Mammoth Hospital

“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: 47360 Based on interview and record review, the hospital failed to implement and maintain its policy and procedure (P&P) for the Emergency Medical Treatment and Active Labor Act (EMTALA) for one of 21 sampled patients (Patient 21) when: 1. There was no documented evidence that Patient 21 received a medical screening examination (MSE- a medical examination by a qualified provider to determine if an immediate threat exists) from Facility A’s Emergency Department (ED) prior to being redirected to Facility B. (Refer to Tag A - 2406) 2. One of 21 sampled patients (Patient 21), presented to Facility A by ambulance, with an emergency medical condition, and was not appropriately transferred to Facility B. (Refer to Tag A-2409) The cumulative effects of these failures resulted in Patient 21 being transferred from Facility A to Facility B without an appropriate MSE being provided, stabilizing treatment for an emergency medical condition, or an appropriate transfer, which delayed treatment and potentially jeopardized Patient 21’s health.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) and 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: 47360 Based on interview and record review, the facility failed to ensure its policy and procedure (P&P) for the Emergency Medical Treatment and Labor Act (EMTALA) was implemented for one of 21 sampled patients (Patient 21) when there was no documented evidence that Patient 21 received a medical screening examination (MSE- a medical examination by a qualified provider to determine if an immediate threat exists) from Facility A’s Emergency Department (ED) prior to being redirected to Facility B. This failure had contributed to Patient 21 not being stabilized to address Patient 21’s airway status which had the potential to negatively impact on Patient 21’s health and safety. Findings: An unannounced visit was conducted on March 23, 2026, through March 24, 2026, to investigate a possible EMTALA violation. During a review of Patient 21’s , “Base Station MICN [Mobile Intensive Care Nurse] Record 26-080” (a documented communication between emergency medical services [EMS-community based emergency medical technicians and paramedics] and the hospital, that details patient’s chief complaint and condition and any ordered medical treatment and direction to the most appropriate hospital), dated January 16, 2026, the “Base Station MICN Record 26-080” indicated, Patient 21 was found nonresponsive on the ground with redness across the chest. Patient 21’s vital signs (measurements of your body’s most basic functions, used to monitor physical health and detect medical issues including blood pressure [BP normal range 90/60 to 120/80 mmHg -millimeters of Mercury- unit of measure], heart rate [HR normal range 60 to 100 beats per minute ], and blood oxygen saturation [SPO2 typically 95%- 100%]) were BP 160/80 mm/Hg, HR 130 beats per minute and SPO2 87%. Patient 21 was being ventilated (receiving mechanical assistance with breathing) by bag valve mask (BVM-a handheld emergency tool used by professionals to force air into a patient’s lungs when they cannot breathe on their own), but ventilation was difficult and Physician 1 instructed EMS to respond to Facility A for stabilization. During a concurrent interview and record review on March 24, 2026, at 8:20 AM, with the Emergency Department Supervisor (EDS), the audio of “Base Sation Call # 26-080”, dated January 16, 2026, was reviewed. The audio of “Base Station Call #26-080” indicated, EMS contacted Facility A’s MICN with an unresponsive trauma patient at 2:26 PM, Patient 21. The audio indicated Patient 21 was initially being ventilated via BVM but started to have difficulty ventilating and were instructed to go to Facility A for stabilization, with an estimated time of arrival of 5 minutes. The EDS confirmed, that per this recording, the destination was Facility A for airway management and stabilization. During a concurrent interview and record review on March 24, 2026, at 8:33 AM, with the EDS, the Hospital’s “Centralized Emergency Department Log” (ED Log), dated January 16, 2026, was reviewed. The ED Log indicated, an unnamed patient [Trauma, D] arrived by ambulance at the ED on January 16, 2026, at 2:48 PM, with chief complaint of trauma, and “Left Without Being Seen”. The EDS confirmed, the “Trauma D” on the ED Log was Patient 21. The EDS accessed Patient 21’s visit in the electronic chart and stated there was no documented medical screening examination by an ED Physician for this visit. During a continued concurrent interview and record review on March 24, 2026, at 8:41 AM, with the EDS, Patient 21’s “ED Triage” (a rapid sorting process that prioritizes patients by the severity of their condition) and “Coding Summary,” dated January 16, 2026, were reviewed. The “ED Triage” indicated, “ ...Chief Complaint: pt [Patient] not seen in ED, medics bypassed and went to flight ...”. The “Coding Summary” indicated, Patient 21 “ ...Left Without Being Seen ...” The EDS stated, she was not aware as to why Patient 21 was logged into the ED Log if EMS bypassed the hospital, but the disposition was probably marked as “Left Without Being Seen” because that would be the only option to discharge the patient from the electronic charting system. During a concurrent interview and record review on March 24, 2026, at 10:50 AM, with Registered Nurse 1 (RN 1), Patient 21’s “ED Triage,” dated January 16, 2026, was reviewed. The “ED Triage” indicated, “ ...Chief Complaint: pt not seen in ED, medics bypassed and went to flight ...”. RN 1 stated, EMS stopped by the hospital in the ambulance bay. RN 1 stated, Physician 1 went to the ambulance to assess Patient 21, but Patient 21 never entered the ED, and a triage was not completed. During a telephone interview on March 24, 2026, at 11:30 AM, with Mobile Intensive Care Nurse 1 (MICN 1), MICN 1 stated she recalled Patient 21’s incident. MICN 1 stated EMS came to the ambulance bay with Patient 21, but Patient 21 did not enter the ED. During a concurrent interview and record review on March 24, 2026, at 2:19 PM, with Physician 1, Patient 21’s “Base Station MICN Record 26-080”, dated January 16, 2026, was reviewed. The “Base Station MICN Record 26-080” indicated, EMS contact Facility A at 2:35 PM. Patient 21 was found unresponsive on the ground, was being ventilated by BVM, ventilation was difficult, and Physician 1 instructed EMS to respond to Facility A for stabilization. Physician 1 stated that she went into the ambulance and assessed Patient 21. Physician 1 confirmed the MSE was not documented because she never saw a chart for Patient 21. Physician 1 stated EMS was then directed to go to the airport for air ambulance and transport Patient 21 to Facility B. During a phone interview on March 24, 2026, at 3:00 PM, with the ED Medical Director EDMD, the EDMD stated it is the ED physician’s responsibility to provide a medical screening exam to any patient presenting to the ED, including patients brought by ambulance, and the MSE is expected to be documented in the patient’s chart. During a concurrent interview and record review on March 24, 2026, at 4:00 PM, with the ED Manager (EDM), the facility’s P&P titled, “EMTALA: Medical Screening Examinations,” dated June 2025, was reviewed. The P&P indicated, “ ... EMTALA stipulates that a hospital that has an emergency department and participates in Medicare must provide a “medical screening exam” (MSE) for anyone who “comes to the emergency department” ED and “requests examination or treatment for a medical condition.” If the MSE reveals that the patient has an “emergency medical condition” (EMC), the hospital must provide such treatment as required to stabilize the condition and or transfer to another medical facility ... “Comes to the Emergency Department (ED)” If a person presents with an emergency medical condition anywhere on Hospital property then they have “come to the ED” ... “Medical Screening Exam (MSE)” An MSE is the process required to reach within reasonable clinical confidence the point at which it can be determined whether or not an emergency medical condition (EMC) exists ...The MSE will be performed using any of the District’s resources that are normally available to any patient at that moment regardless of ability to pay ...”. The EDM stated, it is expected that any patient presenting to the ED is medically screened by a physician, the patient is stabilized and if needed, appropriately transferred to a receiving hospital.”

“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: 47360 Based on interview and record review, the facility failed to ensure its policy and procedure (P&P) for the Emergency Medical Treatment and Labor Act (EMTALA) were implemented for one of 21 sampled patients (Patient 21) when Patient 21 was transferred from Facility A without proper notification or documentation to Facility B. This failure resulted in Patient 21 being transferred from Facility A to Facility B without proper transfer process of notification and documentation which could contributed to delay initiation of trauma treatments upon arrival to Facility B that could negatively affect Patient 21’s health and safety. Findings: During a review of Patient 21’s , “Base Station MICN [Mobile Intensive Care Nurse] Record 26-080” (a documented communication between emergency medical services [EMS-community based emergency medical technicians and paramedics] and the hospital, that details patient’s chief complaint and condition and any ordered medical treatment and direction to the most appropriate hospital), dated January 16, 2026, the “Base Station MICN Record 26-080” indicated, Patient 21 was found nonresponsive on the ground with redness across the chest. Patient 21’s vital signs (measurements of your body’s most basic functions, used to monitor physical health and detect medical issues including blood pressure [BP normal range 90/60 to 120/80 mmHg -millimeters of Mercury- unit of measure], heart rate [HR normal range 60 to 100 beats per minute ], and blood oxygen saturation [SPO2 typically 95%- 100%]) were BP 160/80 mm/Hg, HR 130 beats per minute and SPO2 87%. Patient 21 was being ventilated (receiving mechanical assistance with breathing) by bag valve mask (BVM-a handheld emergency tool used by professionals to force air into a patient’s lungs when they cannot breathe on their own), but ventilation was difficult and Physician 1 instructed EMS to respond to Facility A for stabilization. During a concurrent interview and record review on March 24, 2026, at 8:20 AM, with the Emergency Department Supervisor (EDS), the audio of “Base Sation Call # 26-080”, dated January 16, 2026, was reviewed. The audio of “Base Station Call #26-080” indicated, EMS contacted Facility A’s MICN with an unresponsive trauma patient at 2:26 PM, Patient 21. The audio indicated Patient 21 was initially being ventilated via BVM but started to have difficulty ventilating and were instructed to go to Facility A for stabilization, with an estimated time of arrival of 5 minutes. The EDS confirmed, that per this recording, the destination was Facility A for airway management and stabilization. During a concurrent interview and record review on March 24, 2026, at 8:33 AM, with the EDS, the Hospital’s “Centralized Emergency Department Log” (ED Log), dated January 16, 2026, was reviewed. The ED Log indicated, an unnamed patient [Trauma, D] arrived by ambulance at the ED on January 16, 2026, at 2:48 PM, with chief complaint of trauma, and “Left Without Being Seen”. The EDS confirmed, the “Trauma D” on the ED log was Patient 21. The EDS accessed Patient 21’s visit in the electronic chart and stated there was no documented medical screening examination by an ED Physician for this visit. During a telephone interview on March 24, 2026, at 11:30 AM, with Mobile Intensive Care Nurse 1 (MICN 1), MICN 1 stated she recalled Patient 21’s incident. MICN 1 stated EMS came to the ambulance bay with Patient 21, but Patient 21 did not enter the ED. During a concurrent interview and record review on March 24, 2026, at 2:19 PM, with Physician 1, Patient 21’s “Base Station MICN Record 26-080”, dated January 16, 2026, the “Base Station MICN Record 26-080” indicated, EMS contact Facility A at 2:35 PM. Patient 21 was found unresponsive, being ventilated by BVM, ventilation was difficult, and Physician 1 instructed EMS to respond to Facility A for stabilization. Physician 1 stated that she went into the ambulance and assessed Patient 21, then directed EMS to go to the airport for air ambulance and transport Patient 21 to Facility B. Physician 1 stated, generally, the facility responsible physician would notify a receiving hospital doctor regarding the transfer and ensure transfer documents were completed. Physician 1 further stated, she did not complete any transfer documentation for Patient 21 and did not contact Facility B for an accepting physician or notify Facility B regarding Patient 21 reroute after being seen in the ambulance bay. During a phone interview on March 24, 2026, at 3:00 PM, with the ED Medical Director (EDMD), the EDMD stated, it is the ED physician’s responsibility to contact the receiving doctor at the receiving facility when transferring a patient for a higher level of care. The EDMD stated, because Patient 21 did present at Facility A’s ED ambulance bay first, was seen by Facility A’s physician briefly, then it is Facility A’s responsibility to notify Facility B and provide an appropriate transfer. During an interview on March 24, 2026, at 4:00 PM, with the ED Manager (EDM), the EDM stated, it is expected that any patient presenting to the ED is medically screened by a physician, the patient is stabilized and if needed, appropriately transferred to a receiving hospital. The EDM confirmed there was no transfer documentation related to Patient 21’s visit on January 16, 2026. The EDM stated that the ED physician is still required to contact receiving facility physician so that the hospital can activate the trauma team. During a review of the facility’s P&P titled, “EMTALA: Patient Transfers from [Hospital Name]” dated March 2023, the P&P indicated, “Purpose: To ensure that the transfer of a patient from [Hospital Name] facility to another healthcare facility is performed in compliance with EMTALA law. Procedure: The [Hospital Name] transferring clinician speaks with a representative of the receiving facility who is authorized to accept patient transfers ... The transferring clinician, nurses, clerk, EMT and/or patient complete the following: Transfer Flow Sheet ...Interfacility Transfer Summary ...Physician Certification of Need for Transfer: Physician documents the reason for the transfer, summarizes the risks and benefits, and signs to indicate that the benefits outweigh the risks ...When transferring a patient who has not been stabilized, the physician’s certification of need is an EMTALA requirement ...To be “stable” under EMTALA, no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during transfer or discharge of the individual from the Hospital ...EMTALA Obligation to Transfer: Under EMTALA law, a hospital is required to perform an MSE and “stabilize” and patient who comes to the Emergency Department requesting treatment for an EMC. If stabilization is beyond the capability of the staff (including on-call staff) and of the facility, then the hospital obligated to try to transfer patient to a facility that is better able to treat the patient ...EMTALA Limitations of Transfer: A patient may be transferred to another facility only if at least one of the following three conditions is met ...2. Unstable, but benefits of transfer outweigh the risks (physician signs Certification) ...””

“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: 46696 Based on interview and record review, Facility 1 failed to implement and maintain its Emergency Medical Treatment and Active Labor Act (EMTALA), policy and procedures (P&Ps), Facility 1did not provide a medical screening exam (MSE - an examination performed by a qualified medical provider to determine if a patient has an emergency condition) to ensure an emergency medical condition (EMC) does not exist for two of 23 sampled patients (Patient 1 and 2), when Facility 1 was not in a “diversionary” (the Emergency Department is temporarily closed to incoming ambulances due to being at capacity or unable to handle additional patients) status and Facility 1’s physician diverted a paramedic’s call with spontaneous home delivery with neonatal distress to Facility 2. (Refer to Tag A-2406) The cumulative effects of these failures resulted in the facility’s inability to identify if an emergency medical condition that required immediate care existed, which could place the patients at risk of medical complications and may jeopardize health and safety.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) and 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: 46696 Based on interview and record review, the facility failed to provide a medical screening exam (MSE - an examination performed by a qualified medical provider to determine if a patient has an emergency condition) to ensure an emergency medical condition (EMC) does not exist for two of 23 sampled patients (Patient 1 and 2), when Facility 1 was not in a “diversionary’ ’(the Emergency Department is temporarily closed to incoming ambulances due to being at capacity or unable to handle additional patients) status and Facility 1’s physician diverted a paramedic’s call with spontaneous home delivery with neonatal distress to Facility 2. This failure resulted in the facilities’ inability to identify if an emergency medical condition that required immediate care existed, which could place the patients at risk of medical complications and may jeopardize health and safety. Findings: During a review of “Base Station Mobile Intensive Care Nurse (MICN-registered nurses (RNs) who are authorized to provide medical direction to paramedics and other prehospital personnel in emergency medical services) Record” dated, June 30,2023 at 3:22 AM, the “Base Station MICN Record” indicated “Chief complaint, Difficulty breathing in neonate, status post (after) spontaneous delivery ... 3:27AM Physician [MD1] consulted on diversion to [Hospital 2] given patients stability following birth. MICN instructed to divert medics to [Hospital 2] and report to base station if patient deteriorates.” During a record review of “Emergency Medical Services (EMS) Audio files” dated June 30,2023 at 3:23 AM, the “EMS Audio files indicated, “3:23 AM EMS: 23-year-old female just delivered her first baby at about 2 .... Baby has an APGAR (Apgar score is a quick test performed on newborns at 1 and 5 minutes after birth to assess their physical condition. It evaluates five factors: heart rate, respiratory effort, muscle tone, reflex irritability, and color, each scored from 0 to 2, with a maximum total score of 10) of 6, no cry color blue and pink, and were suctioning the airway, heart rate (HR) over 100, mom checking vitals(measurements of the body’s most basic functions, indicating how well the body is functioning) right now fully alert and oriented, her water broke around midnight she had no contractions but then gave birth. So, we were considering coming to [Facility 1] since it’s the closest facility but since there is no labor and delivery so we ....[cut off] MICN: Copy, Just to clarify? How many weeks pregnant was this patient prenatal? EMS: Delivery date was 2 weeks from today so full term she hasn’t delivered the placenta, yet she wants to keep the cord attached for now. MICN: Copy that hold for further orders I’m going to talk to [MD1] and see what he wants to do. 3:25AM MICN: Just to clarify chief complaint, here would be airway obstruction of the infant? EMS: umm we are managing the airway with suction, the airway looks good now, and its more so just the unexpected delivery. RN: Copy that, Do we have an O2 sat on the baby and also respiration and heart rate? EMS: umm HR strong regular, [cut off] 3:29AM MICN: Ok, just spoke to [MD1], he thinks it would be best to divert baby and mother to [Facility 2]. EMS: Ok, so we will transport to [Facility 2].” During an interview on July 29,2025 at 2:10 PM, with Emergency Department Physician EDMD2, EDMD2 stated, our facility is able to handle normal births very well, but once you get beyond normal, we are not so confident. EDMD2 further stated , all our nurses have Neonatal Resuscitation Program (NRP- equips healthcare professionals with the skills and knowledge to assess and resuscitate newborns) certifications. During a review of the facility policy and procedure titled, “EMTALA : Medical screening Examinations” revised on June, 2025, indicated “ Emergency Medical Treatment and Active Labro Act (EMTALA) stipulates that a hospital that has an emergency department and participates in Medicare must provide a “Medical screening exam (MSE) for anyone who “comes to the Emergency Department” (ED) and “requests examination or treatment for a medical condition” If the MSE reveals that the patient has an “Emergency Medical Condition” (EMC) the hospital must provide such treatment as required to stabilize the condition or a transfer to another medical facility.” During a review of “ State operations manual Appendix V Section 489.24(a) (1) (i)” dated July 19, 2019, the “State operations manual Appendix V Section 489.24(a) (1) (i)” indicates, “If an individual is in an ambulance, regardless of whether the ambulance is owned by the hospital, a hospital may divert individuals when it is in “diversionary” status because it does not have the staff or facilities to accept any additional emergency patients at that time” During an interview on July 30,2025 at 10:35 AM, with the Emergency Department Manager (EDM), the EDM stated, on June 30,2023, at around 3:00 AM, when this event occurred the hospital was not on a diversionary status.”