Owensboro Health Regional 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: 52040 Based on interview, record review, video footage, and review of facility policies, it was determined the facility failed to provide a Medical Screening Examination (MSE) within the capability of the hospital’s emergency department (ED) to determine whether or not an emergency medical condition existed for one (1) of twenty (20) sampled patients. Patient (P) 1 presented to the Obstetrical Emergency Department (OBED) on 01/08/2026 at 3:15 PM requesting to be seen for episodes of lightheadedness and dizziness. The facility failed to provide P1 with an appropriate MSE, the Guest Relations Representative (GRR) told the patient she did not need to be seen in the OBED and turned her away. The findings include: Cross Refer to 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: 52040 Based on hospital policy, interview, video footage and review of the Obstetric Emergency Department (OBED) registration log, it was determined the facility failed to maintain a central log on each individual who came to the OBED seeking assistance and whether she refused treatment, was refused treatment, or whether she was transferred, admitted and treated, stabilized and transferred or discharged. Patient (P) 1 presented to the OBED on 01/08/2026 at 3:15 PM requesting to be evaluated. Interviews revealed P1 left the facility after being told she would not be seen. There was no documented evidence that P1 was entered on the log. The findings include: Review of the video footage (no audio feed) for 01/08/2026, with Director of Accreditation and Senior Manager of Safety & Security present, revealed two (2) females, one (1) which was visibly pregnant, exit the elevator into the OBED at 3:15.04 PM. They wait at the desk until Guest Relations Representative (GRR) 1 appears at the desk at 3:16.53 PM and they are observed to be engaged in conversation. At 3:18.03 PM GRR1 leaves the desk and goes to the “back” while the two (2) females wait. At 3:19.16, GRR1 returns to continue the conversation with the two (2) females. The females leave the desk and enter the elevator, leaving the OBED, at 3:20.10 PM. Review of facility policy, titled “EMTALA - Emergency Medical Treatment”, last revised 08/01/2021, revealed the facility shall retain a central log on each individual who comes to the Emergency Department 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. Review of the OBED Registration Log revealed there is no documentation of time of Triage, time of Medical Screening Exam (MSE), Acuity level, Disposition, or Final Diagnosis included on the Log for P1. In an interview on 01/28/2026 at 2:00 PM with the Manager of Obstetrics/Labor & Delivery, she stated the normal process for patients to be seen in the OBED begins with the Guest Relations Representative (GRR) asking the chief complaint. The patient then fills out an Admission Note (a slip of paper which asks patient demographics, who their doctor is, who their pediatrician is if applicable, due date or date of last menstrual period, and if the pregnancy has been confirmed by a physician). The GRR will then escort the patient to an exam room where the patient may be registered. She stated that the GRR will sometimes talk to a nurse or hospitalist before taking the patient to an exam room to determine if the patient should be seen in the OBED, the main ED, or wait to see their regular physician. It is ultimately the hospitalists’ decision who gets seen, or registered. In an interview on 01/28/2026 at 3:35 PM with Family/Guardian (F)1, she stated P1 never filled out a form of any kind or was registered because she was told “this isn’t an emergency and we won’t see you”. In an interview on 01/29/2026 at 3:25 PM with Hospitalist, she stated she never saw P1 so she would not have been registered.”

“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: 52040 Based on interview, record review, video footage, and review of facility policies, it was determined the facility failed to provide a Medical Screening Examination (MSE) within the capability of the hospital’s emergency department (ED) to determine whether or not an emergency medical condition existed for one (1) of twenty (20) sampled patients. Patient (P) 1 presented to the Obstetrical Emergency Department (OBED) on 01/08/2026 at 3:15 PM requesting to be seen for episodes of lightheadedness and dizziness. The facility failed to provide P1 with an appropriate MSE, the Guest Relations Representative (GRR) told the patient she did not need to be seen in the OBED and turned her away. The findings include: Review of facility policy, titled “EMTALA - Emergency Medical Treatment”, last revised on 08/01/2021 and per Director of Accreditation on 01/29/2026 at 9:00 AM applies to both the Main Emergency Department and the OBED, revealed all patients presenting to the Emergency Department shall receive emergency medical treatment without regard to the patient’s ability to pay. In accordance with EMTALA, patients who “come to the Emergency Department” for treatment must be given an appropriate “Medical Screening Examination” by qualified medical personnel to determine whether they have an “Emergency Medical Condition.” Review of facility policy, titled “Scope of Services for the Obstetrical Emergency Department”, last revised 04/2024, revealed the Obstetrical Emergency Department (OBED) is a locked unit adjacent to the Labor/Delivery unit. The OBED consists of four (4) fully equipped treatment rooms, the OBED nurse’s station and physician office. The OBED delivers care to pregnant patients of all ages with a known pregnancy through 12 weeks post-partum, experiencing uncomplicated, emergency and/or remedial problems associated with pregnancy/post-delivery. The OBED delivers assessment, evaluation, management and treatment that is appropriate and timely, to obstetrical patients with a known pregnancy through 12 weeks post-delivery. The provision of care may begin in the pre-hospital setting (provided by the Emergency Medical Service [EMS]), continues in the OBED, and concludes with responsibility for the patient transferred to the Labor & Delivery Unit, Antepartum unit, another physician, or patient discharge. Review of facility policy, titled “Care of the Obstetrical Triage/Emergency Department Patient”, last revised 10/2023, revealed its purpose is to provide a standardized guideline whereby patients presenting to the OBED are treated based upon acuity system to expedite care for patients. Patients presenting to the OBED will sign in at the OBED desk, be entered into EPIC (an electronic charting system), and a patient identification band shall be applied per hospital policy. Patients with a known pregnancy will be seen in the OBED. Every patient entering the OBED care system shall be triaged and priorities of care shall be determined based on physical and psychosocial needs as well as factors influencing patient flow through the system. Furthermore, a qualified Obstetrical triage nurse will briefly and accurately evaluate all patients based upon urgency of complaints or time of arrival if equal urgency, including, but not limited to chief complaint and clinical status. Additionally, continuous fetal monitoring will be initiated as applicable for pregnancy gestations 24 weeks or greater to evaluate fetal heart rate, variability, presence of periodic and/or episodic patterns, fetal movement and presence of contractions. Review of the facility’s OBED Log for 01/08/2026 revealed P1 was not placed on it, and there was no medical record at Facility 1 (FAC1) for Patient (P)1. Review of the video footage (no audio feed) for 01/08/2026, with Director of Accreditation and Senior Manager of Safety & Security present, revealed two (2) females, one (1) which was visibly pregnant, exit the elevator into the OBED at 3:15.04 PM. They wait at the desk until Guest Relations Representative (GRR) 1 appears at the desk at 3:16.53 PM and they are observed to be engaged in conversation. At 3:18.03 PM GRR1 leaves the desk and goes to the “back” while the two (2) females wait. At 3:19.16, GRR1 returns to continue the conversation with the two (2) females. The females leave the desk and enter the elevator, leaving the OBED, at 3:20.10 PM. In an interview on 01/28/2026 at 2:00 PM with the Manager of Obstetrics/Labor & Delivery she stated that the “normal” process is that patients approach the desk and the Guest Relations Representative asks what is wrong and why they want to be seen. The GRR will then complete an admission note. GRR will escort the patient to an exam room and get their height and weight. She also stated that normally the hospitalist will see the patient immediately. If the patient is there for a condition deemed not related to pregnancy by the hospitalist, such as short of breath or chest pain, the patient will be taken to the Main Emergency Department. She further stated that there is capability to monitor the baby while in the main Emergency Department if needed. Additionally, she stated the GRR will talk to the Hospitalist, possibly before completing an admission note, and it is the Hospitalist who will determine who will be seen, or if the patient should be taken to the Main Emergency Department. In an interview on 01/28/2026 at 3:00 PM with Guest Relations Representative (GRR) 1, she stated she has worked in current position for about three (3) years. EMTALA to her means that no one is turned away and training is received annually. Her memory of the complaint encounter is that a patient and friend came in wanting an ultrasound, but stated she had no complaints. She stated the friend told her that at the last scan, the baby had been breach and they wondered if it still was. She went to the back and told the Hospitalist who said that was something that she needed to see a regular provider for. The Hospitalist told GRR1 to give the patient names of some local obstetric doctors. She stated when she returned to the waiting area, they did not want the names and left. In an interview on 01/28/2026 at 3:35 PM, Family/Guardian (F)1 stated she transported her friend to the OBED because she was having dizzy spells and was light-headed. They were concerned because she was over 39 weeks pregnant and had not been seen by an obstetric doctor for about 20 weeks because she had moved from out of state and was having trouble establishing care. She stated they told that to the “receptionist” (GRR) and asked for her to be seen because they were worried. The GRR told them that wasn’t an emergency, but she would go ask a nurse. When the GRR returned, they were told she asked the doctor who said she would not see them. She stated the GRR tried to give us a list of doctor names my friend could call. She additionally stated “all we wanted was the bare minimum, like vital signs, and to make sure the baby was okay”. When questioned, the complainant stated the word ultrasound was never used by herself, the patient, or the GRR. In an interview on 01/29/2026 at 3:25 PM with the Obstetric Hospitalist, she stated she is contracted through the Obstetrics Hospitalist Group (OBHG) and had received EMTALA training through that group. She did not remember if the training was once or annually. She stated after a patient is registered and triaged by the nurse, that she will see them. She stated she does not document the time she sees a patient. Additionally, she stated the OBED will see anyone with a confirmed pregnancy unless it is more a “medical” issue than “obstetric” issue. If the complaint was medical, the patient would be seen in the Main Emergency Department. When asked if she had a memory of the allegation, she confirmed she never saw the “would be patient”. She remembered GRR1 came to the back and told here there was “someone here requesting an ultrasound for presentation with no other complaints”. She stated she told GRR1 to tell them unless there were other problems or concerns, they could be seen in a doctor’s office.”