Union 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: 42015 Based on interview, review of the Emergency Department (ED) logs, review of the facility Emergency Medical Treatment and Labor Act (EMTALA) transfer forms, medical record review, review of the Emergency Medical Service (EMS) run report, and facility policy review, the facility failed to comply with 489.24 when the facility failed to properly screen, document, and adequately transfer Patient #1. This affected one patient (Patient #1) out of 20 Patients reviewed for EMTALA. The facility census was 71. Findings include: 1. Based on interview, review of the Emergency Department (ED) logs, Review of the facility Emergency Medical Treatment and Labor Act (EMTALA) Transfer Forms, medical record review, review of the Emergency Medical Service (EMS) run report, and facility policy review, the facility failed to document Patient #1 on the ED log. This affected one Patient (Patient #1) out of 20 Patients reviewed for ED services. See A2405 for example. 2. Based on interview, review of the Emergency Department (ED) logs, Review of the facility Emergency Medical Treatment and Labor Act (EMTALA) Transfer Forms, medical record review, review of the Emergency Medical Service (EMS) run report, and facility policy review, the facility failed to ensure documentation that Patient #1 was appropriately screened prior to being transferred to another hospital. This affected one Patient (Patient #1) out of 20 Patients reviewed for ED services. See A2406 for example.”

“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: 42015 Based on interview, review of the Emergency Department (ED) logs, Review of the facility Emergency Medical Treatment and Labor Act (EMTALA) Transfer Forms, medical record review, review of the Emergency Medical Service (EMS) run report, and facility policy review, the facility failed to document Patient #1 on the ED log. This affected one Patient (Patient #1) out of 20 Patients reviewed for ED services. Findings include: Review of Patient #1’s ambulance run report dated 11/11/25 revealed emergency medical services (EMS) arrived on the scene at 3:42 A.M. and EMS arrived with the patient to Hospital A’s emergency room at 4:28 A.M. The report indicated they arrived at another Emergency Department (Hospital B) at 6:09 A.M. The report revealed the medic was called for a one car (flipped) accident. The patient was a 13-year-old female passenger of the vehicle. The patient was self-extricated after the fire department removed the doors. EMS placed the patient in a cervical collar (a neck brace used to support and immobilize the neck after an injury (like whiplash or fractures) or for chronic conditions, preventing further damage by limiting head movement) out of an abundance of caution. The patient was alert and oriented times four. Her pain was a four [on a scale of one to ten, ten being the worst]. The patient report was called to Hospital A where EMS explained that the mother was being flown by helicopter at their helicopter pad. While calling the report, the doctor asked why the ambulance was taking the patient to Hospital A to instead of continuing north to a hospital in Akron. EMS stopped at Hospital A where Physician (Staff D) came into the ambulance and stated the mother wanted her child transported [to Akron] to be with her. The patient did not complain of any head back or neck pain. The patient had a scrape on her right eye, her right wrist hurt, and her left ankle hurt on the top. Hospital C was contacted and stated they could not take pediatric patients, and the patient needed to go to Hospital B where they took pediatric patients. EMS called in report to Hospital B’s trauma team. The trauma team also questioned why the patient was transported to their facility rather than to Hospital A. Continued review of the documents revealed Physician Staff D signed herself as the receiving facility representative. Review of Hospital A’s electronic medical record for Patient #1 revealed the patient was never entered into their system. The Patient did not have any record indicating she was ever transported to or seen at Hospital A’s ED. Review of the facility ED Log from November 2025 revealed Patient #1 was not listed. There was no evidence showing she arrived at the hospital, if she was screened, if she was admitted, if she was transferred, or where she was transferred to. Review of Hospital B’s medical record for Patient #1 revealed the patient arrived at their ED on 11/11/25 at 6:02 A.M. The record indicated she was a 13-year-old female with a history of asthma, depression, and attention-deficit/hyperactivity disorder (ADHD), who was a trauma two activation after she was a front-seat-restrained passenger in a motor vehicle collision (MVC) rollover. She presented with complaints of wrist and ankle pain. A full trauma panel was obtained including imaging studies which included X-rays of the right wrist, thoracic spine, cervical spine, chest, and pelvis, all of which demonstrated no acute fractures or significant abnormalities. On arrival, her Glasgow Coma Scale was 15 (indicating fully alert and oriented), and primary and secondary surveys revealed no life-threatening injuries. The physical exam was notable for a superficial abrasion to the right eye/temple and pain to the thoracic spine, but she was otherwise neurologically intact and hemodynamically stable. It noted the family was from out of state and her mother was admitted at Hospital C. Patient #1’s pain was managed with acetaminophen and ibuprofen, and she was allowed to ambulate with assistance and maintain a regular diet. The admission was primarily for social reasons, as her mother was also hospitalized and there was no available family in Ohio. The tertiary exam was negative for occult injury. The patient was discharged on 11/12/25 at 9:35 A.M. to her father with a diagnosis of MVC. Phone interview on 01/14/26 at 1:57 P.M. with Emergency Medical Technician (EMT) Staff J reported in the early morning of 11/11/25 her and her partner (EMT Staff K) responded to a motor vehicle accident (MVA) where a mother and her youth child (Patient #1) needed extracted from the vehicle. EMT Staff J reported the youth appeared stable, but the mother was needing to be air lifted. The plan was for the youth to be seen at local Hospital A’s ED and for the mother to be airlifted from local Hospital A’s helicopter pad. EMT Staff J stated she called Hospital A to give report and Physician Staff D questioned why they were bringing the youth to them and not taking her to Akron. EMT Staff J reported she explained this was the closest hospital. When they arrived at Hospital A, EMT Staff J was told by EMT Staff K to wait in the bay because the physician was coming down to them. Physician Staff D came into the ambulance and looked at the youth and stated her mother wanted her to go to the same hospital that she was going to. EMT Staff J left with the youth and attempted to call Hospital C to give report. Hospital C stated they could not take her. She then called Hospital B, a children’s hospital, and was able to give them report. EMT Staff J reported staff from Hospital A did not give them any type of paperwork when they left and the youth never left the ambulance. Phone interview on 01/20/26 at 8:11 A.M. with EMT Staff K reported he was driving when they responded to a MVA on 11/11/25 involving a youth and her mother. The mother was to be transported via helicopter [from Hospital A] to Hospital C, and the youth was to be seen at Hospital A. EMT Staff K reported when his partner attempted to call in report, Physician Staff D asked them why they were bringing the youth to them and to keep going North to a hospital in Akron with the youth. When they got to Hospital A, they stayed in the ambulance bay because they were under the understanding, they were to bring the youth to where the mother was going. When they arrived at Hospital A, two staff members came down and asked what the ambulance was doing there. Physician Staff D then came into the ambulance with Patient #1 and then stated to take the youth with her mother. The youth appeared to be stable and was transported to Hospital B. EMT Staff K reported it was not unusual for Hospital A in situations like a MVA to tell them to take the patient to another hospital. Interview on 01/13/26 at 2:40 P.M. Unit Clerk Staff L reported on 11/11/25 they were made aware that EMS was bringing in someone that was in a MVC. She stated they arrived, but did not exit the ambulance. Unit Clerk Staff L stated she went down [to the ambulance], and EMS personnel told her that the mother did not want Patient #1 to come to this hospital. Unit Clerk Staff L reported this to Physician Staff D. Physician Staff D then went to see the youth. Unit Clerk Staff L reported she was not sure what happened after that but confirmed she did not add the patient to the ED log or document that the patient was ever present at Hospital A. She went on to say after this incident she received EMTALA education and all patients who arrived at the hospital were to be checked in and seen. Interview on 01/14/26 at 12:07 P.M. with Physician Staff D reported she took a call from EMS on 11/11/25 stating they were sending a patient by helicopter, but her daughter would be coming to Hospital A. She continued that she and staff went to the trauma room and got ready. It seemed like it was taking a while, and she could see two ambulances in the bay. She got concerned so a medic and Unit Clerk Staff L went down to see if they needed help. They came back without the patient and said the mother wanted the child to follow her (to Hospital C). Physician Staff D reported she needed to hear from the mother herself and wanted to check on the child so she went down with the medic and met EMS outside and asked if she could look in on the patient. EMS reported to her that they were waiting for the mother and were going to follow with the youth. She reported she did a visual exam on the child (Patient #1) who reported right side pain in her arm. She did not do a formal exam, just wanted to make sure she was stable, breathing, talking, and to make sure she was safe. She also wanted to speak with the mother to verify they were refusing treatment from Hospital A. Physician Staff D reported she spoke with the mother who wanted the child to go with her. Physician Staff D reported she knew she needed to document the refusal of care but was unsure of how to do so. She sent an email to the Medical Director asking how to do so. Physician Staff D reported after the incident, Medical Director of the Emergency Department Staff E had a lengthy conversation with her where she was reeducated on EMTALA and on how all patients must be registered, assessed, and documented on. Interview on 01/14/26 at 10:24 A.M. with the Medical Director of the Emergency Department Staff E revealed a day or two after the incident with Patient #1, he received an email from Physician Staff D asking how to address the situation and how to chart the interaction. The facility also received a complaint regarding the incident. Medical Director of the Emergency Department Staff E stated he met with the leadership team, completed a root cause analysis, interviewed Physician Staff D and it was determined that documentation should have been completed including adding Patient #1 to the ED log. Due to the error the facility put a plan in place to reeducate all emergency department staff on EMTALA regulations including physicians, nurses, and supporting staff members. He reported this was completed in November 2025. They would also use this experience in their Objectives and Key Results (OKR) where they would be completing audits starting this month. He reported his expectation would have been for Physician Staff D to register, document the screening, and the mother’s refusal to treat. Review of the facility policy “Emergency Department to Emergency Department Transfer” effective 05/20/25 revealed the purpose is to provide instructions to the ED staff on the care and management of patients that require transfer to another Emergency Department due to services or testing that is currently not available (ultrasound, computed tomography (CT) scanner). This does not apply to trauma or auto launch patients. Emergency Department to Emergency Department transfers provide a continuum of care to patients treated in the Emergency Department. The policy stated ED attending physicians from the transferring facility will initiate the transfer through the transfer center. The ED attending physician from the transferring facility will give report to ED attending physician from the receiving facility. The ED attending physician from the receiving facility will assume all care of the transferred patient upon arrival. The ED attending physician from the transferring facility will complete the transfer form.”

“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: 42015 Based on interview, review of the Emergency Department (ED) logs, Review of the facility Emergency Medical Treatment and Labor Act (EMTALA) Transfer Forms, medical record review, review of the Emergency Medical Service (EMS) run report, and facility policy review, the facility failed to ensure documentation that Patient #1 was appropriately screened prior to being transferred to another hospital. This affected one Patient (Patient #1) out of 20 Patients reviewed for ED services. Findings include: Review of Patient #1’s ambulance run report dated 11/11/25 revealed emergency medical services (EMS) arrived on the scene at 3:42 A.M. and EMS arrived with the patient to Hospital A’s emergency room at 4:28 A.M. The report indicated they arrived at another Emergency Department (Hospital B) at 6:09 A.M. The report revealed the medic was called for a one car (flipped) accident. The patient was a 13-year-old female passenger of the vehicle. The patient was self-extricated after the fire department removed the doors. EMS placed the patient in a cervical collar (a neck brace used to support and immobilize the neck after an injury (like whiplash or fractures) or for chronic conditions, preventing further damage by limiting head movement) out of an abundance of caution. The patient was alert and oriented times four. Her pain was a four [on a scale of one to ten, ten being the worst]. The patient report was called to Hospital A where EMS explained that the mother was being flown by helicopter at their helicopter pad. While calling the report, the doctor asked why the ambulance was taking the patient to Hospital A to instead of continuing north to a hospital in Akron. EMS stopped at Hospital A where Physician (Staff D) came into the ambulance and stated the mother wanted her child transported [to Akron] to be with her. The patient did not complain of any head back or neck pain. The patient had a scrape on her right eye, her right wrist hurt, and her left ankle hurt on the top. Hospital C was contacted and stated they could not take pediatric patients, and the patient needed to go to Hospital B where they took pediatric patients. EMS called in report to Hospital B’s trauma team. The trauma team also questioned why the patient was transported to their facility rather than to Hospital A. Continued review of the documents revealed Physician Staff D signed herself as the receiving facility representative. Review of Hospital A’s electronic medical record for Patient #1 revealed the patient was never entered into their system. The Patient did not have any record indicating she was ever transported to or seen at Hospital A’s ED. Review of the facility ED Log from November 2025 revealed Patient #1 was not listed. There was no evidence showing she arrived at the hospital, if she was screened, if she was admitted, if she was transferred, or where she was transferred to. Review of Hospital B’s medical record for Patient #1 revealed the patient arrived at their ED on 11/11/25 at 6:02 A.M. The record indicated she was a 13-year-old female with a history of asthma, depression, and attention-deficit/hyperactivity disorder (ADHD), who was a trauma two activation after she was a front-seat-restrained passenger in a motor vehicle collision (MVC) rollover. She presented with complaints of wrist and ankle pain. A full trauma panel was obtained including imaging studies which included X-rays of the right wrist, thoracic spine, cervical spine, chest, and pelvis, all of which demonstrated no acute fractures or significant abnormalities. On arrival, her Glasgow Coma Scale was 15 (indicating fully alert and oriented), and primary and secondary surveys revealed no life-threatening injuries. The physical exam was notable for a superficial abrasion to the right eye/temple and pain to the thoracic spine, but she was otherwise neurologically intact and hemodynamically stable. It noted the family was from out of state and her mother was admitted at Hospital C. Patient #1’s pain was managed with acetaminophen and ibuprofen, and she was allowed to ambulate with assistance and maintain a regular diet. The admission was primarily for social reasons, as her mother was also hospitalized and there was no available family in Ohio. The tertiary exam was negative for occult injury. The patient was discharged on 11/12/25 at 9:35 A.M. to her father with a diagnosis of MVC. Phone interview on 01/14/26 at 1:57 P.M. with Emergency Medical Technician (EMT) Staff J reported in the early morning of 11/11/25 her and her partner (EMT Staff K) responded to a motor vehicle accident (MVA) where a mother and her youth child (Patient #1) needed extracted from the vehicle. EMT Staff J reported the youth appeared stable, but the mother was needing to be air lifted. The plan was for the youth to be seen at local Hospital A’s ED and for the mother to be airlifted from local Hospital A’s helicopter pad. EMT Staff J stated she called Hospital A to give report and Physician Staff D questioned why they were bringing the youth to them and not taking her to Akron. EMT Staff J reported she explained this was the closest hospital. When they arrived at Hospital A, EMT Staff J was told by EMT Staff K to wait in the bay because the physician was coming down to them. Physician Staff D came into the ambulance and looked at the youth and stated her mother wanted her to go to the same hospital that she was going to. EMT Staff J left with the youth. Phone interview on 01/20/26 at 8:11 A.M. with EMT Staff K reported he was driving when they responded to a MVA on 11/11/25 involving a youth and her mother. The mother was to be transported via helicopter [from Hospital A] to Hospital C, and the youth was to be seen at Hospital A. EMT Staff K reported when his partner attempted to call in report, Physician Staff D asked them why they were bringing the youth to them and to keep going North to a hospital in Akron with the youth. When they got to Hospital A, they stayed in the ambulance bay because they were under the understanding, they were to bring the youth to where the mother was going. When they arrived at Hospital A, two staff members came down and asked what the ambulance was doing there. Physician Staff D then came into the ambulance with Patient #1 and then stated to take the youth with her mother. The youth appeared to be stable and was transported to Hospital B. EMT Staff K reported it was not unusual for Hospital A in situations like a MVA to tell them to take the patient to another hospital. Interview on 01/14/26 at 12:07 P.M. with Physician Staff D reported she took a call from EMS on 11/11/25 stating they were sending a patient by helicopter, but her daughter would be coming to Hospital A. She continued that she and staff went to the trauma room and got ready. It seemed like it was taking a while, and she could see two ambulances in the bay. She got concerned so a medic and Unit Clerk Staff L went down to see if they needed help. They came back without the patient and said the mother wanted the child to follow her (to Hospital C). Physician Staff D reported she needed to hear from the mother herself and wanted to check on the child so she went down with the medic and met EMS outside and asked if she could look in on the patient. EMS reported to her that they were waiting for the mother and were going to follow with the youth. She reported she did a visual exam on the child (Patient #1) who reported right side pain in her arm. She did not do a formal exam, just wanted to make sure she was stable, breathing, talking, and to make sure she was safe. She also wanted to speak with the mother to verify they were refusing treatment from Hospital A. Physician Staff D reported she spoke with the mother who wanted the child to go with her. Physician Staff D verified she did not complete a formal assessment, document her visual assessment, enter the patient into the system, or provide a report to the receiving hospital. Interview on 01/14/26 at 10:24 A.M. with the Medical Director of the Emergency Department Staff E revealed a day or two after the incident with Patient #1, he received an email from Physician Staff D asking how to address the situation and how to chart the interaction. The facility also received a complaint regarding the incident. Medical Director of the Emergency Department Staff E reported his expectation would have been for Physician Staff D to register, document the screening and the mother’s refusal to treat, and provide the receiving hospital a report of the interaction. Review of the facility policy, “EMTALA - Medical Screening Policy” effective 02/19/25 revealed a purpose to establish the requirement that all patients coming to the hospital requesting emergency services receive an appropriate Medical Screening Examination as required by Emergency Medical Treatment and Labor Act (EMTALA). If an individual arrives at the Hospital and is not technically in the ED but is on Hospital property, and requests emergency care, he or she must receive a Medical Screening Examination within the capabilities of the Hospital, or if necessary, be appropriately transferred. A patient transported by ambulance onto the Hospital property is considered to have come to the Hospital’s ED. A Hospital may deny access to patients when it is in “diversionary” status because it does not have the staff or facilities to accept any additional emergency patients at that time. However, if the ambulance disregards the Hospital’s instructions and brings the individual on to Hospital grounds, the individual has come to the Hospital, and the Hospital cannot deny the individual access to a Medical Screening Examination.”