Meadowview Regional 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: 46710 Based on interview, record review, review of Apple Maps data, and review of the facility’s policies, the facility (FAC) 1 failed to provide an appropriate medical screening exam (MSE) within the capability of the hospital’s emergency department (ED) for one (1) of 22 sampled patients, Patient (P) 1. P1, who was 21 weeks gestation, presented to the obstetric triage in the Emergency Department (ED) at FAC 1 to be evaluated for cramping. Facility staff failed to ensure an appropriate MSE was conducted before sending P1 to walk over to the obstetric clinic (FAC) 2, which was located approximately 670 feet from FAC 1. The findings included: Prior to the start of the on-site investigation the hospital (FAC) 1 had implemented a corrective action plan. The facility has not had a confirmed EMTALA violation within the past six months. Cross Refer to 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: 46710 Based on interview, record review, review of Apple Maps data, and review of the facility’s policies, the facility (FAC) 1 failed to provide an appropriate medical screening exam (MSE) within the capability of the hospital’s emergency department (ED) for one (1) of 22 sampled patients, Patient (P) 1. P1, who was 21 weeks gestation, presented to the obstetric triage in the Emergency Department (ED) at FAC 1 to be evaluated for cramping. Facility staff failed to ensure an appropriate MSE was conducted before sending P1 to walk over to the obstetric clinic (FAC) 2, which was located approximately 670 feet from FAC 1. The findings include: Review of Apple Maps data revealed Physician 1’s obstetrics office/clinic (FAC 2) was 670 feet from the hospital (FAC 1). Review of the facility’s policy titled, “EMTALA-Medical Screening and Treatment of Emergency Medical Conditions,” effective 07/2025, revealed the facility was to provide an appropriate medical screening examination (MSE) to determine if an emergency medical condition (EMC) existed. Review of the facility’s policy titled, “Triage of Obstetrical Patients,” effective 03/2026, revealed the facility treated patients less than 20 weeks gestation in the dedicated emergency department (ED). Further review revealed the facility sent patients of at least 20 weeks gestation who presented at the ED with an obstetrical condition up to the labor and delivery unit for triage and an MSE. Review of the facility’s policy titled, “Labor Medical Screening Exam,” effective 09/2024, revealed elements of an MSE for a patient greater than 20 weeks pregnant (gestation) included but was not limited to: gravida (number of pregnancies), parity (number of pregnancies carried past 20 weeks), estimated date of confinement (due date), maternal age, chief complaint, prenatal care, vital signs, fetal monitoring, frequency of contractions, status of membranes, and a maternal systems review (head-to-toe assessment). Review of the “Labor and Delivery Patient Log” revealed P1 checked in on 04/27/2026 at 1:40 PM with a chief complaint of cramping. Further review revealed P1 left for the clinic, FAC 2, at 2:00 PM with the MSE marked as “not performed.” Review of P1’s “Labor and Delivery Outpatient Assessment Record,” dated 04/27/2026, revealed P1 denied vaginal discharge, bleeding, gushes of water, and severe pain. Further review revealed Registered Nurse (RN) 1 documented Physician 1 called to say P1 should have presented to the clinic for evaluation and stated, “I need to see her at the office to do some things, to check things out here.” Continued review revealed RN 1 told the provider P1 did not have transportation, and Physician 1 responded, “She can walk over to the office, it’s a pretty day.” Per the record, P1 stated she was okay to walk and left with her significant other. Additional review revealed RN1 failed to perform and document vital signs, vaginal exam findings, fetal heart tones, or a maternal systems review. In an interview on 07/07/2026 at 3:31 PM, RN1 stated she initiated the triage process for P1 by asking her to provide a urine sample. RN1 further stated she did not have time to take vital signs, assess fetal heart tones, or perform any physical assessment before Physician 1 called the unit and asked her to send P1 to the office for a more detailed examination. RN1 stated she felt uncomfortable sending the patient over to the clinic (FAC 2) because P1’s mother had dropped her off, so P1 did not have a car at FAC 1. Per interview, RN1 stated she told P1 what Physician 1 said, and P1 told her she felt okay enough to walk to the clinic since it was so close to the hospital. RN1 stated, though she was trained in EMTALA, she did not consider EMTALA regulations when she sent P1 to FAC 2 because she was focused on P1’s transportation. RN1 stated she should have done a full triage assessment and had Physician 1 do a physical exam at FAC 1 before sending the patient to FAC 2. Additionally, RN 1 stated it was never appropriate for a nurse to perform the MSE if the patient was pre-term in pregnancy; she stated a physician or midwife needed to perform MSEs for those patients. In an interview on 07/07/2026 at 10:23 AM, Physician 1 stated she asked P1 to come to FAC 2 because she knew P1 had a baby less than six months prior to presenting to FAC 1 on 04/27/2026. Physician 1 further stated she was at FAC 2, and she was on call, so she had the labor and delivery census board pulled up on her computer so she could see patients who had checked in at FAC 1. Physician 1 stated her focus on 04/27/2026 was to deliver high quality prenatal care, which included measuring a cervical length, because of P1’s obstetric history. Physician 1 stated the cervical length was not necessary to determine the presence of an emergency medical condition, rather, it was part of routine clinic care to prevent onset of preterm labor. Per Physician 1’s interview, she judged it would be safe to have P1 walk to FAC 2 because the weather was nice and P1 denied severe pain, vaginal discharge, and bleeding. She stated she trusted RN1’s report over the phone that P1 denied those symptoms. Therefore, Physician 1 stated she determined P1 was not experiencing an emergency medical condition, even though no one had physically assessed P1. In an additional interview on 07/09/2026 at 11:07 AM, Physician 1 stated she had not received training on EMTALA prior to 04/27/2026. She stated she believed EMTALA was a financial non-discrimination law, and she was not aware that MSEs were required under EMTALA. She stated, at the time P1 presented to the hospital, Physician 1 did not think asking P1 to come to FAC 2 was a problem because she was not aware that FAC 2 and FAC 1 were separate entities, since all the obstetricians at FAC 2 had privileges at FAC 1, and FAC 1 only had obstetricians from FAC 2. In an interview on 07/09/2026 at 4:43 PM, the Director of Women’s Services (DWS) stated RN1 notified her late in the evening on 04/27/2026 of Physician 1 asking her to send P1 FAC 2 before the MSE was complete. The DWS stated she told RN1 this was a likely EMTALA violation. The DWS stated RN1 told her she did not have EMTALA in mind when she sent P1 out, only that she was worried about P1 walking to FAC 2. The DWS further stated she did not understand why RN1 sent P1 to FAC 2 when RN1 was uncomfortable with it. Per the DWS, she was in her office, which was next to the nurse’s station, when P1 presented. She stated however, RN1 did not notify her of Physician 1’s request or that RN1 was hesitant to send P1 on foot to FAC 2. The DWS stated she reported the incident to the hospital CEO the next morning and immediately began re-educating her nurses on EMTALA obligations and the importance of ensuring a qualified medical professional (QMP) performed an appropriate MSE before allowing a patient to leave the hospital. In an interview on 07/10/2026 at 1:29 PM with Physician 2, the Chair of Obstetrics, who contacted the State Survey Agency (SSA) Surveyor, she stated she was not involved in P1’s care on 04/27/2026 and could not provide further information on the case. She further stated she had not received any training on EMTALA and how it applied to obstetrics. Physician 2 stated she expected nurses to notify physicians when an unscheduled patient presented for evaluation. Physician 2 stated physicians were to provide all MSEs for obstetric patients greater than 20 weeks gestation. In an interview on 07/09/2026 at 2:18 PM, the Chief Nursing Officer (CNO) stated she expected facility staff to fulfill EMTALA obligations by ensuring each patient who presented to the emergency department or obstetric triage window received an MSE. She further stated she investigated P1’s care on 04/27/2026 and found Physician 1 called the obstetric unit as RN1 was triaging P1. She stated when Physician 1 asked for staff to send P1 to FAC 2, RN1 should have said Physician 1 needed to come to FAC 1 to perform an MSE before P1 could be safely discharged to go to FAC 2 for additional evaluation. The CNO stated the culture at FAC 1 was physician-driven, and nurses tended to trust what the physicians told them to do. Per interview, the CNO stated, in this case, RN1 should have escalated her concerns to the DWS or reminded Physician 1 that an unscheduled OB patient was subject to EMTALA requirements, including the need for an MSE. In an interview on 07/09/2026 at 6:03 PM, the Chief Executive Officer (CEO) stated the DWS called her first thing in the morning on 04/28/2026 and told her of a likely EMTALA violation involving P1. She further stated the management team, including the legal department, determined the facility needed to report the incident because of the facility’s failure to perform an MSE. The CEO stated her expectations were for FAC 1 to always follow policies, including those related to EMTALA. Plan of Correction Validation Review of the facility’s policy titled, “Labor Medical Screening Exam,” effective 06/2026, revealed it was updated from a previous version. The review revealed the new policy clearly delineated roles for specially qualified RNs to perform MSEs for patients at least 37 weeks gestation without further concerns. Further review revealed the provider was to perform all other MSEs timely. In interviews with OB nurses RN1, RN2, RN5, and RN6, they all stated they received education about EMTALA following the incident with P1. In interviews with Physician 1 and Physician 2, they both stated they received training on the EMTALA policy after the incident with P1. They further stated they knew it was important for each patient to get an MSE when they presented to the ED or OB unit for an unscheduled examination. In interviews with RN3, RN4, and Physician 5, they all stated they received recent and frequent training about EMTALA obligations, and it was important for each patient who presented to the ED to receive an MSE. In an interview, the Director of Women’s services (DWS) stated she immediately began re-educating nurses that EMTALA required every patient who presented needed an MSE. She also stated she updated the form of their EMTALA log to serve as a visual reminder that the date, time, and practitioner for the MSE needed to be on the log. She stated she updated the “Labor Medical Screening Exam” policy, to take effect 06/2026, to include the clarification that RNs could only perform MSEs for patients who were at least 37 weeks gestation and had no other concerns beyond evaluation for active labor. She further stated the investigation into P1’s care on 04/27/2026 revealed confusion between the physicians and nurses on who was responsible for MSEs. Per interview, this was always their practice, but the DWS and management team believed it was important to clarify it in the policy. In an interview, the Medical Staff Coordinator stated the facility had not previously verified completion of trainings assigned to physicians in the facility’s online training portal. She further stated verification of completion of EMTALA trainings would now be part of their credentialing process for physicians every two years. In an interview, the CNO stated the DWS re-educated all nursing staff and worked with Physician 2 to ensure all physicians were re-educated on the facility’s processes for fulfilling EMTALA obligations. She further stated the management team re-enforced with staff that they should escalate any patient care concerns to their nurse manager. In an interview, the CEO stated the facility re-evaluated their EMTALA processes and provided education where necessary, in this case with the OB physicians and nurses. She stated it was important for staff to follow the facility’s policies for patient safety. Additionally, she stated the facility was in the process of writing the EMTALA process for OB into the medical bylaws.”