Ouachita County 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: 47891 Based on interview it was determined that the facility failed to place all patients presenting to the Emergency Department (ED) on the ED log and failed to provide a complete Medical Screening Exam for 2 (#1-#3 ) of 26 (#1-#26) patients seen in the Emergency Department. The failed practice did not ensure the patients were fully screened for an emergency medical condition. The failed practice had the likelihood of affecting all patients seen in the Emergency Department. Based on clinical record review, it was determined the facility failed to ensure one of one (#26) patient transferred to another hospital was informed of the risks and benefits of the transfer. The physician certification only indicated the benefit of transfer, but did not identify any risks associated with transfer and does not explicitly state that physician certifies benefits outweigh risks. See A2406 and A2409 for details.”

“EMERGENCY ROOM LOG CFR(s): 489.20(r)(3) [The provider agrees,] in the case of a hospital as defined in §489.24(b) (including both the transferring and receiving hospitals), to maintain a central log on each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged. §489.24 The provisions of this regulation apply to all hospitals that participate in Medicare and provide emergency services. This Standard is not met as evidenced by: 44854 Based on clinical record review, policy review, and interview, it was determined the facility failed to ensure 1 (#2) of 25 (#1 -#25) patient was placed on the Emergency Department (ED) Log. Failure to place the patient on the ED Log did not ensure the facility had a means of tracking the patient for emergency medical treatment. The failed practice affected Patient #2 and had the likelihood to affect all patients presenting to the ED. Findings follow: A. Review of Policy and Procedure “Emergency Medical Treatment and Labor Act”, revised 02/2026, showed the facility would maintain a central log of individuals who came to the dedicated Emergency Department seeking treatment and incdicated where these individuals refused treatment, ere denied treatment, were treated, admitted, stabilized and/or transferred , discharged, Left Against Medical Advice (AMA) of Left without being seen (LWBS). B. Review of the ED Log dated from 03/13/26 through 03/19/26 showed no evidence Patient #2 was registered on the ED Log. C. During an interview on 04/15/26 at 1:00 PM, the Risk Manager confirmed the findings in A and B.”

“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: 47891 Based on interview it was determined that the facility failed to provide a complete Medical Screening Exam for 2 (#1 and #3) of 26 patients seen in the Emergency DepartmentThe failed practice did not ensure the patient was fully screened for an emergency medical condition. The failed practice had the likelihood of affecting all patients seen in the Emergency Department. Findings follow: A. Review of policy/procedure: Managing Obstetrical Patients in the Emergency Room it was shown “1. EMTALA Compliance, hospitals must provide an appropriate medical screenings exam (MSE) to determine if an emergency medical condition or active labor exists, stabnilizing the poatient regardless of ability to pay. This screening must assess both mother and fetus.7 Documentaion: Clearn documentation of pregnancy status and fetal heart tones, any cervical dilation, station, vital signs, contraction and status of membrances should be identified.” B. Review of Patient #1’s clinical record showed: 1.The patient was admitted on 2/11/2026 at 7:26 AM with a chief complaint of vaginal bleeding starting in the morning. 2. There was no evidence that that Patient #1 had a tocodynamometer (TOCO) or Electronic Fetal Monitoring (EFM) device placed till within 10 minutes of transfer to South Arkansas Regional Hospital at 8:24 AM. C. Further reivew of Patient #1’s clinical record showed no evidence a sterile vaginal exam was performed prior to transfer. D. During interview with Licensed Practical Nurse (LPN) #1, conducted on 4/15/2026 at 1:35 PM , it was stated that “I have had no obstetrics (OB) training, so I laid out the TOCO for the Assistan Director of Nursing (ADON). I think she had a contraction once it was on. I don’t know why an Sterile Vaginal Exam (SVE) wasn’t done. I guess the doctor didn’t think it was needed. We get some OB training tomorrow (4/16/2026)” E. During interview conducted on 4/15/2026 at 8:45 AM with Physician #1, it was stated “The patient was 39 weeks pregnant with cramping since early morning. (Patient #1) showed no signs of distress or bleeding. ADON hooked patient up to the monitor that showed contractions without decelerations. I did not feel a Sterile Vaginal Exam would alter diagnosis or care.” F .Review of self-report submitted by staff member of the facility it was stated that “We had a patient (pt) come into our Emergency Department (ED) on 02/11/2026 at 7:23 AM by the name of (Patient #1). Patient #1 was 39 weeks Intra Uterine Pregnancy (IUP), (Gravida/Para) G4P3 with vaginal bleeding and abdominal pain. She stated that her pain started around 4:00 AM this morning and that she was having contractions every 5-10 minutes. Pt had seen her Obstetrician-Gynecologist (OB) doctor the previous day and was told she was dilated to 2 centimeters (cm) at that visit. I was called to the ED as House Supervisor/Assistant Director of Nursing (ADON), to come and make sure the Electronic Fetal Monitor (EFM) was placed on the patient (pt) correctly due to there are no OB trained nurses in the ED today and they were unsure of placement. When I arrived in ED I walked into (Patient #1’s) room and she was on the stretcher with her personal clothing on and the external monitor in place. The monitor was not placed correctly and the tocodynamometer (TOCO) that was on her was not picking up her contractions. I changed out the TOCO and moved the Fetal Heart Monitor part of the machine so that it would pick up. Pt had one contraction just as I put her on the monitor and Fetal Heart Rate (FHR) was 130’s with good variability. The ED MD, (Physician #1) came into the room and I asked him if he had done a sterile vaginal exam (SVE) on her to check for cervical dilation and he stated that “No, she saw her OB doctor yesterday and he told her she was 2 centimeteres (cm) so that is what I am going with.” He explained that with her bleeding, which I had no knowledge of at the time, he didn’t want to do another vaginal exam. I then went out to the Nurse’s Station and began documenting what I saw on the EFM, and the ED nurse was on the phone with South Arkansas Regional Hospital (SARH) giving pt report to the Registered Nurse (RN) there because pt had been accepted by Physician #1 to their OB. I was asked by the ER nurse to get on the phone with the receiving nurse because that nurse was upset that we had not done a SVE on the pt prior to her being loaded on the ambulance, therefore we did not know if the pt’s cervical dilation had progressed or not and we couldn’t give a thorough report because there was not a thorough exam done. I explained to the receiving nurse that I completely understood what she is saying as I was a prior OB nurse. I informed her of the ED MD’s concerns with checking the pt’s cervix with the vaginal bleeding present and she just stated that it was dangerous putting a pregnant pt in that state on an ambulance for transfer without knowing what she was dilated to. I agreed with her on this matter and apologized for that not happening. When I got off that phone call pt was already loaded on the ambulance and leaving for transport. Physician #1 deferred doing a Sterile Vaginal Exam on a 39 week pregnant pt with vaginal bleeding (enough to use a towel) according to his documentation prior to her being transferred to South Arkansas Regional Hospital this morning. I was involved with the pt care long enough to put her on the EFM for approximately 10 minutes prior to her departing our ED. The ED Nurse that was her primary nurse was not OB trained.” G. Review of Patient #1’s chart showed no evidence of any ultrasound diagnostic testing ordered or performed. H. Interview with Physician #1 on 4/15/2026 at 8:45 AM: When asked which Practices or Professional Organization Standards he followed Physician #1 stated that he doesn’t use any but, relies on his 18 years in Emergency Medicine. When asked to recount this case Physician #1 stated that “The patient was 39 weeks pregnant with cramping since early morning. (Patient #1) showed no signs of distress or bleeding. ADON hooked patient up to the monitor that showed contractions without decelerations. I did not feel a Sterile Vaginal Exam would alter diagnosis or care.” I. Interview with LPN #1 on 4/15/2026 at 1:35 PM it was stated “I have had no OB training, so I laid out the TOCO for ADON. I think she had a contraction once it was on. I don’t know why an SVE wasn’t done. I guess the doctor didn ’ t think it was needed. We get some OB training tomorrow.” J. The findings in A and B were verified through interview with ADON on 4/15/2026 at 2:15 PM. K. Review of Patient #3’s medical record showed 1. 9/26/2025 Timeline follows: 6:20 PM Patient (pt) arrives in the Emergency Department (ED) 6:20 PM Method of Arrival: Ambulatory 6:26 PM Triage ...ran out of the hydro medication that he was given for surgery 7:15 PM Drug: Ketorolac 60 milligrams 9mg) Intra-Muscular (IM) once 7:15 PM Drug: Dexamethasone 8 mg IM once 7:53 PM Computed Tomography (CT) Report signed C6-7: Anterior cervical disc fusion and interbody disc spacer. C4-5, C5-6 Mild degenerative disc disease with disc space narrowing, endplate spondylosis and marginal osteophyte formation. Prevertebral soft tissue is unremarkable. Impression: 1 No acute cervical spine fracture or traumatic subluxation 2 Cervical Spondylosis as above 8:03 PM Drug Follow-up Response pain is unchanged. 8:03 PM Discharged home, Condition at discharge: Stable, Discharge instructions given to patient. 8:03 PM Pt left the ED. L. Failed to assess for critical historical and physical exam findings of potential cervical neurological injury.”

“APPROPRIATE TRANSFER CFR(s): 489.24(e)(1)-(2) (1) General If an individual at a hospital has an emergency medical condition that has not been stabilized (as defined in paragraph (b) of this section), the hospital may not transfer the individual unless - (i) The transfer is an appropriate transfer (within the meaning of paragraph (e)(2) of this section); and (ii)(A) The individual (or a legally responsible person acting on the individual’s behalf) requests the transfer, after being informed of the hospital’s obligations under this section and of the risk of transfer. The request must be in writing and indicate the reasons for the request as well as indicate that he or she is aware of the risks and benefits of the transfer. (B) A physician (within the meaning of section 1861(r)(1) of the Act) has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual or, in the case of a woman in labor, to the woman or the unborn child, from being transferred. The certification must contain a summary of the risks and benefits upon which it is based; or (C) If a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as determined by the hospital in its bylaws or rules and regulations) has signed a certification described in paragraph (e)(1)(ii)(B) of this section after a physician (as defined in section 1861(r)(1) of the Act) in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certification. The certification must contain a summary of the risks and benefits upon which it is based. (2) A transfer to another medical facility will be appropriate only in those cases in which - (i) The transferring hospital provides medical treatment within its capacity that minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child; (ii) The receiving facility (A) Has available space and qualified personnel for the treatment of the individual; and (B) Has agreed to accept transfer of the individual and to provide appropriate medical treatment. (iii) The transferring hospital sends to the receiving facility all medical records (or copies thereof) related to the emergency condition which the individual has presented that are available at the time of the transfer, including available history, records related to the individual’s emergency medical condition, observations of signs or symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of the studies, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) required under paragraph (e)(1)(ii) of this section, and the name and address of any on-call physician (described in paragraph (g) of this section) who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment. Other records (e.g., test results not yet available or historical records not readily available from the hospital’s files) must be sent as soon as practicable after transfer; and (iv) The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer. This Standard is not met as evidenced by: 44854 Based on clinical record review, it was determined the facility failed to ensure one of one (#26) patient transferred to another hospital was informed of the risks and benefits of the transfer. The physician certification only indicated the benefit of transfer, but did not identify any risks associated with transfer and does not explicitly state that physician certifies benefits outweigh risks. The findings follow: A. Review of Patient #26’s clinical record dated 03/17/26 showed the following: 1) Admission at 7:15 PM: Chief Complaint: Abdominal pain, Nausea and vomiting and less than 8 weeks pregnant. 2) Laboratory results showed the following: a. Hemoglobin (Hgb)) 12.4 g/dL (Grams per Deciliter) and Hematocrit (Hct) 36.8% b. WBC ( White Blood Count) 16.3 K/uL (thousands per microliter) c. Beta HCG ( human chorionic gonadotropin) 10393 u/L 3) Transvaginal and Transabdominal Ultrasound (U/S) dated 03/17/26 showed, “ There is no evidence of an intrautering pregnancy is seed. Very early intrauterine pregnancy that is not yet visualized sonographically or missed spontaneous abortion would be possibilities. Ectopic pregnancy is not seen but also cannot be entirely excluded. 4) Physician note dated 03/17/26 at 7:15 PM showed the following: a. Review of symptoms: Abdomen/GI(Gastrointestinal): “Positive for pain; nausea, vomiting, Negative for diarrhea. GU(Geniourinary): Positive for pelvic pain for urinary frequency, flank pain, burning with urination, difficulty urine vaginal bleeding, vaginal discharge b. Differential diagnosis: ectopic pregnancy, uti (Urinary Tract infection), hyperemesis c. ED course: “discussed results with patient, needing another hcg level in 2 (?) ultrasound in 1 week.” d. Discharged home on 03/18/26 at 1:20 AM. 5) There was no evidence showing the risk and benfits of transfer to another hoespital for higher level of care. B. During an interview with Physician #2 on 04/20/26 at 12:30 PM, when surveyor asked what the process for a patient is presenting with positive pregnancy test and abdominal pain, he stated,” I will do an exam and order lab and a pelvic U/S to confirm pregnancy. I this case, I was focused on treating her symptoms.” When asked, what is the process for a patient complaining of n/v and abdominal pain, positive hcg greater than 10000u/L level test and does not have intrauterine pregnancy, he stated, “Women who have positive pregnancy and I immediately get a pelvic u/s and depending on the results, determine the treatment. I will either transfer the patient to a higher level of care or d/c the patient home.” When the surveyor asked the Physician to explain the guidelines regarding the EMTALA guideline regarding what it means to stabilize the patient versus stabilizing the condition, he stated, “I am not that familiar with the guidelines.” C. During an interview on 04/15/26, the Risk Manager confirmed the findings in A. D. Review of Patient #26 OCMC clinical record dated 03/18/26 showed the following: 1. Admission data sheet showed Patient #26 was admitted with complaints of abdominal pain and n/v at 12:24 PM and was transferred to SARH( South Arkansas Regional Hospital) on 03/18/26 at 2:06 PM. 2. Laboratory results dated 03/18/26 showed the following: a. Hgb 0.2 g/dL and Hct 26.5% b. WBC 28.4 K/uL c. There was no evidence of Beta HCG was completed. 3. Transvaginal and transabdominal U/S dated 03/18/26 showed, “New findings of free fluid in pelvis, containing echogenic material. In this clinical setting this would be most consistent with ruptured ectopic pregnancy. Additionally, a large are of mixed echogenicity material is seen anterior to the uterus, likely hemorrhage. 4. ROS (Review of Symptoms) abdomen/GI: positive for abdominal pain, Palpation: severe abdominal tenderness 5. Diagnosis: Ectopic Pregnancy 6. Disposition: Transfer to SARH via EMS E. During an interview on 04/15/26, the Risk Manager confirmed the findings in D. F. Review of Patient #26 SARH clinical record showed the following: 1. Admitted 03/18/26 as a transfer for a surgical management for ruptured ectopic pregnancy. Hgb had dropped for 12 g/dL to 9g/dL. Patient #26 was tachycardic and received one unit of Packed red blood cells. 2 Operative report showed a post operative diagnosis of ruptured right cornual pregnancy. 3. Admission data sheet showed discharge on 03/20/26 at 10:00 AM.”

“NURSING SERVICES CFR(s): 482.23 The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or supervised by a registered nurse. This Condition is not met as evidenced by: 44854 Based on policy and procedure review, clinical record review, and interviews, it was determined that the facility failed to develop, update, implement, and/or individualize an interdisciplinary integumentary plan of care for 2 (#1- #2) patients at risk for altered skin integrity. Failure to develop an individualized interdisciplinary integumentary plan of care did not assure the skin care policies, protocol, and orders were followed to prevent further skin breakdown. The failed practices did not assure patients were protected from potential injury; the nursing staff could determine when a wound had improved, remained the same or declined; the nursing staff could readily identify which interventions were linked to which problem; and integumentary goals were measurable to determine if the problem continued or was resolved. The failed practice affected Patient #1- #2 and had the likelihood to affect all patients admitted to the facility. See Tag A0396.”

“NURSING CARE PLAN CFR(s): 482.23(b)(4) The hospital must ensure that the nursing staff develops, and keeps current, a nursing care plan for each patient that reflects the patient’s goals and the nursing care to be provided to meet the patient’s needs. The nursing care plan may be part of an interdisciplinary care plan. This Standard is not met as evidenced by: 44854 Based on policy and procedure review, clinical record review, and interviews, it was determined that the facility failed to develop, update, implement, and individualize an interdisciplinary integumentary plan of care for 2 of 2 (#1-2) patients. Failure to develop an individualized interdisciplinary integumentary plan of care did not assure the skin policies, protocol, and orders were followed to prevent further skin breakdown. The failed practices did not assure patients were protected from potential injury; the nursing staff could determine when a wound had improved, remained the same or declined; the nursing staff could readily identify which interventions were linked to which problem; and integumentary goals were measurable to determine if the problem continued or was resolved. The failed practice affected Patients #1and #2 and had the likelihood to affect all patients admitted to the facility. A. Review of policy titled, “Pressure Ulcer Prevention and Care,” revised 01/09 showed the following: 1) Begins with a thorough risk assessment using the Braden numerical scale which corresponds with the severity of patients risk to develop a pressure ulcer during hospitalization. 2) “The assessment was to be completed by the AM by an RN or LPN”. 3) The numerical risk level was to have interventions aimed at managing and improving the risk factors by reducing moisture, improving nutritional status and reducing friction. 4) After appropriate staging of the ulcer, documentation of location and actual measurement must be obtained and documented on the Wound Flow Sheet. B. Review of policy titled, “Wound Care management for Home Health Care, Hospital Acute Care, and Hospital Outpatients,” dated 01/09 showed the following: 1) To provide patients with the most current therapy and treatments in wound management. 2) Documentation was to include the following a) Date and time of procedure b) Materials used and procedure performed c) Assessment of wound bed, including color, size. odor and surrounding tissue amount, color and odor of any drainage d) Patient’s reaction to procedure e) Patient teaching performed with level of understanding verified by return demonstration as indicated. C. Review of policy titled, “ Wound Assessment and Reassessment,” dated 05/15/14 showed the following: 1) Each patient admitted was to receive a complete head-to¿toe assessment by a qualified individual so that a plan of care can be developed to best meet the needs of the patient. The assessment of the care or treatment required to meet the needs of the patient will be ongoing throughout the patient’s hospital stay, with the assessment process individualized to meet the needs of the patient population. 2) Skin assessment is a component of the initial assessment. If it is determined, at the time of admission, that the patient is at high risk for developing a wound or if the patient is admitted with a wound, further assessment will be completed by the Wound Care Team. 3) The wound assessment will be documented in the Nurses’ Notes and on the Wound Care Flow Sheet. D. During an interview on 04/09/25 at 2:10 PM, the Risk Manger confirmed the findings in A-C. E. Review of Patient # 1’s Clinical record on 02/19/25 through 03/07/25, showed the following: 1) Patient #1 was admitted on 02/19/25, with the following diagnosis: Pneumonitis, Acute Respiratory Failure with hypoxia, Sepsis, Right Heel pressure ulcer, Type 2 Diabetes, Chronic Kidney disease, Alsheimer’s Disease, dysphagia, Depression and Braden score of 12. 2) There was no evidence Patient #1 had a skin assessment on admission, every shift and on discovery per established policy. For example: a) LPN (License Practical Nurse) patient assessment on 02/19/25 at 1:19 AM, showed a dressing on Left forearm, Bilateral lower extremities. b) On 02/20/25, at 8:41 AM, the RN (Registered Nurse) assessment showed a Stage II pressure ulcer between the buttocks . 3) There was no evidence of measurements of the wound with changes or upon discovery per established policy on 02/20/25, at 8:41 AM. 4) There was no evidence Patient #1 was repositioned every two hours. For example: a) On 02/21/25, the patient was turned at 00:31 AM. There was no evidence the patient was turned until 02/21/25, at 2:49 AM. b) on 02/21/25 at 10:48 pm RN noted Stage II Pressure ulcer between the buttocks. There was no evidence the patient was turned until 03/06/25, at 4:11AM. c) On 03/06/25, the patient was turned at 11:17 PM. There was no evidence the patient was turned until 03/06/25, at 6:30 PM. 5)There was no evidence of an individualized care plan for the patient’s skin breakdown/wound. 6) During an interview on 04/10/25, at 10:00 AM, the Clinical Informatics Nurse confirmed the findings in E. F. Review of Patient # 2’s Clinical record for 02/23/25 through 03/09/25, showed the following.: 1) Patient #2 was admitted on 02/23/25, with the following diagnosis: Pulmonary Edema and Braden score of 18. 2) There was no evidence Patient #2 was repositioned every two hours. On 02/24/25 at 6:12 PM, showed the patient positions self. 3) There was no evidence of a skin assessment each shift per established policy. For example: a) On 03/01/25 at 9:18 AM, showed the LPN applied mepilex to a small sacral breakdown. b) On 03/02/25, at 4:00 PM, showed the LPN applied protectant to sacrum and dressing changed. c) On 03/03/25, at 4:00 PM, the WONC note showed wound care evaluation with sacral pressure injury with instructions for cleaning and was to apply mepilex dressing three times per week. 4) During an interview on 04/10/25, at 10:30 AM, the Clinical Informatics Nurse confirmed the findings in F.”

“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: 47891 Based on interview and video recording it was deteremined 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 A 2406”

“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: 47891 Based on interview and video recording it was determined that the facility failed to provide a Medical Screening Exam for 1 (1 of 25) patient seen in the Emergency Department. The failed practice did not ensure the patient was screened for an emergency medical condition. The failed practice had the likelihood of affecting all patients seen in the Emergency Department. Findings follow: A. Review of Ouachita Count Medical Center (OCMC) video from the Emergency Department (ED) Registration area showed Patient #1 approached the window at 4:05 PM and spoke with the registrar. The registrar made a phone call and moved the phone closer to the window and put the call on speaker phone. After a discussion with the phone call and the patient the registrar walked away, and Patient #1 conversed with their companion and then without contacting the registrar the couple exited the facility. B. In an interview with ED Clerk, it was stated that, “I called the 700 unit (obstetrics unit) to let them know this lady was here. I had them on the speaker because the cord was too short for me to talk on at the desk. I guess they heard we were on diversion but, not that we were going to see her in the Emergency Department. “The mother made the decision to leave for El Dorado.” C. During interview with OCMC Emergency Room Manager on 04/08/2025 at 10:03 AM it was stated that, On 3/29/2025 the facility was on Obstetrics (OB) diversion due to both newborn physicians being off for spring break. D. Review of complaint form from Southwest Arkansas Regional Medical Center (SARMC) hospital showed that Patient #1 arrived at 4:55 PM to the facilities Labor and Delivery unit. E. Review SARMC’s of Clinical Record document titled “History and Physical” dated 03/30/2025 and timed 5:06 AM stated, “This is a 22-year-old white female gravida 1 para 0 who was admitted at 40 weeks gestational age in latent labor, She had been followed for her prenatal care in Camden by (Named Physician). The hospital was on diversion. On admission she was having regular contractions and was 3.5cm/ 90%/minus 2 station. She had spontaneous rupture of membranes at 12:00 PM on 03/29/2025 of clear fluid. She had no fever chills genitourinary or gastrointestinal symptoms. Estimated length of stay 48 hours.” F. Review of Clinical Record from SARMC showed document titled “Operative Report” dated 03/30/2025 at 5:03 AM showed, “The patient went to completion with an epidural in place and pushed for 1 hour about 1 hour 50 minutes. The patient remained stable throughout.””

“EMERGENCY ROOM LOG CFR(s): 489.20(r)(3) [The provider agrees,] in the case of a hospital as defined in §489.24(b) (including both the transferring and receiving hospitals), to maintain a central log on each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged. §489.24 The provisions of this regulation apply to all hospitals that participate in Medicare and provide emergency services. This Standard is not met as evidenced by: 44854 Based on clinical record review, policy review, and interview, it was determined the facility failed to ensure 1 (1) of 25 (#1-#25) patient was placed on the Emergency Department (ED) Log. Failure to place the patient on the ED Log did not ensure the facility had a means of tracking the patient for emergency medical treatment. The failed practice affected Patient #1 and had the likelihood to affect all patients presenting to the ED. Findings follow: A. Review of Policy and Procedure “Transfer to Another Facility or Nursing Home”, revised September 2006, showed identifying information for all persons presenting to the Emergency Department (ED) shall be entered into a Central Log maintained in both the ED and the Obstetrics Department. B. Review of the ED Log dated from 10/01/2024 to 02/28/2025 showed no evidence Patient #1 was registered on the ED Log. C. During an interview on 03/05/2025 at 1:00 PM, the Risk Manager confirmed the findings in A and B.”