, facility map review, video review and interviews, it was determined the Facility failed to ensure an appropriate medical screening examination was provided within a timely manner by qualified medical personnel for 1 (Patient #1) of 25 patients who experienced a medical event on hospital property. This failed practice had the likelihood of affecting all individuals presenting on hospital property with emergent medical needs. Findings include: A. Review of Facility’s Policy titled “EMTALA” with a revision date of 04/26 to the on 05/11/26 at 1:00 PM by the Director of Quality showed the following: (see attached EMTALA Policy A) 1. “The term “hospital property” means the entire main hospital campus as defined in 413.65(a), including physical areas immediately adjacent to the provider’s main building, and other areas an structures that are not strictly contagious to the main buildings but are located within 250 yards of the main building and operated by the entity.” EMTALA does not routinely apply to individuals in the facility campus other than the ED, but EMTALA can be triggered in other areas through any of the following. a. A request is made by an individual or on behalf of an individual for treatment or examination for an emergency medical condition. b. “Where no explicit request is made, a prudent layperson would believe (based on and individual’s appearance and behavior) that the individual needs an examination or treatment for an emergency medical condition.” 2. “Medical Screening Exam” (MSE) means the process required to reach, with reasonable clinical confidence, the point at which it can be determined where a patient has an EMC or not. The MSE must be conducted by Qualified Medical Personnel. a. In summary, the purpose of a MSE is simply to determine if an EMC (Emergency Medical condition) exists. EMTALA obligations end if no EMC exists b. If the MSE reveals no EMC, then the hospital has no further obligations under EMTALA . c. If the patient is determined to have an EMC, then EMTALA obligations continue and the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility, or an appropriate transfer.” B. Review of facility policy titled “Visitor Medical Emergency Plan” with a revision date of 06/25/26 received on 05/11/26 by Director of Quality at 1:00 PM showed the following: (see document (see document EMTALA Policy B) 1. “If a visitor is to have an emergency in the parking lot/outside area (fall, loss of consciousness, cardiac arrest, etc.) the following steps should be taken: a. If the visitor appears injured and is unable to get up without pain or fear of causing further injury, call 911 to respond and transfer them to the Emergency Department. Be sure to manage the visitor’s needs until emergency services arrive (this could mean performing CPR until they arrive on site). b. If the visitor appears uninjured, offer to assist them in a wheelchair to the ED for further evaluation. c. If you are not necessary personnel to the emergency, or if there are already plenty of people on site attending to the visitor, please do not continue to watch the event unfold.” C. Review of Pateintn #1’s clinical ED (Emergency Department) record history and physical dated 04/01/26 at 8:44 AM by medical doctor showed the following: Patient #1 is a “75-year-old male brought by EMS (Emergency Medical Service) after a ground-level fall in the hospital parking lot ..... Patient said he was walking to meet his wife this morning and he got really dizzy .... This caused him to fall in a parking lot and hit his head. EMS was called and brought the patient here.” D. Review of Facility Parking Lot Map provided by the Director of Quality on 05/15/26 at 1:45 showed the following: There is an X which marks where Patient #1 fell in lot E. (See attached document Facility Map A). E. Review of video of Patient #1 dated 04/01/26 received from by the Director of Quality on 05/ 26 showed the following: Times: minutes/ seconds .07 seconds: Patient walking in parking lot going towards the back of the parking lot. .25: Patient stumbling and falls to the ground (parking lot). 2:41 seconds: Grounds keeper approaches Patient. 15:59 Ambulance appears and approaches scene where Patient is sitting. 18:41 Ambulance personnel x2 start assisting Patient up to standing position and assist onto stretcher. F. During phone interview on 05/18/26 Security Officer #1 he said he did not find Patient #1 but was called by one of the ground keepers who said a man had fallen in the parking lot. As he started walking to the area of the parking lot, he called House Supervisor and 911. Once he approached the scene which was lot E- East side Patient #1 was sitting on a walkway. House Supervisor arrived and then the ambulance arrived. Once the Paramedic arrived, he said this is an EMTALA because hospital property is covered under EMTALA. Security Officer #1 explained that he has been instructed to call 911 if someone falls in the parking lot. House Supervisor explained this was public property and not hospital property. The Paramedic then took over the scene and transported Patient #1to the Emergency Department. Security Officer #1 said he does not know EMTALA, but he has been instructed if someone falls in the parking lot to call 911. G. During interview on 05/13/26 at 10:00 AM with House Supervisor said received a call from security informing him a man was found face down in the parking lot and is now stumbling around. I told security to sit Patient #1 down and call 911. When he arrived at the area of the parking lot Patient #1 was sitting on a walkway, confused, and had ED discharge papers from the day before rolled up in his hand. Patient #1 said he was waiting for his wife who was at the mall. House Supervisor remained patient until the ambulance arrived. Once the ambulance arrived the paramedic stated this is an EMTALA because it is on hospital property. “I explained to the paramedic the hospital policy is to contact 911 if someone falls in the parking lot.” H. During interview on 05/22/26 at 10:15 AM, Patient #1 said all he knew was he just fell in the hospital parking lot, and he does not remember where he was going or coming from. When asked, do you remember being in the hospital or Emergency Room the day before the fall in the parking lot? He said, “no all I can remember is being admitted, a drain put in and going to a nursing home.” I. During interview on 05/11/326 at 2:00PM, the ED Director said it is the hospital policy to call 911 if a visitor falls in the parking lot, but as a nurse she would attempt to help and get them to the ED if the situation was one she could safely transport the individual to the ED. When asked how do you know when the individual is a visitor or someone is attempting to go to the ED for treatment? She said you would not know. J. During interview on 05/13/26 at 1:30 PM, the Director of Risk Management said if an individual is in the parking lot needing ED assistance, the House Supervisor is notified to assess the situation and determine the individual’s stability. If the individual is stable without fear of injury, he or she can be taken to the ED, but if for example an individual is in cardiac arrest 911 would be called because the ambulance has the proper equipment for transferring from the parking lot to the ED. If someone falls in the parking lot, the House Supervisor is called and assesses the individual’s status. If fracture stabilization is needed, 911 is called because the ambulance has the equipment for proper fracture stabilization and the ability to safely transfer the individual to the ED. The facility does not have a dedicated transfer team. K. During interview with Director of Quality on 05/11/24 at 1:00 PM she said it is a policy to call 911 when a visitor falls in the parking lot and it is advised by our insurance company that nurses remain in the ED and not perform medical treatment in the parking lot. When asked how you know if it is a visitor or someone attempting to go to the ED seeking treatment, she said that would depend on what the individual reports, but 911 would most likely be called. L. Findings in A through C were verified by the Director of Quality on 05/11/26 at 2:30 PM. M. Findings in D and E were verified by the Director of Quality on 05/19/26 via email.”