HCA Florida Lake City 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: 49777 Based on medical record reviews, staff interviews, video footage review, personnel record reviews, and policy and procedure review, the facility failed to ensure the individuals presenting to the hospital’s emergency department (ED) received an appropriate medical screening examination (MSE) within the capability of the hospital’s emergency department including ancillary services routinely available to the emergency department to determine whether or not emergency medical condition existed for 1 (Patient #1) of 20 sampled patients. The findings included: Patient #1 presented to the hospital’s property seeking medical assistance for Rape (Sexual Assault). Patient #1 stated, “I was raped,” and the Greeter announced “triage” over the radio to let the nursing staff know that a patient presented for care/treatment. Patient #1 was not seen by the nursing staff or the physician on duty. A Police Officer came out to the waiting area and told Patient #1 that she had to go to Lake City or Gainesville. Patient #1 and her friend departed the emergency department to HCA Florida Lake City Emergency Room. Cross Refer to 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: 49777 Based on medical record reviews, staff interviews, video footage review, personnel record reviews, and policy and procedure review, the facility failed to ensure the individuals presenting to the hospital’s emergency department (ED) received an appropriate medical screening examination (MSE) within the capability of the hospital’s emergency department including ancillary services routinely available to the emergency department to determine whether or not emergency medical condition existed for 1 (Patient #1) of 20 sampled patients. Patient #1 presented to the hospital’s property seeking medical assistance for Rape (Sexual Assault). Patient #1 stated, “I was raped,” and the Greeter announced “triage” over the radio to let the nursing staff know that a patient presented for care/treatment. Patient #1 was not seen by the nursing staff or the physician on duty. A Police Officer came out to the waiting area and told Patient #1 that she had to go to Lake City or Gainesville. Patient #1 and her friend departed the emergency department to HCA Florida Lake City Emergency Room. Findings include: Review of the policy and procedure titled “Florida EMTALA Medical Screening Examination and Stabilization Model Facility Policy” with an effective date of 6/17/2024 read, “1. Purpose: To establish guidelines for providing appropriate medical screening examinations (MSE) and any necessary stabilizing treatment or an appropriate transfer for the individual as required by EMTALA, 42 U.S.C. §1395dd, and all Federal regulations and interpretive guidelines promulgated thereunder, as well as section 395.1041, Florida Statutes, and all related administrative rules. 2. Policy: An EMTALA obligation is triggered when: 1. An individual or a representative acting on the individual’s behalf, including EMS or a transferring hospital, requests emergency services and care; or 2. A prudent layperson observer observing an individual who comes to the dedicated emergency department (DED) would conclude from the individual’s appearance or behavior that the individual needs an examination or treatment of a medical condition ... 3. Procedure: 3.1. When an MSE (medical screening exam) 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, to determine whether or not an EMC [Emergency Medical Condition] exists: (i) to any individual, including a pregnant woman having contractions, who requests such an examination; (ii) an individual who has such a request made on his or her behalf; or (iii) an individual whom a prudent layperson observer would conclude from the individual’s appearance or behavior needs an MSE. An MSE shall be provided to determine whether or not the individual is experiencing an EMC or a pregnant woman is in labor. An MSE is required when: a. A request is made by the Individual or on the individual’s behalf for examination or treatment for a medical condition, including where: i. The individual requests medication to resolve or provide stabilizing treatment for a medical condition. ii. The individual arrives as a transfer from another hospital or health care facility. Upon arrival of a transfer, a physician or qualified medical person (QMP) must perform an appropriate MSE. The physician or QMP shall provide any additional screening and treatment required to relieve or eliminate the EMC. The MSE of the individual must be documented. This type of screening cannot be performed by the triage nurse. If an EMC is determined to exist and the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under EMTALA ceases ... b. The individual arrives on the hospital property other than a DED and makes a request or another makes a request on the Individual’s behalf for examination or treatment for an EMC... Note: Anyone may make the request for an MSE or treatment described in both a. and b. above ... 3.3. Extent of the MSE: a. Determine if an EMC exists. The hospital must perform an MSE to determine if an EMC exists. It is not appropriate to merely “log in” or triage an Individual with a medical condition and not provide an MSE. Triage is not equivalent to an MSE. Triage entails the clinical assessment of the individual’s presenting signs and symptoms at the time of arrival at the hospital in order to prioritize when the individual will be screened by a physician or other QMP. b. Definition of MSE. An MSE is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether the individual has an EMC or not. It is not an isolated event. The MSE must be appropriate to the individual’s presenting signs and symptoms and the capability and capacity of the hospital ...” Review of the ED video footage dated 3/21/2026 beginning at 4:06:37 AM showed two female patients entering the waiting room. Patient #1 was greeted by the Greeter at 4:07 AM. Patient #1 and Patient #1’s Friend (with an orange visitor sticker) sat down at 4:08:26 AM. At 4:09:54 AM, at ambulance entrance, a police officer with long dark hair and dark glasses was holding a phone with her left hand, attempting keypad entries, which did not work. At 4:12:12 AM, the police officer rang the door buzzer. Staff A, Registered Nurse (RN), let the police officer inside the building. Staff A and the police officer walked down the hallway while talking and (video has no audio) and then stopped outside of the ED Room #8 at 4:13:21 AM. Staff A was talking to someone (later to be identified as Staff B, RN) inside Room #8. At 4:14:31 AM, the police officer and Staff A then walked back down the hallway. Staff A departed to the left and at 4:14 36 AM, the police officer walked towards the door to the waiting room where Patient #1 was sitting. The door opened but the police officer did not enter the waiting room and the door was ajar. The video does not show what the police officer was doing. At 4:18:34 AM, the police officer walked out into the waiting area. At 4:18:41 AM, the police officer with sexual assault kit in her hand spoke to Patient #1. Patient #1 was nodding her head. The police officer then handed the sexual assault kit to Patient #1’s Friend. At 4:19:33 AM, Patient #1 and Patient #1’s Friend stood and walked toward the entrance of building to exit. The police officer walked in opposite direction. At 4:19:50 AM, Patient #1 and Patient #1’s Friend got into a car, with Patient #1’s Friend behind the wheel, and departed the property. Review of Patient #1’s emergency department visit summary showed Patient #1 walked in on 3/21/2026 at 4:07 AM with chief complaint of sexual assault. Further review showed no documentation for completion of triage (the sorting of patients as in an emergency room according to the urgency of their need for care) or a Medical Screening Examination for Patient #1. During an interview on 4/7/2026 at 10:00 AM, the Emergency Room Nursing Director stated, “All patients need to have a medical screening examination and even though we do not have a SANE nurse, nurses at both the main and at Live Oak emergency departments can assist the physician to collect samples as needed for the sexual assault kit.” During a telephonic interview on 4/9/2026 at 2:53 PM, Patient #1 stated, “My best friend drove me to the emergency room in Live Oak. I was asked by the receptionist why I was there and I told her I was raped. I also had abdominal pain. She [the receptionist] told me to sit down, and someone would be out to get me in 10-15 minutes. A female cop with long dark hair and dark glasses who I had not seen before came out to the waiting room and stated she did not know why she had to come here since she was not on the case and told me they cannot do a rape kit at Live Oak and I would have to go to Lake City or Gainesville. This is the first time I saw this cop. Two male cops came to the house for me to file the report. I did not see a nurse or a physician. My friend and I got up, and my friend drove me to the Lake City Hospital emergency room. When we arrived at Lake City emergency room, someone must have let them know we were coming because they were expecting us. I was brought right in to be seen by a nurse and then physician. I had an examination, lab work, samples were taken for the kit, and I received medications and discharge instructions for follow up.” During an interview on 4/8/2026 at 10:00 AM, the Medical Director of Emergency Services stated, “All patients need to have MSE completed and the provider should be notified if the patients want to leave before MSE or leave AMA [Against Medical Advice]. Staff should have them sign the AMA form and if they refuse, document the patient’s refusal. All ED providers have completed EMTALA training. We do not have SANE [Sexual Assault Nurse Examiner] but physician and nursing staff are competent to complete the sexual assault kit at both the main and the Live Oak Emergency locations. I was not aware of the patient not having a MSE until the survey. “ During a telephonic interview on 4/8/2026 at 10:26 AM, Staff A, RN, stated, “I never spoke to or was aware of a patient at Suwannee Live Oak Emergency Room. I was getting off orientation at Suwannee. The police officer came in back door and stated I have a rape kit. She wanted to know if we have SANE nurses here. I escalated it to the charge nurse [First name of charge nurse]. The charge nurse let LEO [Law Enforcement Officer) know we can perform kit but do not have a SANE nurse. The officer then said she would speak to the patient. A Medical Screening Exam (MSE) is required for all patients who present to the emergency room.” During a telephonic interview on 4/8/2026 at 6:15 PM, Physician #1 (the emergency room physician on duty when Patient #1 presented for care/treatment) stated, “I was not aware that a patient with a complaint of sexual assault came to the emergency room on 3/21/2026 until [name of the Medical Director of Emergency Services] told me today. Staff had not informed me that there was a patient present who had been sexually assaulted. All patients presenting to the ED need to have an MSE. I feel awful that she was not treated and left. We could have treated her and completed the sexual assault kit. We do not need a SANE nurse to provide care to a patient.” During a telephonic interview on 4/9/2026 at 2:24 PM, Staff B, RN, stated, “I remember well about taking care of the COPD [Chronic Obstructive Pulmonary Disease] critically ill patient in Room 8 at the Live Oak ED. I recall while in the room that [Staff A, RN’s name] was outside of Room 8 with a policewoman who wanted to know if the nurses here are SANE certified and can we do a rape kit. The officer was abrasive. The officer stated, “this is not my case and I do not want to be here.” I did not see and was not aware that a sexual assault patient had presented to the ED. Triage was called over the radio earlier while I cared for my critically ill patient. I believe [Staff D, RN’s name] was in the room with me caring for my patient when the officer came outside the room. I got a text message from the hospital nursing supervisor [name of the supervisor] stating a sexual assault patient came to Lake City because we cannot do the rape kit at Live Oak. I told him that no one told the officer that we do not do rape kits at Live Oak. I was not even aware that we had a sexual assault patient present to the Live Oak ED. At the end of my shift, I got a text message stating that the last shift worked was my last shift. I called [Manager of ED’s name] and [Nursing Director’s name] about the text regarding last shift work is my last. I told them that if it was about the sexual assault patient presenting to Lake City, she was not refused care or turned away and that we can do rape kits at the Live Oak ED and the police officer was told that.” During a telephonic interview on 4/9/2026 at 5:30 PM, the House Supervisor stated, “I was upset that the patient came to the main ED instead of being treated at Live Oak. I did send a message to the charge nurse. The patient should have been treated at Live Oak. We do not have SANE nurses, but we can care for a patient and follow the evidence chain of command without being SANE certified. We were notified that the patient was coming, but I do not know who contacted us. I believe the nurse assisting the physician with the examination let ED nursing management know. All patients need to have an MSE when they present to the ED.””