HCA Florida Memorial 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: 42310 Based on medical record reviews, staff interviews, Facility self-report letter review, and policy review, it was determined, the hospital failed to ensure if an individual who comes to the emergency department 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 existed for one (Patient #1) of 20 patients sampled seeking treatment. Refer to findings in Tag A2406.”

“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: 42310 Based on review of the facility’s self-report letter, staff interviews, video surveillance review, Policy review, and Electronic Central Log review, it was determined, the hospital failed to maintain a central log on each individual who comes to the emergency department, seeking assistance and whether he or she refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for one (Patient #1) of 20 patients sampled. The findings included: Review of the facility’s Self-Report letter dated 2/11/2026 submitted to CMS (Center for Medicare and Medicaid Services) revealed in part, that patient #1 was a 16-year-old female pediatric patient who arrived at HCA Florida Memorial Emergency Department on Saturday February 7, 2026, accompanied by her father, after reportedly ingesting 11 ibuprofen (medication used to relieve pain, reduce fever, and inflammation) tablets. Further review revealed the father and patient left HCA Florida Memorial Emergency before being entered into the HCA Florida Memorial Hospital Emergency visit log. A review of the video from 2/7/26 at 12:59 AM to 1:11 AM. Father brings daughter (Pt. #1) in and is seen looking at his phone. He picks up the pen and begins to write on the sign-in-sheet when the nurse comes out and a conversation ensues. He then starts walking away with his daughter at the end of the conversation and exits the ER. A review of the Facility’s Electronic Central Log dated February 7, 2026, failed to reveal that central log containing information was maintained for patient #1 . The facility’s Central Log Policy , PolicyStatID 18603815 Effective 6/9/2009, last revised 2/12/2025 was reviewed. The policy revealed in part, A review of the facility’s Central Log Policy revealed in part, “.Policy: The hospital will maintain a Central Log containing information on each individual who request 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 left before a medical screening examination (MSE) could be performed, whether he or she was transferred, admitted and treated, stabilized and transferred or discharged.” On 02/19/26 at 2:10 PM an interview was conducted with Employee A, ED Registered Nurse. She confirmed she was the staff member who spoke to the father on 2/7/26. She confirmed the chain of events. She confirmed that the patient was not placed into the central log. On 2/20/26 at 9:30 AM an interview was conducted with the Chief Nursing Officer (CNO). He confirmed the patient was not placed into the central log. The facility failed to ensure that their policy was followed as evidenced by failing to maintain a Central Log for Patient # 1 when presented to the hospital’s ED with her father who believed she needed examination and treatment for a medical condition on 2/7/2026.”

“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 reviews, staff interviews, Facility self-report letter review, and policy review, it was determined, the hospital failed to ensure that an individual who comes to the emergency department 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 existed for one (Patient #1) of 20 patients sampled seeking treatment. The findings included: The facility’s Policy titled “Florida EMTALA Medical Screening Examination And Stabilization Policy”, PolicyStat ID 17759195, Effective 3/20/2019, Last Revised 3/20/1019 was reviewed. The policy revealed in part, “Policy: An EMTALA obligation is triggered when: 1. an individual or a representative acting on the individual’s behalf, including EMS (Emergency Medical Services) or a transferring hospital, request emergency services and care; ... Procedure: When an MSE 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.” A review of the facility’s Self-Report letter dated 2/11/2026 submitted to CMS revealed in part, that patient #1 was a 16-year-old female pediatric patient who arrived at HCA Florida Memorial Emergency on Saturday February 7, 2026, accompanied by her father, after reportedly ingesting 11 ibuprofen tablets. Security notified the triage nurse that the father had questions before checking her in. The nurse observed the patient standing behind her father and appearing in no visible distress. The nurse informed him that, due to the reported ingestion, the patient required an emergency screening examination and that she would need medical evaluation prior to any transfer, as the facility did not provide pediatric psychiatric services. The father and patient left HCA Florida Memorial Emergency Department prior to receiving a Medical Screening Examination. The facility later learned they presented to the local children’s hospital. The medical record for Patient #1 from the local children’s hospital was reviewed. Review of the Pediatric Psychiatry Discharge Note dated 2/12/2026 at 8:27 a.m. was reviewed. Further review revealed the patient was admitted to the facility on 2/8/26 with diagnosis listed as Severe episode of recurrent major depressive disorder, without psychotic features and generalized anxiety disorder. The patient was discharged on 2/12/2-26. On 2/19/26 at 1:53 PM a telephone interview was conducted with Employee B, Emergency Medicine Medical Doctor. He confirmed he was working the night of the event. He stated the nurse mentioned that a dad asked about his kid who took ibuprofen. I was not aware they were here and left. He confirmed an MSE was never performed on the patient. On 2/20/26 at 9:10 AM during a telephone interview with the Security Officer who was present in the ED on 2/7/2026. He stated the father came in with the daughter. He said he wanted to check his daughter in for a Baker Act. I went and got the nurse. I let the nurse discuss it with him because I am not allowed to know protected health information. He also stated that he did hear her ask if he was ready to check in and I don’t remember him saying anything. He just left. On 2/20/26 at 9:30 AM an interview was conducted with the Chief Nursing Officer (CNO). He confirmed the patient was not assessed and was not provided with an MSE.”