Honorhealth Tempe 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: 46598 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 as evidenced by: Hospital policy titled, “Emergency Medical Treatment and Active Labor Act (EMTALA)”, revealed: “ ...Policy. Every patient regardless of ability to pay, who (i) presents to the hospital’s Dedicated Emergency Department or presents on Hospital property and (ii) requests an examination or treatment of a potential Emergency Medical Condition (“EMC”) shall receive an appropriate Medical Screening Examination (“MSE”) to determine whether the patient is experiencing an EMC ...Medical Screening Examination (MSE): Means the screening process required to determine with reasonable clinical confidence whether an EMC does or does not exist. Depending on the patient presenting symptoms, The MSE represents a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures within the capability of the Hospital. Triage does not constitute an MSE. Triage involves the clinical assessment of the patient presenting signs and symptoms at the time of arrival at the Hospital to prioritize when the patient will be seen by a physician or QMP ...Procedure. I. Medical Screening Examination Requirements. All patients who present to the Hospital DED or on Hospital Property and request examination or treatment of a potential EMC shall receive an appropriate MSE ...B. Scope of the MSE. 1. A physician or QMP must perform the MSE to determine if an EMC exists ....” Hospital policy titled “Emergency Department Triage” revealed: “...Policy. Emergency Department registered nurses who have met the clinical competencies will perform triage assessment,...Procedure. 1. All patients receive a rapid triage assessment including: a. Chief complaint, b. Allergies, c. Vital signs, including temperature, pulse, respirations, blood pressure and pain intensity.,d. Other information, if appropriate, may include oxygen saturation, last menstrual period, past medical history and weight ...2. Whenever possible, patients are immediately placed into open treatment spaces and triage is performed at the bedside ....” Twenty ED medical records, Patients 1 through 20, in May through July 2022, were randomly selected for review including patients who were transferred, admitted, left before triage, or left before Medical Screening Examinations (MSE). Four out of twenty medical records revealed patients who did not receive an appropriate MSE: Patient # 1, 07/22/2022, arrived 0923, triaged 2246, no MSE, Left 11:00. Time elapsed 1 hour and 14 minutes 2. Patient #4, 07/31/2022, arrived 10:34, triaged 10:52, MSE 15:29. Time elapsed 4 hours, 37 minutes. Patient #11, 05/01/2022, arrived 13:46, no triage, no MSE, left 15:00. Time elapsed 1 hour 14 minutes. Patient #15, 05/26/2022, arrived at 0359, no triage, no MSE, left 0501, Time elapsed 1 hour 2 minutes. An additional 5 ED medical records, (Patients 21-25), in December 2023, who left without being triaged, were reviewed. Four out of five records revealed patients who did not receive an MSE: Patient # 21, on 12/04/2023, chest pain, arrived at 0023, no triage, no MSE exam, left 0057. Time elapsed 34 minutes. Patient # 22, on 12/10/2023, at 1523, no triage, no MSE, left 1643. Time elapsed 1 hour 20 minutes. Patient # 23, on 12/24/2023, abdominal pain, arrived 0643, no triage,no MSE, left 0711. Time elapsed 28 minutes. Patient #24, on 12/25/2023, panic attack, arrived 0449, no triage, no MSE, Left 0545. Time elapsed 54 minutes. Employee # 1 confirmed during an interview on 12/29/2023, that 8 out of the 25 medical records reviewed did not receive a medical screening examination or treatment before leaving the ED.”

“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: 46598 Based on review of clinical records, policies and procedures, hospital documents, and staff interviews, it was determined the hospital failed to provide a Medical Screening Examination (MSE) to a patient who was taken to the Emergency Department by ambulance (Patient #1). Findings include: Patient # 1 was brought to Tempe St. Luke Emergency Department by EMS after passing out while working as a UPS delivery driver. Upon arrival to the Emergency Department the patient was offloaded from the ambulance and sent to the lobby. The patient waited in the lobby for 83 minutes before being triaged. After being triaged the patient decided to leave. No medical screening exam was completed. Hospital policy titled, “Emergency Medical Treatment and Active Labor Act (EMTALA)”, revealed: “ ...Policy. Every patient regardless of ability to pay, who (i) presents to the hospital’s Dedicated Emergency Department or presents on Hospital property and (ii) requests an examination or treatment of a potential Emergency Medical Condition (“EMC”) shall receive an appropriate Medical Screening Examination (“MSE”) to determine whether the patient is experiencing an EMC ...Medical Screening Examination (MSE): Means the screening process required to determine with reasonable clinical confidence whether an EMC does or does not exist. Depending on the patient presenting symptoms, The MSE represents a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures within the capability of the Hospital. Triage does not constitute an MSE. Triage involves the clinical assessment of the patient presenting signs and symptoms at the time of arrival at the Hospital to prioritize when the patient will be seen by a physician or QMP ...Procedure. I. Medical Screening Examination Requirements. All patients who present to the Hospital DED or on Hospital Property and request examination or treatment of a potential EMC shall receive an appropriate MSE ...B. Scope of the MSE. 1. A physician or QMP must perform the MSE to determine if an EMC. Exists ....” Document titled “TFMRD Pre-Hospital Care Report,” dated 07/22/2022, revealed: “ ...At Tempe St. Luke ER at 2123, patient stood and walked to ER Lobby from the gurney and sat down in a chair. Patient care turned over to RN and a report was given ....” A review of Patient #1 ’ s medical record revealed that the patient was brought to Tempe St. Luke Emergency Department by EMS on 07/22/2022 at 2123. The Emergency Department’s Visit summary reveals a triage time of 2246. An additional 19 ED medical records, Patients 2 through 20, in May through July 2022, were randomly selected for review including patients who were transferred, admitted, left before triage, or left before Medical Screening Examinations (MSE). Four out of twenty medical records revealed patients who did not receive an appropriate MSE: Patient # 1, 07/22/2022, arrived 0923, triaged 2246, no MSE, Left 11:00. Time elapsed 1 hour and 14 minutes. Patient #4, 07/31/2022, arrived 10:34, triaged 10:52, MSE 15:29. Time elapsed 4 hours, 37 minutes. Patient #11, 05/01/2022, arrived 13:46, no triage, no MSE, left 15:00. Time elapsed 1 hour 14 minutes. Patient #15, 05/26/2022, arrived at 0359, no triage, no MSE, left 0501, Time elapsed 1 hour 2 minutes. An additional 5 ED medical records, (Patients 21-25), in December 2023, who left without being triaged, were reviewed. Four out of five records revealed patients who did not receive an MSE: Patient # 21, on 12/04/2023, chest pain, arrived at 0023, no triage, no MSE, left 0057. Time elapsed 34 minutes. Patient # 22, on 12/10/2023, at 1523, no triage, no MSE, left 1643. Time elapsed 1 hour 20 minutes. Patient # 23, on 12/24/2023, abdominal pain, arrived 0643, no triage,no MSE, left 0711. Time elapsed 28 minutes. Patient #24, on 12/25/2023, panic attack, arrived 0449, no triage, no MSE, Left 0545. Time elapsed 54 minutes. Employee #1 confirmed during an interview on 12/29/2023, that 8 out of the 25 medical records reviewed left without receiving a medical screening examination. Employee # 1 also confirmed that Patient #1 waited in the ED lobby for 83 minutes before being triaged and did not receive a medical screening examination.”

“DELAY IN EXAMINATION OR TREATMENT CFR(s): 489.24(d)(4-5) (4) Delay in treatment. (i) A participating hospital may not delay providing an appropriate medical screening examination required under paragraph (a) of this section or further medical examination and treatment required under paragraph (d)(1) of this section in order to inquire about the individual’s method of payment or insurance status. (ii)A participating hospital may not seek, or direct an individual to seek, authorization from the individual’s insurance company for screening or stabilization services to be furnished by a hospital, physician, or nonphysician practitioner to an individual until after the hospital has provided the appropriate medical screening examination required under paragraph (a) of this section, and initiated any further medical examination and treatment that may be required to stabilize the emergency medical condition under paragraph (d)(1) of this section. (iii) An emergency physician or nonphysician practitioner is not precluded from contacting the individual’s physician at any time to seek advice regarding the individual’s medical history and needs that may be relevant to the medical treatment and screening of the patient, as long as this consultation does not inappropriately delay services required under paragraph (a) or paragraphs (d)(1) and (d)(2) of this section. Hospitals may follow reasonable registration processes for individuals for whom examination or treatment is required by this section, including asking whether an individual is insured and, if so, what that insurance is, as long as that inquiry does not delay screening or treatment. Reasonable registration processes may not unduly discourage individuals from remaining for further evaluation. A hospital meets the requirements of paragraph (d)(1)(ii) of this section with respect to an individual if the hospital offers to transfer the individual to another medical facility in accordance with paragraph (e) of this section and informs the individual (or a person acting on his or her behalf) of the risks and benefits to the individual of the transfer, but the individual (or a person acting on the individual’s behalf) does not consent to the transfer. The hospital must take all reasonable steps to secure the individual’s written informed refusal (or that of a person acting on his or her behalf). The written document must indicate the person has been informed of the risks and benefits of the transfer and state the reasons for the individual’s refusal. The medical record must contain a description of the proposed transfer that was refused by or on behalf of the individual. This Standard is not met as evidenced by: 46598 Based on review of clinical records, policies and procedures, hospital documents, and staff interviews, it was determined the hospital the hospital delayed screening and treatment of 8 out of 25 patients who presented to the Emergency Department. Findings include: Hospital policy titled, “Emergency Medical Treatment and Active Labor Act (EMTALA)”, revealed: “ ...Policy. Every patient regardless of ability to pay, who (i) presents to the hospital’s Dedicated Emergency Department or presents on Hospital property and (ii) requests an examination or treatment of a potential Emergency Medical Condition (“EMC”) shall receive an appropriate Medical Screening Examination (“MSE”) to determine whether the patient is experiencing an EMC ...Medical Screening Examination (MSE): Means the screening process required to determine with reasonable clinical confidence whether an EMC does or does not exist. Depending on the patient presenting symptoms, The MSE represents a spectrum ranging from a simple process involving only a brief history and physical examination to a complex process that also involves performing ancillary studies and procedures within the capability of the Hospital. Triage does not constitute an MSE. Triage involves the clinical assessment of the patient presenting signs and symptoms at the time of arrival at the Hospital to prioritize when the patient will be seen by a physician or QMP ...Procedure. I. Medical Screening Examination Requirements. All patients who present to the Hospital DED or on Hospital Property and request examination or treatment of a potential EMC shall receive an appropriate MSE ...B. Scope of the MSE. 1. A physician or QMP must perform the MSE to determine if an EMC. Exists ....” Hospital policy titled “Emergency Department Triage” revealed: “...Policy. Emergency Department registered nurses who have met the clinical competencies will perform triage assessment, Procedure. 1. All patients receive a rapid triage assessment including: a. Chief complaint, b. Allergies, c. Vital signs, including temperature, pulse, respirations, blood pressure and pain intensity. Other information, if appropriate, may include oxygen saturation, last menstrual period, past medical history and weight ...2. Whenever possible, patients are immediately placed into open treatment spaces and triage is performed at the bedside ....” Four out of twenty medical records, Patients 1 through 20, in May through July 2022, were randomly selected for review including patients who were transferred, admitted, left before triage, or left before Medical Screening Examinations (MSE). Four out of twenty medical records revealed patients who did not receive an appropriate MSE: Patient # 1, 07/22/2022, arrived 0923, triaged 2246, no MSE, Left 11:00. Time elapsed 1 hour and 14 minutes. Patient #4, 07/31/2022, arrived 10:34, triaged 10:52, MSE 15:29. Time elapsed 4 hours, 37 minutes. Patient #11, 05/01/2022, arrived 13:46, no triage, no MSE, left 15:00. Time elapsed 1 hour 14 minutes. Patient #15, 05/26/2022, arrived at 0359, no triage, no MSE, left 0501, Time elapsed 1 hour 2 minutes. An additional 5 ED medical records, (Patients 21-25), in December 2023, who left without being triaged, were reviewed. Four out of five records revealed patients who did not receive an MSE: Patient # 21, on 12/04/2023, chest pain, arrived at 0023, no triage, no MSE exam, left 0057. Time elapsed 34 minutes. Patient # 22, on 12/10/2023, at 1523, no triage, no MSE, left 1643. Time elapsed 1 hour 20 minutes. Patient # 23, on 12/24/2023, abdominal pain, arrived 0643, no triage,no MSE, left 0711. Time elapsed 28 minutes. Patient #24, on 12/25/2023, panic attack, arrived 0449, no triage, no MSE, Left 0545. Time elapsed 54 minutes. Employee # 1 confirmed during an interview on 12/29/2023, that 8 out of the 25 medical records reviewed from did not receive a medical screening examination or treatment.”