Concord Hospital- Laconia

“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: 47129 Based on interview and record review, it was determined that the hospital’s dedicated Emergency Department (ED) failed to comply with the requirements for the Emergency Medical Treatment and Labor Act (EMTALA) at 42 CFR §489.20 (Patient identifier is #1). Findings include: The hospital failed to provide an appropriate medical screening examination to an individual who presented to the hospital campus ED for 1 of 20 patients reviewed for presenting to the ED between 10/14/24 to 12/3/24. (Refer to C2406: Medical Screening Exam).”

“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: 47129 Based on record review and interview, the hospital failed to provide an appropriate medical screening examination (MSE) to an individual who presented to the hospital campus of the emergency department (ED) for 1 of 20 patients reviewed for presenting to the ED between 10/14/24 to 12/3/24 (Patient identifier is #1). Findings include: Interview on 11/21/24 at approximately 10:23 a.m. with Patient #1 revealed that he/she was in a motor vehicle accident on 11/11/24. Patient #1 stated that he/she went to the Concord Hospital Laconia Emergency Department on 11/11/24 to seek treatment and was refused treatment because of his/her service dog. Review on 12/4/24 of the facility’s form titled “Patient Acknowledgement of Departure Prior to Completion of Medical Evaluation and Treatment - Leaving without being seen”, dated 11/11/24, and signed by Staff A (Registrar) revealed the following: “...Explanation/reason patient left: Other (explain): Patient had “Companion Service Dog”, no identifiers of animal - left due to possibly not being able to be seen...” Review on 12/4/24 of Patient #1’s nursing note, dated 11/11/24, and signed by Staff C (Registered Nurse) revealed the following: “...Pt presents to registration with his leashed dog. States [pronoun omitted] was in a rollover car accident and has left shoulder pain. Dog is stated to be a service animal, does not have any vests/patches, ect [sic]. I advised [pronoun omitted] that security may not allow the dog in at which point [pronoun] started yelling that that’s illegal, is [pronoun omitted] serious? I can’t believe you are refusing to see me after an accident” and stormed out. Lead made aware.” Interview on 12/4/24 at 11:25 a.m. with Staff B (Director of Nursing) confirmed the above findings. Interview further revealed that Staff B had called Patient #1 the next day and Patient #1 was treated at another hospital’s emergency department on 11/11/24. Interview on 12/4/24 at 1:48 p.m. with Staff A revealed that Staff A had told Patient #1 that his/her dog needed to be cleared by security first before he/she would be seen. Patient #1 got angry and left the emergency department. Interview on 12/4/24 at 12:56 p.m. with Staff D (Director of Compliance) revealed that the above events were discussed at the organization’s compliance meeting on November 25, 2024, no corrective action was put in place. Review on 12/4/24 of the facility’s policy and procedure titled, “EMTALA [Emergency Medical Treatment and Active Labor Act] - Medical Screening Examination and Patient Transfer Policy”, effective 2/21/2-24, revealed the following: “4.1 Medical Screening Examination”, 4.1.1 Any individual who comes to... Concord Hospital - Laconia... Emergency Departments... requesting examination or treatment shall be provided with an appropriate medical screening examination by a QMP [Qualified Medical Provider].””

“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: 47129 Based on interview and record review, it was determined that the hospital’s dedicated Emergency Department (ED) failed to comply with the requirements for the Emergency Medical Treatment and Labor Act (EMTALA) at 42 CFR §489.20 (Patient Identifier #1). Findings include: The hospital failed to ensure appropriate transfers for 1 of 20 emergency room records reviewed. Refer to C2409: Appropriate Transfer.”

“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: 43002 47129 Based on interview and record review, it was determined that the hospital failed to send medical records related to the emergency condition available at the time of transfer for 1 of 20 patients reviewed presenting to the Emergency Department (ED) (Patient Identifier #1). Findings include: Review on 10/14/24 of Patient #1’s medical record revealed that Patient #1 arrived at the ED by private vehicle and was admitted to the ED on 9/1/24 at 8:04 p.m. with hip pain (with redness and swelling). The patient was seen by multiple providers during the ED stay, including an orthopedic consult done on 9/2/24 at 9:01 a.m. Laboratory testing and a Computed Tomography (CT) scan were performed. The patient was started on antibiotics and other medications during the course of the ED visit. Review on 10/14/24 of Patient’s #1’s “Notice of Risks and Benefits and Physician’s Certificate to Transfer” revealed that the form was signed by the Ambulance Service on 9/2/24 at 11:01 a.m. Review of the “EMS [Emergency Medical Services] Prehospital Incident Report...”, dated 9/2/24 revealed that the patient arrived at the receiving hospital on 9/2/24 and care of the patient was transferred at 12:07 p.m. Interview 10/16/24 at 9:50 a.m. with Staff M (EMS Coordinator) from the receiving hospital revealed that Staff M accepted the transfer of care from the ambulance service. Staff M stated that the ambulance service was given a transfer form but denied being given any medical records from the sending hospital at the time of transfer. Staff M called the sending hospital to request medical records. Interview on 10/16/24 on 11:45 a.m. with Staff N (Emergency Medical Technician) from the transportation company revealed that Staff N provided all the documentation that was given to him/her from the sending hospital to the receiving hospital. Interview on 10/14/24 at 1:00 p.m. with Staff A (Risk Manager) from the sending hospital revealed that he/she was notified by the receiving hospital on 9/4/24 that Patient#1 had been transferred without medical records. Staff A confirmed that Patient #1’s medical record was faxed to the receiving hospital after the patient had arrived there. Interview on 10/14/24 at approximately 2:30 p.m. with Staff C (Director of Compliance) revealed that they were aware of the above incident, but since the records had been sent to the receiving hospital, they did not believe there was any corrective actions necessary.”