Baptist Health Medical Center - Jacksonville

“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: 42310 Based on medical record review (MRR), Baptist Medical Center Jacksonville Baptist Medical Center South Rules and Regulations, Interviews, and facility policy review, it was determined the facility failed to provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department (ED), to determine whether or not an emergency medical condition exists for 1 (Patient #21) of 21 who husband brought her to the hospital, and was acting on her behalf reported to the hospital ED staff that his wife (Patient #21) was in sent to this hospital by her Obstetrical physician because patient #21 was in labor. Refer to findings in Tag A -2406 Based on Interviews, and facility policy review, the facility failed to provide an appropriate Medical Screening Exam (MSE) as required or further medical examination and treatment required, in order to inquire about the individual’s method of payment or insurance status resulting in a delay for 1 (Patient #21) of 21 patients sampled. Refer to findings in Tag A 2408”

“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: 42310 Based on medical record review (MRR), Baptist Medical Center Jacksonville Baptist Medical Center South Rules and Regulations, Interviews, and facility policy review, it was determined the facility failed to provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department (ED), to determine whether or not an emergency medical condition exists for 1 (Patient #21) of 21 who husband brought her to the hospital, and was acting on her behalf reported to the hospital ED staff that his wife (Patient #21) was in sent to this hospital by her Obstetrical physician because patient #21 was in labor. Findings include: A review of the facility policy titled “Emergency Medical Treatment and Labor Act (EMTALA)” with an effective date of 08/2024 was conducted. Page 1 of 7 stated “Every individual who comes to the ED and requests examination or treatment for a medical condition will be provided an appropriate medical screening by a Qualified Medical Professional (QMP) examination and necessary stabilizing treatment as required by the Emergency Access Laws.” Baptist Medical Center Jacksonville Baptist Medical Center South Rules and Regulations, last revision 4.19.2027 was reviewed. The section of the hospital’s Rules and Regulations revealed in part, “11.5 RESPONSIBILITIES ... Care in the Emergency Department may also include the initial diagnosis and treatment of patients presenting themselves to the Emergency Department suffering from chronic intermittent and/or episodic disease or injury. It shall be the responsibility of the on-duty emergency medicine physician, APRN (Advanced Practice Registered Nurse), or physician’s assistant to perform a “medical screening examination” as required by applicable law, on patients who present to the Emergency Department requesting emergency service and care.” The medical record from Hospital B for Patient #21 was reviewed. The medical record revealed that Patient #21 presented to hospital B’s emergency department on March 31, 2025, at 11:37 A.M. Further review revealed the patient was admitted to Hospital B as a inpatient on 3/31/3035 at 12: 17 P.M. The ED nurse documented on 3/31/2025 at 12:25 P.M., that the reason Patient #21’s ED visit was listed as “Labor Check.” Further review revealed that fetal movement was present, and the patient was experiencing contractions every 5 minutes. The admitting ED physician documented in the section of the note titled, “History of Present Illness” revealed in part, “This patient is a 34 yo (year old) ...at 40 6/7 weeks. She presents to the OB (Obstetrical) ED complaining of contractions. This started at 4:30 this morning. Denies ...VB (vaginal bleeding). Her pregnancy is complicated by history of 2 SAB’s (Spontaneous Abortions) ... She sees a physician at Baptist South ...Good FM (Fetal Movements)”. Review of the Discharge Summary /OB revealed the Associated Diagnoses: 40 weeks gestation pregnancy; Single live birth; SVD (spontaneous vaginal delivery); vagina delivery; Postpartum care following vaginal delivery.” On April 11, 2025, at 10:00 AM an interview was conducted with Employee A, Patient Access Services. She stated that she had only been an employee with the facility for about 6 weeks. She remembered a man came to the registration desk and told her his wife was sent by her doctor because she was in labor. When she pulled up the patient information, she didn’t see any pre-registration or orders in the system, so she started registering her as an outpatient. While checking her insurance, she saw that this hospital was out-of-network. She told the husband about the insurance and also mentioned that another hospital was in-network. After that, they said they would go to that other hospital and left before she completed anything else. At the time, she didn’t escalate to clinical staff for an EMTALA screening because she didn’t fully understand EMTALA. On April 11, 2025, at 2:00 PM an interview was conducted with the Director of Risk Management. The Director of Risk Manager verified that on March 31, 2025, a male individual presented at a non-ER check in desk at Baptist Medical Center South (Hospital A). He stated to a Patient Access Services (PAS) staff member that his wife had been instructed by her OB/GYN (Obstetrician-Gynecologist- a physician specializing in female reproductive health, pregnancy and childbirth) physician to come to the hospital because she was in labor. PAS was unable to locate pre-registration information such as physician orders in the hospital’s system. PAS began processing the patient as a routine outpatient. She stated on April 3, 2025, their leadership was made aware of an incident that occurred on March 31, 2025, in which a patient presenting in labor departed the facility without receiving a Medical Screening Examination (MSE), as required under EMTALA. An internal review confirmed that the patient was not evaluated by clinical staff and that no MSE was performed prior to her departure. The facility failed to ensure that their own EMTALA Policy and Procedure and Baptist Medical Center Jacksonville Baptist Medical Center South Rules and Regulations were followed as evidenced by the facility’s failure to provide an appropriate medical screening examination by a Qualified Medical Provider; when a male individual acting on her behalf when a request was made on her behalf seeking medical assistance. As the patient’s OB physician instructed the patient to go to Hospital A because she was in labor. Corrective actions were confirmed by facility leadership and supported by documentation including in-service training records, updated workflow protocols, and staff interviews.”

“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: 42310 Based on Interviews, and facility policy review, the facility failed to provide an appropriate Medical Screening Exam (MSE) as required or further medical examination and treatment required, in order to inquire about the individual’s method of payment or insurance status resulting in a delay for 1 (Patient #21) of 21 patients sampled. Findings include: On April 11, 2025, at 10:00 AM an interview was conducted with Employee A, Patient Access Services. She stated that while checking her insurance, she saw that this hospital was out-of-network. She told the husband about the insurance and also mentioned that another hospital was in-network. After that, they said they would go to that other hospital and left before she completed anything else. At the time, she didn’t escalate to clinical staff for an EMTALA screening because she didn’t fully understand EMTALA. She also stated that she has since completed EMTALA re-education, including updated training on her responsibilities when someone presents with a potential emergency condition like labor. She now understands that anyone with signs of an emergency condition must be referred immediately to clinical staff for a medical screening exam, regardless of their insurance status. The training also covered how to recognize EMTALA situations and the importance of notifying clinical personnel right away. On April 11, 2025, at 2:00 PM an interview was conducted with the Director of Risk Management. She stated the decision to leave the facility occurred after the patient’s husband was informed that Hospital A was out-of-network and that Hospital B was in-network under the patient’s insurance. No clinical assessment or EMTALA-compliant screening was initiated prior to the patient leaving. She also stated that it was determined a communication error occurred at the outpatient registration desk, which may have contributed to the patient departing the facility before the EMTALA obligation was fulfilled. A review of the facility policy titled “Emergency Medical Treatment and Labor Act (EMTALA)” with an effective date of 08/2024 was conducted. Page 3 of 7 stated “Patient Access Services may request and collect insurance and financial information from an individual, provided that the individual’s emergency medical screening examination (and any necessary stabilizing treatment) is not delayed by, or denied, because of, nor discouraged as a result of such inquiries.””