Donalsonville Hospital Inc.

“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: 42305 Based on review of medical records, policies and procedures, and interviews, it was determined the facility failed to provide an appropriate medical screening exam for one Patients (P) #1 of 20 (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#11, P#12, P#13, P#14,P#15, P#16, P#17, P#18, P#19, P#20) patients reviewed that sought treatment in the facility’s emergency department (ED). P#1 presented to Donalsonville Hospital (Hospital A) the ED on 5/5/24 with complaints of bilateral (both) knee and lower back pain and was discharged home with a diagnosis of a left femur fracture. The medical screening examination was inappropriate and failed to include an evaluation of P#1’s complaints of right knee pain and lower back pain. Additionally, the hospital failed to consult with an outside facility where Orthopedic consultation was available for further evaluation and treatment of patient #1’s severe fracture to her left femur (thigh bone) prior to discharging the patient. Cross reference to A 2406 as it relates to the facility’s failure to provide an appropriate medical screening examination.”

“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: 42305 Based on review of medical records, policies and procedures, and interviews, it was determined the facility failed to provide an appropriate, ongoing medical screening exam for one patient (P #1) of 20 (P#1, P#2, P#3, P#4, P#5, P#6, P#7, P#8, P#9, P#10, P#11, P#12, P#13, P#14, P#15, P#16, P#17, P#18, P#19, P#20) patients reviewed who came to Hospital A’s Emergency Department (ED) seeking treatment. P#1 presented to the ED with complaints of low back and bilateral (both) knee pain because of a fall. The medical screening examination lacked appropriate work up including ancillary services to rule out an emergency medical condition related to the complaints of right knee pain and lower back pain. Additionally, the hospital failed to consult with an outside facility where Orthopedic consultation was available for further evaluation and treatment of Patient #1’s severe identified fracture to her left femur (thigh bone) prior to discharging the patient. Findings include: The “Emergency Triage and Physician Record” timed 1:08 p.m. revealed that P#1 arrived by EMS (Emergency Medical Services) with a chief complaint of lower back pain and bilateral (both) knee pain after a fall. The “Physical Exam” by the Medical Doctor (MD) DD at 2:29 p.m. revealed that P#1 had left knee effusion (swelling) that was tender, painful, with limited range of motion. There was no documentation in the medical record to indicate that Patient #1’a right knee was examined, and no imaging performed to the right knee to rule out an emergency medical condition of the right knee fracture. As this resulted in an inappropriate medical screening examination. Review of orders by the MD DD on 5/5/14 at 2:47 p.m. revealed verbal orders for lumbar (lower)spine and left knee. Review of radiology reports failed to reveal a spinal x-ray or any radiology other than the Left knee. Further review of the section titled “Procedure Information” revealed that there was an x-ray of the left knee at 5:21 p.m. for Patient #1. The radiology impression included comminuted fracture of the femur (a severe injury of the thigh bone breaks into 3 or more pieces, cause by trauma like severe falls and car accidents: requiring surgical interventions to repair bones; inability to walk)., knee effusion (abnormal accumulation of excess fluid inside or around the knee); bones were osteopenia (bones are weaker than normal), diffuse soft tissue swelling, and degenerative changes of the knee. “Discharge/Admission Information” revealed that P#1 was discharged in stable condition at 6:10 p.m. with a pain scale of 2/10. P#1 verbalized understanding of discharge instructions. Review of “Aftercare Instructions to the Patient” by the Licensed Practical Nurse (LPN BB) at 7:24 p.m. revealed in part, “General instructions: ...OTHER INSTRUCTIONS: Please follow-up with ortho (Orthopedic) in the morning. Ice and elevated left leg,” P#1 was given a prescription for crutches and discharged with discharge information, the x-ray report, a brace for the knee, and orthopedic contact information. The medical record for Patient #1 from Hospital B was reviewed. Review of the medical record the section titled “HPI (History of Present Illness) revealed that Patient #1 presented to Hospital B via Emergency Medical Services, date of service on 5/6/24 at 6:24 PM. The patient’s chief complaint was listed as Hypoglycemia (low blood sugar level) and was found unresponsive at home. The patient was admitted to Hospital B. The Emergency Department physician documented in part, Physical Examination revealed in part, “Neurological: Mental Status: she is alert. Comments: ..Lower extremities were difficult to evaluate because she was having pain in both lower extremities and can not raise either leg off the bed.” Continued review revealed the reason for an Orthopedic Consult was “Bilateral distal femur (lower part of the thigh bone) fractures.” Further review revealed in part, “The patient stated she fell over the weekend and injured bilateral knees with left greater that right. She went to an outside hospital and was told they were fractured.” The Orthopedic consult physician documented in part, ...Physical Exam: ...Musculoskeletal: Comments: Pain with ROM (Range of Motion) bilateral legs.” ...ASSESSMSNT/PLAN: ...54-year-old female with left intra-articular distal femur fracture as well as right nondisplaced distal femur fracture (a small non-displaced crack in the thigh bone just above the knee joint, often caused by falls) after tripping in a hole 3 days prior. She will require ...definitive fixation of her left distal femur fracture ...will plan to make patient NPO (Nothing by mouth) at midnight and plan for surgery tomorrow.” Review of the facility’s policy titled “EMTALA/COBRA Procedure” reviewed 9/24/25, revealed that any individual who came to the hospital and requested examination or treatment for a medical condition would be provided an appropriate medical screening examination within the capability and capacity of the hospital’s emergency department to determine whether an emergency condition existed or not. The screening requirement encompassed the use of ancillary services routinely available to the emergency department. If it was determined that no emergency medical condition existed, there was no mandate for the hospital to provide further treatment. If it was determined the individual did have an emergency medical condition, the hospital would either provide further examination and treatment required to stabilize the condition or transfer the individual to another medical facility. Once the patient was stabilized, the patient could be transferred or discharged. An interview took place with LPN BB on 12/9/25 at 2:12 p.m. LPN BB said P#1 refused to go to x-ray because of pain. The doctor was notified, and pain medication was ordered. The pain medication was not effective, so LPN asked the doctor for something different. A telephone interview took place with the ED Medical Doctor (MD) DD on 12/10/25 at 12:50 p.m. MD DD did not remember P#1. MD DD said in general it would have been safer to transfer a patient with a comminuted femur fracture versus splinting and discharging. The facility failed to ensure that their policy and procedure was followed as evidenced by failing to provide an appropriate medical screening examination by failing to examine Patient #1’s right knee, despite the patient complaining of bilateral knee pain status post a fall. The facility also failed to transfer Patient #1 to an outside facility for an Orthopedic consult for further evaluation and treatment of the identified severe fracture to her left femur on 5/5/24.”