HCA Florida Osceola 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: 25370 Based on medical records review, policy and procedure review, written statements review, and interviews, it was determined the facility failed to ensure that when an individual comes to the hospital’s ED (regardless of ability to pay) the hospital must 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 for one (1) of twenty-three (23 sampled patients (Patient #1). Refer to finding in Tag A- 2406.”

“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: 13640 Based on witness statements, interviews, review of video recording, Emergency Department (ED) Log review, Policy and Procedure review, it was determined the facility failed to ensure that an ED central log is maintained on each individual who comes to the emergency department 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 for one (1) of twenty-three (23) sampled patients, (#1). Findings: Review of HCA FL (Florida) Osceola Hospital (Hospital A) video recording on 12/23/25 at 10:20 AM, involved two different cameras with different views. The recording showed the ED (Emergency Department) lobby and entrance, but not staff at an abutting counter. The following was observed in the video recording. On 9/29/25 at 7:50:14 PM, a girl and an adult male were seen entering the ED. At 7:50:51 PM, an adult female was seen entering the ED and approaching the counter. Later video revealed that she was affiliated with the other two who had entered. Soon thereafter all three left the counter to take a seat in the lobby and filled out paperwork which had been given to them by facility staff. At 7:52:24 PM, the adult female and the child were seen going to the counter. At 7:53:12 PM the adult man was seen going to the counter with paperwork and leaving it at the counter. At 7:54:30 PM, the adult female was seen talking on her telephone. At 7:56:24 PM, a nurse came to the lobby to speak with the adult female and the girl. Upon arriving to see them, the adult female left to go speak on her telephone in the entrance way. At this time, the nurse approached the adult male and the child. At 7:58:01 PM, the adult female left the entrance way, went to the counter and then left the counter with the paperwork which the adult male had left at the counter. At 7:58:03 PM, the adult female was seen tearing up the paperwork and gave the torn pieces to the nurse. At 7:58:18 PM, the nurse was seen going back to the ED proper. At 7:58:48 PM, all three individuals were seen leaving the ED lobby. The video attested to an interaction between a facility nurse and an adult female who was in a party of three who entered and exited the ED at specified times on 9/29/25. Examination of the ED log for this date did not reveal any entries which would correspond to what was seen in the video. As a result, the ED log dated 9/29/2025 verified that Patient #1 was not entered on the facility’s ED log. A review of the witness statement (Officer-A) dated 9/30/2025 at 2:58 P.M. affirmed that he witnessed the presentation of a patient (Patient #1) in the ED lobby on 9/29/25. Review of the witness statement dated 10/1/2025 RN- (Registered Nurse) A confirmed she interacted with an adult female in the ED lobby who had accompanied a child (Patient #1) needing a medical screening examination on 9/29/25. She also admitted in part, “Explained process is to enter as LPT (leave prior to treatment) on the log but states she did not have the information since it was ripped up”. (by grandmother). She also “stated she doesn’t know how else to log this information.” During an interview with the VP of Quality on 12/23/25 at approximately 4:15 PM, she confirmed there was no EMTALA log entry for the above-described presentation on the evening of 9/29/25. The facility’s policy titled “Florida -EMTALA Central Log, Origination: 6.7/2024; Effective: 6/7/2024, Status (Active) PolicyStatID 17067085 was reviewed. The Policy revealed in part, “The hospital will maintain a Central Log containing information on each individual who requests emergency services or care or whose appearance or behavior would cause a prudent layperson observer to believe the individual needed examination or treatment, whether he or she refused treatment, whether he or she was refused treatment, or whether he or she was transferred, admitted an treated, stabilized and transferred or discharged. The facility failed to follow that their own policy and procedure This was evidenced by the facility’s failure maintain a central log to ensure whether she refused treatment, was refused treatment, or whether she was transferred, admitted and treated, stabilized and transferred or discharged on 9/29/2025 for Patient #1 who presented to the hospital’s ED with her family members seeking medical assistance”

“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: 13640 Based on medical records review, policy and procedure review, written statements review, and interviews, it was determined the facility failed to ensure that when an individual comes to the hospital’s ED (regardless of ability to pay) the hospital must 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 for one (1) of twenty-three (23 sampled patients (Patient #1). Findings: The facility policy titled “Florida- EMTALA Medical Screening Examination and Stabilization Model Policy, Status Active PolicyStat, Effective 6/17/2024 was reviewed. The policy revealed in part, “2. Policy: An EMTALA obligation is triggered when: 1. An individual or a representative acting on the individual’s behalf, including ...requests emergency services and care ... 3. Procedure: 3.1. When an MSE (Medical Screening Examination) is Required. A hospital must provide an appropriate MSE within the capability of the hospital’s emergency department, including ancillary services routinely available to the DED (Dedicated Emergency Department), to determine whether or not an EMC exists: (i) to any individual ...(ii) an individual who such a request a request made on his or her behalf ...An MSE shall be provided to determine whether or not the individual is experiencing an EMC ...a. A request is made by the individual or on the individual’s behalf for examination or treatment for a medical condition.” A review of the witness statement dated 9/30/2025 at 2:58 P.M., an interview with Officer- A was reviewed. The written statement revealed in part,” Officer- A stated patient (Pt.#1) and family walked in requesting to be seen, said they were at a pediatric clinic, and they sent them here to have her private area examined. He does not recall the specific details of the conversation but summarized that the nurse told the grandmother how much the visit will cost, which upset the grandmother. The RN (Registered Nurse) A left to go to speak to someone and then returned, she basically told them that they could help with any type of emergency but not the problem they are reporting at that time.” An additional witness statement dated October 1, 2025, at 11:25 A.M. interview with Officer -A was reviewed. The witness statement revealed in part, “ ...Officer- A stated the responding nurse (RN-A) then stated “its gonna cost around 4,000.00 and you may not want to spend that just to look at your daughter’s injury, Officer- A also stated, the responding nurse then stated she should go to another facility, and continued to dissuade the woman into staying for medical treatment.” The witness statement dated 10/1/2025 at 2:02 PM was reviewed, an interview with RN-A read, in part, “Older lady, child and gentleman arrived. Introduced myself and asked how I could help them. They reported the child was seen at PM (evening) Pediatrics for a large cyst inside her vagina and asked if the doctor here could take care of it. I asked (MD-1) and then told them he would need to assess them and depending on what is needed, we would need to transfer her somewhere else. She asked how much it would cost. I told her I didn’t know exact, but it could be up to a few thousand dollars. I thought it was okay because we have pricing posted. She was on the phone with the child’s mother and stated they decided to leave and take her somewhere else. The grandmother ripped up her form and asked me to shred it for her.. inquired about EMTALA training received prior to that evening ...Was not aware they could not discuss money/billing. Feels she encouraged her to stay and only said treatment options at their questioning.” During an interview with the VP of Quality on 12/23/25 at 1:35 PM, she stated on the day following the incident she called the grandmother (who had called the ED) on 9/30/25, who said they took her to another hospital. The grandmother would not provide the girl’s name and did mention which hospital she had gone to. The surveyor was able to reach grandmother on 12/23/25 2:12 PM. She stated they were initially greeted by security and eventually the nurse came out. She said she explained the situation to the nurse and the nurse told her the visit would cost $4,000. She questioned why the cost would be so high without having even been seen. She stated: “We had a few words.” She explained that during this interaction her son (the adult male in the video) had filled out the paperwork requesting treatment. The nurse told her that she could not leave with the paper. She (the grandmother) told the nurse the paper had personal information on it and then tore it up and gave the scraps to the nurse to shred. She stated they then took the patient to Hospital B ...” During an interview with the VP of Quality on 12/23/25 at approximately 4:15 PM, she confirmed the actions of the RN served as a discouragement for the presenting patient to wait for a medical screening examination. During an interview on 12/23/25 at 2:40 PM, with the ED physician, MD-1 who was on duty in the evening of 9/29/25, he stated he recalled the incident. He stated he was with a patient in a room when the family arrived. The nurse pulled him out to ask about the patient. She told him the patient had been referred from urgent care for a labial abscess. He told her he could not give an opinion without seeing the patient and told her to bring the patient back for a medical screening examination. He told the nurse the patient may need to be referred to a pediatric physician, but he did not expect the nurse to convey this to the patient’s family. He stressed he needed to see the patient first. Review of Hospital B’s medical record noted the patient (Patient #1) arrived at the ED on 9/29/25 at 8:10 PM with chief complaint of “boil on vagina.” She was assessed in the ED with diagnosis of labial swelling. She was prescribed both oral antibiotics and topical antibiotics and discharged to home. The facility failed to ensure that their policy and procedure was followed as evidenced by failing to ensure that an appropriate medical screening examination was provided that was within the capability of the hospital’s emergency department , including ancillary services routinely available to the DED, to determine whether or not and EMC existed when a representative acting on Patient #1’s behalf requesting an examination for a medical condition on 9/29/2025.”