Merit Health Natchez

“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: 45467 Based on staff interview, medical record review, and policy and procedure review, the facility (Hospital #1) failed to provide an appropriate Medical Screening Exam (MSE) to an individual who presented to the emergency department to determine if an Emergency Medical Condition (EMC) existed. This deficient practice affected one (1) of 20 medical records reviewed (Patient #1) and had the potential to affect all individuals presenting to the emergency department seeking care. The facility also failed to take reasonable steps to have the individual or legally responsible person sign a Leaving Against Medical Advise/Refusal of Care (AMA) form and provide education on the risk and complications if not treated for one (1) of 20 medical records reviewed, Patient #1. Findings Include: Medical records review for Patient #1, aged 5 years, reveals patient presented to Hospital #1 Emergency Department (ED) on 12/01/2025 at 6:58 p.m. via privately operated vehicle escorted by her mother, requesting medical care related to a laceration to left fifth digit (pinky finger) after being caught in a wooden door. Staff documented pain score 10 out of 10 (using pain scale with zero being no pain and 10 being severe pain), and was assigned an Emergency Severity Score of four (4), a radiography (x-ray) was ordered at 7:12 p.m. and not performed prior to 8:50 p.m. when the mother and Patient #1 left the facility. After Triage, Patient #1 was sent to the waiting room. The mother and Patient #1 Left Without Being Seen (LWBS) after waiting approximately two (2) hours without an appropriate Medical Screening Exam (MSE), x-ray, or aid with severe pain. Review of the discharge summary reveals discharge was incomplete, there is no transcribed documented physician discharge summary. Review of ED Nurse Documentation at 8:50 p.m. reveals the ED admission clerk reported that Patient #1 and mother are going to another facility for medical care due to wait time. Review of the ED Encounter Events documented at 9:19 p.m. indicate Patient #1 eloped/left after triage. Patient #1 was not informed of risks or benefits if not treated. Review of the facility’s policy, Emergency Medical Treatment and Active Labor Act (EMTALA), Version 6, original date 12/01/1998, review/revision date 07/14/2022, published 07/14/2022, reveals “ ...Capacity refers to the ability of the hospital to accommodate the individual requesting examination or treatment ...(EMTALA) ... Medical Screening Exam (MSE) ...determined whether or not an emergency medical condition exists ...Triage ...is not the equivalent of an MSE and does not determine the presence or absence of an emergency medical condition ...Documentation When Patient Leaves Without Being Seen, Against Medical Advice, Without Notifying Hospital Staff ...If a patient informs the ED Registration staff that s/he is leaving prior to receiving an MSE, ED staff should obtain the patient’s signature, date and time, on an “AMA” or “Refusal of Care” form, indicating that they have been informed of the risks of leaving ...receiving stabilizing treatment ...staff should document the circumstances ...triage nurse takes and documents vital signs, along with any relevant observations, and assigns ...an acuity level ...”. An interview on 01/20/2026 at 3:37 p.m. with the Director of Risk confirmed the facility does not have documentation of an incident report for the failure to complete an MSE or to obtain a refusal of care and educate on the risks and benefits of leaving before treatment for Patient #1, or improvement projects related to the facility’s failure to follow its policy and procedures. An interview with Registered Nurse (RN) #1 on 01/21/2026 at 11:22 a.m. confirmed RN #1 was the nurse who provided a triage assessment on Patient #1 when presented to the ED with a laceration to a finger. RN #1 could not confirm the size, depth, or severity of the laceration and confirmed incomplete documentation of the triage assessment in the ED medical record for Patient #1. Review of the facility’s policy and procedure, Emergency Room Documentation, version 2, Publish date 06/05/2025, reveals “ ...documents assessment findings, medication ...intervention ...subsequent assessment ...findings ...patient disposition ...accurate ...concise ...”. During exit conference on 01/29/2026 at 1:15 p.m. with the Chief Nursing Officer, Emergency Department Director, Chief Quality Officer, Executive Assistant, Director of Risk, Vice President of Nursing Operations, Director of Quality and Compliance, and Regional Director of Emergency Services, survey findings were discussed, and no further documentation was submitted for review. 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: 45467 Based on staff interview, medical record review, review of the Medical Staff Rules and Regulations, and facility policy and procedure’s review, the facility failed to provide an appropriate Medical Screening Exam (MSE) by a qualified individual to determine if an emergent medical condition exist for a patient who presented to the facility requesting assistance with a laceration to left fifth (5th) digit (pinky finger) after being caught in a wooden door and reporting severe pain which resulted in the patient leaving the facility before a medical screening exam was performed for one (1) of 20 medical records reviewed, Patient #1. Findings Include: An interview with Registered Nurse (RN) #1 on 01/21/2026 at 11:22 a.m. confirmed RN #1 was the nurse who provided a triage assessment on Patient #1 when patient presented to the Emergency Department (ED) with a laceration to a finger. RN #1 could not confirm the size, depth, or severity of the laceration and confirmed incomplete documentation of the triage assessment on Patient #1 ED medical record. RN #1 also confirmed no pain relief medication was ordered or administered to Patient #1 for pain documented as 10 out of 10 on a pain scale of zero to 10, with zero being no pain and 10 being severe pain. An interview with Nurse Practitioner (NP) #1 on 01/21/2026 at 11:53 a.m. confirmed an MSE for Patient #1 was not provided during ED visit on 12/01/2025. Review of ED medical record at Hospital #1 for Patient #1, aged, 5 years, reveals patient presented to the facility’s Emergency Department (ED) on 12/01/2025 at 6:58 p.m. via privately operated vehicle, escorted by her mother, requesting medical care related to a laceration to left pinky finger after being caught in a wooden door. Vital signs obtained; blood pressure 132/67, pulse 92, respirations 22, oral temperature 98.2, oxygen level 100 percent (%) on room air, weight 48 pounds, pain score 10 out of 10 and was assigned an Emergency Severity Score four (4). A radiography (x-ray) was ordered at 7:12 p.m. and not performed prior to 8:50 p.m. when mother and patient left the facility. After Triage Patient #1 was sent to the waiting room. The mother and Patient #1 Left Without Being Seen (LWBS) after waiting approximately two (2) hours without an appropriate Medical Screening Exam (MSE), x-ray, or aid with severe pain. Review of the discharge summary reveals discharge was incomplete, there is no transcribed documented physician discharge summary. Review of ED Nurse Documentation at 8:50 p.m. reveals the ED admission clerk reported that Patient #1 and the mother are going to another facility for medical care due to wait time. Review of the ED Encounter Events documented at 9:19 p.m. indicate Patient #1 eloped/left after triage. Patient #1 was not informed of risks or benefits of remaining at Hospital #1’s ED for evaluation. Review of Patient #1’s medical record from Hospital #2 reveals, Patient #1 arrived at Hospital #2’s Emergency Department on 12/01/2025 at 9:18 p.m. via privately operated vehicle, escorted by her mother. Patient #1’s chief complaint is a laceration to the left fifth digit (pinky finger) after it was slammed in a door. Review confirms a laceration to the top left fifth digit (pinky finger) at side of the nail with partial amputation of the left fifth digit, painful to touch, with bleeding controlled. A MSE was performed at 9:20 p.m. and revealed a moderate laceration to the left pinky finger that does not reveal bone deformity. Review of the facility’s policy, Emergency Medical Treatment and Active Labor Act (EMTALA), Version 6, original date 12/01/1998, review/revision date 07/14/2022, published 07/14/2022, reveals “ ...Capacity refers to the ability of the hospital to accommodate the individual requesting examination or treatment ...(EMTALA) ... Medical Screening Exam (MSE) ...determined whether or not an emergency medical condition exists ...Triage ...is not the equivalent of an MSE and does not determine the presence or absence of an emergency medical condition ...Documentation When Patient Leaves Without Being Seen, Against Medical Advice, Without Notifying Hospital Staff ...If a patient informs the ED Registration staff that s/he is leaving prior to receiving an MSE, ED staff should obtain the patient’s signature, date and time, on an “AMA” or “Refusal of Care” form, indicating that they have been informed of the risks of leaving ...receiving stabilizing treatment ...staff should document the circumstances ...triage nurse takes and documents vital signs, along with any relevant observations, and assigns ...an acuity level ...”. Review of the facility’s Medical Staff Rules and Regulations with revision dated 2/2023, reveal “ ...A provisional diagnosis for emergency admission shall be provided as promptly as possible ...”. During exit conference on 01/29/2026 at 1:15 p.m. with the Chief Nursing Officer, Emergency Department Director, Chief Quality Officer, Executive Assistant, Director of Risk, Vice President of Nursing Operations, Director of Quality and Compliance, and Regional Director of Emergency Services, survey findings were discussed, and no further documentation was submitted for review. Cross refer to A2400.”