Northern Light Maine Coast 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: 09447 Based on document reviews and interviews, the hospital failed to follow their policy and provide a medical screening examination within the capability of the hospital’s Emergency Department for a patient who was seeking care on 4/15/2025. (Patient #1) Findings: The Northern Light (NL) Maine Coast Hospital policy titled, ‘Emergency Treatment and Transfer Rules Policy’, last revised 4/1/2024, stated in part...”POLICY AND PROCEDURE I. HOSPITAL DUTY WITH RESPECT TO EMERGENCY MEDICAL CONDITION If an individual Comes to the Emergency Department, then the hospital must provide a Medical Screening Examination...” NL Maine Coast Hospital brochure titled, ‘Patient Rights and Responsibilities’ stated in part, “...As a Northern Light Health patient, you have the right to safe, respectful, and dignified care. While you are here, you will receive hospital services and care that are medically appropriate and in accordance with the Northern Light Health stated mission, the capabilities of the Northern Light Health system, and all applicable laws and regulations...” On 04/18/2025, Northern Light Maine Coast Hospital self-reported a possible EMTALA violation stating, in part, “It has come to the attention of Northern Light Maine Coast Hospital (MCH) leadership that the 15-year-old individual named above presented with his parents to the MCH Emergency Department on 4/15/2025 at approximately 5:30 PM and, prior to being registered, departed the Emergency Department approximately 10 minutes after arrival. The patient presented to the Emergency Department at the instruction of his primary care provider following a CT scan that revealed concern for a ruptured appendicitis. It is our understanding that, upon presenting to the MCH Emergency Department, the parents of the patient spoke with a hospital employee and the employee informed the family that the patient would need to wait to be seen and would need to be transferred to another hospital to receive necessary treatment. The mother of the patient asked the employee if they should stay at MCH to be seen or proceed directly to the other hospital. The employee responded that he could not advise the family whether to stay or go but reiterated that it would be a long wait and the patient would ultimately need to be transferred to another hospital. On 5/6/2025 at 10:26 AM, an interview was conducted with the ED Nurse Manager regarding her involvement in the alleged EMTALA violations. She stated that she first became aware on 4/16/2025 when she received an email from the Compliance Officer. She stated that the email asked her to look into what occurred on 4/15/2025 with [Patient #1]. She stated that she spoke with the Patient Access person, and the Certified Nursing Assistant.. She stated that [the Patient Access person] said that the family and the patient were waiting to register when the[Certified Nursing Assistant] came to the registration desk to get some papers. She stated that the [Patient Access person] said that the [Certified Nursing Assistant] informed them (patient’s family) that the wait to be seen was about three (3) hours and probable the patient would be transferred to another hospitalanyway. She stated that it really isn’t clear if the Mom asked how long the wait would be or if the [Certified Nursing Assistant] just volunteered that information. She stated that the Emergency Department (ED) was very busy that day between 5 PM and 8 PM. On 5/6/2025 at 1:00 PM, an interview was conducted with the [Certified Nursing Assistant], regarding 4/15/2025. He was asked if he worked that day and he stated yes. He was asked if he remembered a patient coming in from a physician’s office and he stated yes. He stated it was a 15-year-old and he took the call from the Nurse Practitioner (NP) in the patient’s provider’s office. The NP told him that the recent CT Scan showed a ruptured appendix. He stated that he then went to the triage nurse to tell her that patient was coming in. He stated that everyone, the nurses and all, were saying that the patient would have to go to another hospital anyway. He stated that he went out to reception to pick up some papers and this family standing there asked him how long the wait would be. He stated that he told them he couldn’t give them information or medical advice. He stated that the family and the patient left. He was asked if he received EMTALA training and he stated yes thru HealthStream yearly. On 5/6/2025 at 1:11 PM, an interview was conducted with the [Patient Access person], regarding 4/15/2025. She was asked if she worked the evening of 4/15/2025 and she stated yes. She was asked if she remembered a young patient and their family coming to her desk to register. She stated yes. She stated that she was in the process of finishing registering another patient and had to tell the mother of that patient that she would have to wait until she finished the current registration. She stated that she does not remember why the [Certified Nursing Assistant] was at the registration desk where she was. She was asked if there were people in the waiting room and she stated it was full. She stated that she doesn’t know if it was the young child’s Mom who asked the [Certified Nursing Assistant] how long the wait would be or if it was the [Certified Nursing Assistant] who volunteered that information. She stated that she does recall that the [Certified Nursing Assistant] stated that the patient would have to go to Bangor anyway. She stated that she heard the father state loudly, “Come on let’s go”. She was then asked if she registered the young patient and she stated no, they all left before she could do that. Northern Light Maine Coast Hospital identified the potential violation, self-reported the event, and put in measures to ensure that the Emergency Department staff would not deter a patient in the future from seeking care. These measures included the following: The Emergency Department Nurse Manager sent an email to all Emergency Department staff reviewing the EMTALA regulations and the responsibilities of the staff. Additionally she provided scripting of what to say in certain circumstances regarding EMTALA was provided. Counseling was held with the Certified Nursing Assistant involved. Mandatory EMTALA training was to be provided to all Emergency Department Staff and the Patient Access staff with a deadline of May 31, 2025 for completion. As of 5/7/2025 all Patient Access staff had completed the mandatory reeducation related to EMTALA. As of 5/7/2025 approximately 54.5% of the Emergency Department Staff had completed the mandatory reeducation related to EMTALA. At the time of the on-site survey, surveyors determined, through observation, document reviews, and interviews, that Northern Light Maine Coast Hospital was in compliance, but previously out of compliance with 42 CFR, Part 489, Responsibilities of Medicare Participating Hospitals in Emergency Cases.”

“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: 09447 Based on review of documentation and interviews, the facility failed to provide an appropriate medical screening examination at the facility’s Emergency Department (“ED”) on 04/15/2025. (Patient #1) Findings: The Northern Light Maine Coast Hospital policy titled, ‘Emergency Treatment and Transfer Rules Policy’, last revised 4/1/2024, stated in part...”POLICY AND PROCEDURE I. HOSPITAL DUTY WITH RESPECT TO EMERGENCY MEDICAL CONDITION If an individual Comes to the Emergency Department, then the hospital must provide a Medical Screening Examination...” On 04/18/2025, Northern Light Maine Coast Hospital self-reported a possible EMTALA violation stating, in part, “It has come to the attention of Northern Light Maine Coast Hospital (MCH) leadership that the 15-year-old individual named above presented with his parents to the MCH Emergency Department on 4/15/2025 at approximately 5:30 PM and, prior to being registered, departed the Emergency Department approximately 10 minutes after arrival. The patient presented to the Emergency Department at the instruction of his primary care provider following a CT scan that revealed concern for a ruptured appendicitis. It is our understanding that, upon presenting to the MCH Emergency Department, the parents of the patient spoke with a hospital employee and the employee informed the family that the patient would need to wait to be seen and would need to be transferred to another hospital to receive necessary treatment. The mother of the patient asked the employee if they should stay at MCH to be seen or proceed directly to another hospital. The employee responded that he could not advise the family whether to stay or go but reiterated that it would be a long wait and the patient would ultimately need to be transferred to another hospital. On 5/6/2025 at 10:26 AM, an interview was conducted with the ED Nurse Manager regarding her involvement in the alleged EMTALA violations. She stated that she first became aware on 4/16/2025 when she received an email from the Compliance Officer. She stated that the email asked her to look into what occurred on 4/15/2025 with [Patient #1]. She stated that she spoke with the [Patient Access person], and the [Certified Nursing Assistant]. She stated that [the Patient Access person] said that the family and the patient were waiting to register when the[Certified Nursing Assistant] came to the registration desk to get some papers. She stated that the [Patient Access person] said that the [Certified Nursing Assistant] informed them (patient’s family) that the wait to be seen was about three (3) hours and probable the patient would be transferred to another hospitalanyway. She stated that it really isn’t clear if the Mom asked how long the wait would be or if the [Certified Nursing Assistant] just volunteered that information. She stated that the Emergency Department (ED) was very busy that day between 5 PM and 8 PM. On 5/6/2025 at 1:00 PM, an interview was conducted with the [Certified Nursing Assistant], regarding 4/15/2025. He was asked if he worked that day and he stated yes. He was asked if he remembered a patient coming in from a physician’s office and he stated yes. He stated it was a 15-year-old and he took the call from the Nurse Practitioner (NP) in the patient’s provider’s office. The NP told him that the recent CT Scan showed a ruptured appendix. He stated that he then went to the triage nurse to tell her that patient was coming in. He stated that everyone, the nurses and all, were saying that the patient would have to go to another hospital anyway. He stated that he went out to reception to pick up some papers and this family standing there asked him how long the wait would be. He stated that he told them he couldn’t give them information or medical advice. He stated that the family and the patient left. He was asked if he received EMTALA training and he stated yes thru HealthStream yearly. On 5/6/2025 at 1:11 PM, an interview was conducted with the [Patient Access person], regarding 4/15/2025. She was asked if she worked the evening of 4/15/2025 and she stated yes. She was asked if she remembered a young patient and their family coming to her desk to register. She stated yes. She stated that she was in the process of finishing registering another patient and had to tell the mother of that patient that she would have to wait until she finished the current registration. She stated that she does not remember why the [Certified Nursing Assistant] was at the registration desk where she was. She was asked if there were people in the waiting room and she stated it was full. She stated that she doesn’t know if it was the young child’s Mom who asked the [Certified Nursing Assistant] how long the wait would be or if it was the [Certified Nursing Assistant] who volunteered that information. She stated that she does recall that the [Certified Nursing Assistant] stated that the patient would have to go to Bangor anyway. She stated that she heard the father state loudly, “Come on let’s go”. She was then asked if she registered the young patient and she stated no, they all left before she could do that. Northern Light Maine Coast Hospital identified the potential violation, self-reported the event, and put in measures to ensure that the Emergency Department staff would not deter a patient in the future from seeking care. These measures included the following: The Emergency Department Nurse Manager sent an email to all Emergency Department staff reviewing the EMTALA regulations and the responsibilities of the staff. Additionally she provided scripting of what to say in certain circumstances regarding EMTALA was provided. Counseling was held with the Certified Nursing Assistant involved. Mandatory EMTALA training was to be provided to all Emergency Department Staff and the Patient Access staff with a deadline of May 31, 2025 for completion. As of 5/7/2025 all Patient Access staff had completed the mandatory reeducation related to EMTALA. As of 5/7/2025 approximately 54.5% of the Emergency Department Staff had completed the mandatory reeducation related to EMTALA. At the time of the on-site survey, surveyors determined, through observation, document reviews, and interviews, that Northern Light Maine Coast Hospital was in compliance, but previously out of compliance with 42 CFR, Part 489, Responsibilities of Medicare Participating Hospitals in Emergency Cases.”