HCA Florida Putnam 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: 49444 Based on medical record review, review of policies and procedures, staff interviews, and review of the document titled “Recap of Conversation with patient’s mother (Pt. #1) regarding the EMTALA event.”, it was determined the facility failed to ensure that an individual who was brought to the hospital’s emergency department received an appropriate medical screening examination with in 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 1 (Pt. #1) of 23 sampled patients. Patient #1 presented to the Emergency Department (ED) with a chief complaint of vomiting and weakness for four days. The facilities emergency department had the capability and the capacity to conduct an appropriate medical screening examination. Findings: Cross Refer to tag - A2406: Medical Screening Examination”

“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: 49444 Based on review of the central log, interviews, video footage, and policy and procedure review, the facility failed to maintain a central log on each individual who comes to the emergency department seeking assistance for 1 (Pt.#1) of 23 sampled patients. Patient #1 presented to the check-in/triage window of the emergency department with a chief complaint of vomiting and weakness for four days was not documented on the central log. Findings include: Review of video surveillance footage dated 11/30/2025, starting at time marker of 1:18 PM showed three people entering the Emergency Department (ED) entrance. One was a female, and one was male who was holding a male child. The child was 15 months old. The three people went to the check-in/triage window that was located directly in front of them upon entrance to the emergency room. The couple with the child were observed to exit the ED on 11/30/2025 at 1:21 PM. Review of the hospital central log dated 11/30/2025 does not document Patient #1 as having presented to the hospital seeking medical assistance. The policy and procedure titled “Florida - EMTALA Medical Screening Examination and Stabilization Model Policy” PolicyStat ID 16922161, Effective 6/17/2024, Approved 6/17/2024 was approved. The policy read, in part page 10 of 14,” d. Documentation of Unannounced Leave... All individuals presenting for evaluation or treatment must be entered into the Central Log.” During an interview on 12/11/2025 at 10:45 AM Staff A, RN (Registered Nurse) stated, “I remember the mother, the father, and the child who needed to be seen for vomiting for a few days and he had become weak. She [the mother] was concerned that there would be a long wait because the waiting room was full when they walked in. They left here stating they were traveling to [Name of another hospital] because they had a pediatrician on staff there. I know I should have logged the patient in the central log, but I didn’t because I didn’t get a name or date of birth. I shut down the record the moment she walked away.” During an interview on 12/11/2025 at 11:25 AM the Chief Nursing Officer (CANO) stated, “There is no record for him [Patient #1] ...on 11/30/2025. The patient’s name should have been documented on the log even if they didn’t want services. Any patient who presents to the ER should be documented on the central log.” During an interview on 12/11/2025 at 12:05 PM the Director of Emergency Services stated, “All patients requesting services are to be documented in the central log upon arrival at the facility. The patient should have his name, the chief complaint, the date and time of arrival and his disposition status all documented in the central log. His name is not on the log but should have been.” During an interview on 12/12/2025 at 10:30 AM the Emergency Department Manager stated, “ ... The patient should have been documented on the central log even though they were not wanting to stay for the triage or for the medical exam the doctor would have provided ... “ The facility failed to ensure that their own policy and procedure was followed as evidenced by failing to ensure that on 11/30/2025, that Patient #1, who presented to the hospital’s ED seeking medical assistance was entered into the facility’s Central Log.”

“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: 49444 Based on medical record review, review of policies and procedures, staff interviews, and review of the document titled “Recap of Conversation with patient’s mother (Pt. #1) regarding the EMTALA event.”, it was determined the facility failed to ensure that an individual who was brought to the hospital’s emergency department received an appropriate medical screening examination with in 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 1 (Pt. #1) of 23 sampled patients. Patient #1 presented to the Emergency Department (ED) with a chief complaint of vomiting and weakness for four days. The facilities emergency department had the capability and the capacity to conduct an appropriate medical screening examination. Findings include: Review of the facility’s policy titled “Florida- EMTALA Medical Screening Examination and Stabilization Model Policy” PolicyStatID 1692261, Effective 6/17/2024, Approved 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, ...requests emergency services and care ... 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 (Emergency Medical Condition) exists ...3.4 Who May Perform the MSE: i. A qualified licensed physician with appropriate privileges; ii. Other qualified licensed independent practitioner (LIP) with appropriate competencies and privileges.” Review of policy and procedure titled, “Triage and Admission into the Emergency Department, 780100” PolicyStatID 1081006, Effective 12/1/2006, Approved 5/9/2022 read in part, “ Policy: All patients will be evaluated by an RN [Registered Nurse]. The assessment will be documented to include any initial intervention. The acuity level will be established, following written guidelines established by the Emergency Nurses Association. We use Emergency Severity Index (ESI a 5 level, standardized algorithm used in emergency departments, to triage patients based on acuity (severity) and anticipated resource needs. It enables rapid sorting of patients, ensuring immediate care are prioritized) version four (ESI v5)”. The medical record from the hospital where Patient #1 was taken to was reviewed. The medical record revealed the patient and his parents arrived at the hospital’s ED on November 30, 2025, at 2: 05 PM. Patient #1’s Chief complaint was listed as “Vomiting (Vomiting since Thursday). The patient was triaged at 2:14 PM as an ESI level 4 (conditions that are semi-urgent and not immediately life threatening). Physician’s orders were placed for the following test RSV ( Respiratory Syncytial Virus - a test used to see if RSV is the cause of moderate to severe cold symptoms in infants, older adults ...), FLU ( Influenza- test used to detect antigens to confirm influenza infection) A and B, Covid (test detects SARS-CoV-2 virus, determining if you have a current infection by analyzing samples from the nose and mouth) nasal swabs. All tests came back negative. Intravenous (IV) fluid Normal Saline and laboratory blood work was ordered. No IV line or fluids were started because it was difficult to obtain.. All of the laboratory blood work came back within normal limits. Ultrasound (non-invasive diagnostic imaging that uses high-frequency sound waves to produce real-time moving images of internal organs, tissues and blood flow), KUB (Kidneys, Ureters, and Bladder- test is a diagnostic imaging study, usually an X-ray used to examine the urinary system and surrounding abdominal structures), and chest x-rays were ordered; all tests were also negative. Further review revealed that at 5:13 PM the patient tolerated 4 oz of apple juice by mouth. At 5:22 PM Patient #1 was “discharged home with Zofran (medication used to treat nausea and vomiting) called into Pharmacy. Diagnosis of acute vomiting. Follow-up with PCP (Primary Care Physician) in 1-2 days as needed.” Review of documentation titled, “Recap of Conversation with patient’s (Pt. #1) mother regarding EMTALA event. Date of Call: December 3, 2025. Time of Call: 1612 [4:12 PM]. Mother’s name: [Name documented]. Patient/Child’s Name: [Name of child]. Original ED Visit: November 30,2025 at 1305 [1:05 PM]. On December 3, 2025, at 1612, [4:12 PM], I spoke with the mother of patient [Name of child] regarding her experience during their visit to the Emergency Department on November 30, 2025 at approximately 1305 [1:05 PM]. [Name of mother] reported the following: When she arrived with her child, she stated the ED appeared to be very busy. She approached the front window but did not immediately see anyone present. A staff member eventually came to the window, opened it, asked what she needed, and [Name of mother] explained that her child had been vomiting since Thursday and was weak. According to [Name of mother], the staff member told her, ‘We don’t have pediatrics here. Do you know where [Name of a facility] is. [Name of mother] then asked whether the wait would be long to have her child seen at our facility. Per her account, the staff member looked into the lobby and told her, ‘Do you see all these people here? They all have to be seen first, so it will be after them.’ The staff member then showed her the address for [Name of hospital] and advised her to drive there. [Name of mother] states the nurse told her to drive carefully and go straight there. She reported that she rode in the back seat with her child on the way to the other facility because she was worried. Upon arrival at [Name of hospital] she stated her child was seen immediately, taken straight back, and received medication. She confirmed the child is now doing well and back home. During our conversation, I apologized for her experience and clarified that all of our Emergency Department providers are fully trained to care for pediatric patients through geriatric patients. I informed her that we are always available and more than willing to care for her child should they require medical attention in the future.” During an interview on 12/11/2025 at 11:25 AM the Chief Nursing Officer (CNO) stated, “ There is no record for him [Patient #1] because the patient was not treated in the facility on 11/30/2025 ...” During an interview on 12/12/2025 at 10:30 AM the Emergency Department Manager stated, “All patients who enter the facility or who are on facility property and requests services get services. No one is refused care ... We had the capabilities and adequate staff to see this patient at the time of the patient’s arrival.” The facility failed to ensure that their policies and procedures were followed as evidenced by failing to ensure that an appropriate medical screening examination was provided by a qualified medical personnel, which was within the capability of the hospital’s Emergency Department. Additionally, no triage or vital signs were performed for Patient #1 on 11/30/2025. .”