Shoshone Medical Center

“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: 49416 Based on medical record review, policy review, and patient and staff interview, it was determined the facility failed to ensure emergency services were provided in compliance with 42 CFR Part 489.24: Responsibilities of Medicare Participating Hospitals in Emergency Cases. Refer to A - 2406 as it relates to the facility’s failure to provide an appropriate MSE for 1 of 20 patients (Patient #12) whose records were reviewed. Noncompliance with 42 CFR Part 489.24 had the ability to negatively affect all patients who presented to the ER seeking emergency care.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) and 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: 49416 Based on staff interview and review of policies and medical records, it was determined the hospital failed to ensure a complete medical screening exam was provided to 1 of 20 patients (#12), who had an emergency medical condition and whose records were reviewed. This had the potential for patient’s condition to deteriorate and suffer complications without proper treatment. Findings include: The policy “Stabilization and Transfer of Patient to Outside Facilities,” revised 4/28/2021, stated “Medical Screening Examination: Individuals coming to the emergency department must be provided a Medical Screening Examination appropriate to the individuals’ presenting signs and symptoms. ... The MSE must be the same MSE that the hospital would perform on any individual coming to the hospital’s dedicated emergency department with those signs and symptoms.” This policy was not followed. An example included: Patient #12 was a 14-year-old female who presented to the ED on 9/20/25 at 4:30 PM with chief complaint of abdominal pain with recent bladder infection. Patient #12’s medical record included labs ordered which included a pregnancy test and STI panel. Patient#12’s medical decision making note documented, “She was found to have a positive urine pregnant test. Because of a false positive, I checked a qualitative hCG and it is 619. Her urinalysis shows both pyuria and hematuria. ... I did of course inform the patient’s mother of the positive pregnancy test and the hCG. She politely asked that I do not discuss this pregnancy issue with her daughter and I certainly respect that. Unfortunately, we do not have ultrasound services available on the weekends. ... Therefore, we will be sending her to the emergency department at [hospital with higher level of care]. ... The patient’s mother very politely emphasized the strong desire for her to take her daughter by private vehicle to their emergency department. I think that is reasonable in this scenario.” Patient #12’s medical record documented a completed EMTALA transfer form and indicated patient left in private vehicle with a saline lock intact. The ED Physician was interviewed via phone on 11/5/25 beginning at 2:00 PM and Patient #12’s record was reviewed. The ED Physician stated he wanted Patient #12 to be transferred to a higher level of care to rule out an ectopic pregnancy and his facility did not have access to an ultrasound at the time of visit. When asked if the patient should have been informed of the pregnancy the ED Physician reported that it was unclear under Idaho law if a physician was allowed to disclose that information when the parent was requesting it not be provided. Medical records were obtained from the receiving hospital and Patient #12 informed the receiving hospital’s providers that she had been bleeding for the last several days and eventually found to be having a miscarriage. Additionally, Patient #12 had presented to the ED with her father at the receiving hospital on 8/29/25 and was informed of her pregnancy at that visit. A MSE was not completed for Patient #12 as she was not informed of her pregnancy nor given the opportunity to discuss presenting symptoms or complications, including bleeding status or possible other sources of abdominal pain, at time of ED visit and private vehicle transfer.”