Dr Dan C Trigg Memorial 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: 49844 Based on observation, record review and interview the facility failed to meet the Emergency Medical Treatment and Labor Act (EMTALA) to ensure EMTALA signs were posted, failed to have a Central log with all patients presenting to the Emergency department, and failed to ensure a medical screening examination was done all patients that present to the Emergency Department. This deficient practice is likely to lead to poor outcomes related to patients not being evaluated when seeking medical care. A.The facility failed to have required signs posted. Refer to tag 2402. B. The facility failed to have all patients presenting to the emergency department on the Emergency Deparment central log. Refer to tag 2405. C. The facility failed to provide a Medical screening examination. Refer to tag 2406.”

“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: 49844 Based on observation and interview the facility failed to have an EMTALA sign posted in the Ambulance entrance area where patients presenting to the emergency department can visualize the sign. This deficient practice is could possibly lead patients to not knowing their right to receive emergency care when entering the hospital via ambulance truck. The findings are: A. During an observation on 08/14/24 at 12:30 PM of the ambulance entrance area, the ambulance entrance area did not have an EMTALA sign posted. B. During an interview on 08/14/24 at 12:47 PM with Staff (S)1, Non-clinical staff member, when asked if there was an EMTALA sign posted where patients can see when entering the ambulance area S1 confirmed an EMTALA sign was not posted.”

“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: 49844 Based on record review and interview the facility failed to have an accurate central log by failing to have 1(P (patient) 1) out of 20 (P1-P20) patients who presented to the emergency department requesting medical care on their central log. This deficient practice could possibly to lead to an inaccurate central log and untracked patients being refused emergency care. The findings are: A. Record review of the facility’s policy titled EMTALA Central log dated 03/05/2021, stated “Each hospital must maintain a central log to track the care provided to each individual who comes to the hospital seeking care for an emergency medical condition.” B. Record review of the facility’s policy titled “Patient access - EMTALA - Registration Policy” dated 09/25/2023 stated “All hospital staff, including registration personnel and clinical staff, shall refrain from making any remarks that the patient might interpret to mean services may not be provided based on the individuals ability to pay.” C. Record review of the facility’s central log revealed that P1 was not registered as a patient at the hospital on 06/25/24. D. During an interview with P1 on 08/15/24 at 3:37 PM, P1 confirmed that she went to the facility’s emergency room on the early morning of June 25th, 2024. P1 had an emergency medical condition. P1 was asked the reason for presenting to the emergency room, P1 explained that she was pregnant and was “leaking fluid”. P1 explained that she was only 35 weeks pregnant (which indicates a premature delivery). P1 explained that she was told by Staff (S)6, clinical staff member, “There is nothing here for pediatrics . . . There is nothing here for babies.” P1 explained that she wanted to be transferred but that the hospital told her she would have to pay upfront before being transferred because she did not have insurance. P1 explained that she then had her baby on this same day while enroute via ambulance to another hospital and that her baby was five weeks premature. E. During an interview on 08/15/24 at 2:30 PM, with S1 clinical staff member, when asked if P1 was registered patient. S1 stated “She was not registered on that visit correct”. Confirming that P1 came to the hospital emergency department and was not placed on the central log.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) and 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: 49844 Based on record review and interview the facility failed to provide a medical screening examination (MSE) that ensured there is no emerency medical condition present for 2 (P[patient P3 and P10) out of 20 (P1-P20) patients being reviewed. This deficient practice is likely to lead to patients being discharged from the emergency department with an untreated emergency medical condition. The findings are: A. Record review of the facility’s policy titled “Patient Access - EMTALA - Registration Policy” dated 09/25/23 under section “Procedure” stated “ Any individual who presents to a [Name of hospital] emergency room and requests an examination or treatment for a medical condition is entitled to an MSE [medical screening examination] regardless of their ability to pay”. B. Record review of P3’s medical record under arrival information revealed P3 presented to the emergency department on 06/14/24, with a pregnancy problem. Under “Assessment & Plan” revealed a provider note that indicated the patient is having a miscarriage with a note that stated “Quant hCG [lab test to check for pregnancy] is dropping probably will need an ultrasound to confirm [sic]. Apparently we do not have ultrasound at this facility”. This indicated that P3 needed an ultrasound, but the facility does not have ultrasound services available. The providers examination also does not include a pelvic examination to rule out ectopic pregnancy, determine if there is ongoing vaginal bleeding from the cervix, or if there is adnexal tenderness present. C. Record review of P10’s medical record under care timeline revealed that P10 arrived to the emergency room on 07/28/24 at 5:35 PM. Under the providers note it stated “. . . presents to the ED [emergency department] with complaint of wasp bite to his right index finger, patient has very mild erythema [redness/inflammation] and mild edema [swelling] otherwise there is no reaction present he denies any respiratory symptoms or difficulty swallowing [sic].” P10 was discharged on 07/28/23 at 6:20 PM and vital signs were not obtained for this patient to check for decreased oxygen levels or increased or decreased respirations (breaths per minute). The providers note also does not indicate the time or when the wasp sting occured. D. During an interview on 08/16/24 at 5:00 PM with S7, Clinical staff member, when asked if it is possible to rule out an Emergency Medical Condition without a set of vital signs S7 stated “No you should have vital signs”. When asked if a patient presented with a wasp or hornet sting and there is a concern about airway (breathing) would a set of vital signs be necessary, S7 explained that a whole set of vital signs is important.”