St Bernard Parish 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: 26351 Based on record reviews and interviews, the hospital failed to be in compliance with 42 CFR §489.20 (l) of the provider’s agreement which requires hospitals comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases as evidenced by: 1. Failure of the facility to determine an emergency condition existed for 1 (#14) of 20 (#1-#20) patients prior to releasing the patient from the emergency department (see findings A-2406). 2. Failure to document informed consent of the patient, or a legally responsible person acting on the patient’s behalf, in writing of the risks and benefits of the transfer specific to each patients condition for 1 (#20) of 20(#1-#20) reviewed patients that were transferred to a higher level of care (see findings A-2409).”

“POSTING OF SIGNS CFR(s): 489.20(q) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to post conspicuously in any emergency department or in a place or places likely to be noticed by all individuals entering the emergency department, as well as those individuals waiting for examination and treatment in areas other than traditional emergency departments (that is, entrance, admitting area, waiting room, treatment area) a sign (in a form specified by the Secretary) specifying the rights of individuals under section 1867 of the Act with respect to examination and treatment for emergency medical conditions and women in labor; and to post conspicuously (in a form specified by the Secretary) information indicating whether or not the hospital or rural primary care hospital (e.g., critical access hospital) participates in the Medicaid program under a State plan approved under Title XIX. This Standard is not met as evidenced by: 48050 Based on observation and interview, the hospital failed to ensure signs were posted conspicuously in places likely to be noticed by all individuals entering the emergency department (ED) specifying the rights of individuals under section 1867 of the Emergency Medical Treatment and Active Labor Act (EMTALA), with respect to examination and treatment for emergency medical conditions and women in labor, and to post conspicuously information indicating whether or not the hospital participated in the Medicaid program under a State plan approved under Title XIX. The deficient practice is evidenced failure of the hospital to post EMTALA signage in the ambulance entrance and ED entry way from a public hallway that leads to other hospital departments. Findings: On 10/09/2025 between 12:30 PM to 1:00 PM, a tour of the emergency department with S5EDD was conducted. The tour revealed there was no EMTALA signage in the following entryways to the emergency department: “ Ambulance Entrance “ ED entry way from a public hallway that leads to other hospital departments. In an interview on 10/09/2025 at 12:50 AM, S5EDD verified there was no EMTALA signage in the ambulance entrance to the emergency department and entry way from public hallway that leads to other hospital departments. S5EDD verified both were potential points of entry into the emergency department by patients in need of care.”

“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: 48050 Based on record reviews and interviews, the hospital failed to ensure all patients who presented to emergency department (ED) had an appropriate medical screening exam. This deficient practice is evidenced by failure of the facility to determine an emergency condition existed for 1 (#14) of 20 (#1-#20) patients prior to releasing the patient from the emergency department. Patient #14 Review of Patient #14’s medical record revealed Patient #14 presented to the ED on 09/22/2025 at 7:21 PM with documented chief complaint was right sided abdominal pain that started after eating, vomiting multiple times within the last hour, and had 2 seizures. It is documented Patient #14 further revealed she was currently 31 weeks pregnant and had not felt baby move since pain began. Review of Patient #14’s current medications included Lamictal 25mg 2 tablets by mouth daily. There was no documentation by the provider if the patient was compliant with this medication or when the last dose was taken. Review of the ED Provider’s physical examination revealed the following abdominal assessment: Abdomen soft. Bowel sounds are normal. She exhibits no distention and no mass. There is abdominal tenderness (RUQ and RLQ). There is guarding. There is no rebound. Further review of the ED Provider’s physical examination documentation failed to reveal a pelvic examination was performed on Patient #14. The ED Provider documented Patient #14’s clinical diagnoses of decreased fetal movement and right lower quadrant abdominal pain (Primary). Review of the diagnostic testing revealed the ED provider ordered a bedside ultrasound for fetal movement and noted the cervix was not seen. There was no attempt to evaluate the patient for the presence of contractions. On 09/23/2025 at 1:00 AM, Patient #14 was transferred to another facility for further OB-GYN evaluation and treatment. On 10/08/2025 at 11:45 AM, an interview was conducted with S5EDD who verified the above mentioned information. S5EDD also verified there was no cervical examination performed and the cervix could not be seen on ultrasound. S5EDD verified the facility does not have a tocodynometer to evaluate for possible contractions.”

“APPROPRIATE TRANSFER CFR(s): 489.24(e)(1)-(2) (1) General If an individual at a hospital has an emergency medical condition that has not been stabilized (as defined in paragraph (b) of this section), the hospital may not transfer the individual unless - (i) The transfer is an appropriate transfer (within the meaning of paragraph (e)(2) of this section); and (ii)(A) The individual (or a legally responsible person acting on the individual’s behalf) requests the transfer, after being informed of the hospital’s obligations under this section and of the risk of transfer. The request must be in writing and indicate the reasons for the request as well as indicate that he or she is aware of the risks and benefits of the transfer. (B) A physician (within the meaning of section 1861(r)(1) of the Act) has signed a certification that, based upon the information available at the time of transfer, the medical benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweigh the increased risks to the individual or, in the case of a woman in labor, to the woman or the unborn child, from being transferred. The certification must contain a summary of the risks and benefits upon which it is based; or (C) If a physician is not physically present in the emergency department at the time an individual is transferred, a qualified medical person (as determined by the hospital in its bylaws or rules and regulations) has signed a certification described in paragraph (e)(1)(ii)(B) of this section after a physician (as defined in section 1861(r)(1) of the Act) in consultation with the qualified medical person, agrees with the certification and subsequently countersigns the certification. The certification must contain a summary of the risks and benefits upon which it is based. (2) A transfer to another medical facility will be appropriate only in those cases in which - (i) The transferring hospital provides medical treatment within its capacity that minimizes the risks to the individual’s health and, in the case of a woman in labor, the health of the unborn child; (ii) The receiving facility (A) Has available space and qualified personnel for the treatment of the individual; and (B) Has agreed to accept transfer of the individual and to provide appropriate medical treatment. (iii) The transferring hospital sends to the receiving facility all medical records (or copies thereof) related to the emergency condition which the individual has presented that are available at the time of the transfer, including available history, records related to the individual’s emergency medical condition, observations of signs or symptoms, preliminary diagnosis, results of diagnostic studies or telephone reports of the studies, treatment provided, results of any tests and the informed written consent or certification (or copy thereof) required under paragraph (e)(1)(ii) of this section, and the name and address of any on-call physician (described in paragraph (g) of this section) who has refused or failed to appear within a reasonable time to provide necessary stabilizing treatment. Other records (e.g., test results not yet available or historical records not readily available from the hospital’s files) must be sent as soon as practicable after transfer; and (iv) The transfer is effected through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures during the transfer. This Standard is not met as evidenced by: 48050 Based on record review and interview, the hospital failed to ensure the appropriate transfer of patients requiring a higher level of care. The deficient practice is evidenced by failure to document informed consent of the patient, or a legally responsible person acting on the patient’s behalf, in writing of the risks and benefits of the transfer specific to each patients condition for 1 (#20) of 20(#1-#20) reviewed patients that were transferred to a higher level of care. Findings: Review of Patient #20’s medical record revealed Patient #20 presented to the ED for 37 weeks pregnant with abdominal pain and decreased fetal movement on 10/04/2025. The Chief Complaint was documented as “Abdominal Pain- This is a 22 year old female currently 37 weeks and 4 days pregnant presenting to the emergency department for abdominal cramping and contractions that have been ongoing since yesterday. States that contractions or [sic] about 10 minutes apart. Denies any leakage of fluid. Reports decreased fetal movement. Has had OB follow up and presents here for further evaluation.” Vital sign on presentation were blood pressure-115/63, pulse-81 beats per minute, respirations-16 per minute, temperature 97.2 degrees Fahrenheit and pulse oxygenation-99 %. Patient #20 was triaged as an ESI level 3. Review of the medical record revealed the provider performed a physical examination which included a cervical examination and noted the cervix to be closed. Fetal heart tones were documented as 127 beats per minute, and a bedside ultrasound showed “good fetal movement.” The evaluation did not include a biophysical profile, a modified biophysical profile, a non-stress test, amniotic fluid index, or Doppler velocimetry to ensure fetal wellbeing related to the complaint of decreased fetal movement. Further review of the medical record revealed the ED physician documented, “Does not appear patient is in active labor. I offered ambulance transfer to Hospital B but patient states that she would prefer to drive herself. Discussed risks of self transfer including labor EN route. Patient verbalized understanding. Was given the address for [receiving hospital named] and discharged. I put in a transfer request to speak to OB to inform them that patient was EN route.” The ED physician documented the disposition for Patient #20 as,” transfer to another facility for further evaluation.” Further review of Patient #20’s medical record did not reveal an accepting MD at the receiving hospital and did not reveal a physician certification of transfer or a transfer consent or explaining specific risks and benefits of transfer other than labor in route. Patient #20 left the ED via private vehicle. ED Provider documented Patient #20’s diagnosis and disposition as “abdominal cramping affecting pregnancy requiring a higher level of care. Transfer for OB transfer evaluation which we do not have here.” In interview on 10/08/2025 at 9:30 AM, S5EDD verified the facility did not provide obstetrical services and fetal heart tones were verified by Doppler or ultrasound. S5EDD verified the facility did not have a tocodynometer with a fetal heart rate monitor for evaluation of pregnant patients who present with complaints of contractions. S5EDD also verified the patient was considered a transfer and there were no consents for transfer, other than the documentation in the physician note described above and verified there was no documentation the receiving hospital was contacted and a receiving physician accepted the transfer.”