Holzer Medical Center

“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: 47059 Based on record review, interview, review of UpToDate reference, and policy review, the facility failed to provide an appropriate medical screening examination within the capability of the hospital’s emergency department (ED) for one patient who came to the ED requesting examination or treatment. This affected one (Patient #4) of 20 records reviewed. Findings include: Review of the medical record revealed on 09/09/25 at 11:12 P.M. Patient #4 presented to the emergency department at the Meigs County location with a complaint of intense right-sided abdominal pain with nausea and vaginal bleeding on the day of presentation. An emergency department visit on 09/03/25 resulted in a positive pregnancy test. She was noted to have been diagnosed with a 2.7 centimeter (cm) right ovarian cyst the week prior and had a gynecology appointment scheduled within the upcoming days. Patient #4 was evaluated by the emergency department provider for medical screening using Patient #4’s history and a physical examination. Patient #4 was documented as having an acute onset of abdominal pain in the setting of an ovarian cyst. The physician initially documented the patient had right lower quadrant tenderness on exam, and later in the same physical exam, noted in the document the patient had no abdominal tenderness. During the emergency room visit, Patient #4 received Toradol for pain and Zofran for nausea. A reassessment of Patient #4’s pain was documented prior to discharge. Review of the complete blood count revealed patient had an elevated white count of 12.2 (normal 4.5-11). The patient was discharged with diagnosis of ovarian cyst. The record documented under Medical Decision Making “No additional work-up planned.” Despite documentation of tachycardia, leukocytosis, known ovarian cyst, and worsening pain, and despite the hospital’s written screening process suggesting that consultation with the on-call gynecologist physician and ultrasound capabilities would typically be an expected part of screening for this type of patient complaint, the record contained no further documentation about the presence or absence of multiple potential emergency medical conditions including ovarian torsion, ectopic pregnancy, infection, etc. A review of the medical record for Patient #4 at a different hospital on 09/11/25 revealed the arrived for an outpatient surgery. The history and physical documents the patient presented with right sided pain and a positive pregnancy test at seven weeks gestation. The history and physical documents the diagnosis for the visit as inappropriate change in quantitative serum human chorionic gonadotropin (hCG) in early pregnancy and pregnancy of unknown anatomic location. The patient underwent a laporoscopic surgery which identified a tubal (ectopic) pregnancy and required removal of her fallopian tube. Interview on 12/10/25 at 9:30 AM the ED Manager Staff B stated the UpToDate reference “Approach to the patient with pregnancy of unknown location,” is used by the ED physicians for screening patients in the ED. Review of the UpToDate article titled “Approach to the patient with pregnancy of unknown location,” current review November 2025, revealed pregnancy of unknown location (PUL) describes the clinical scenario in which a pregnancy test is positive, but the location of the pregnancy is not visualized on transvaginal ultrasound. As the location of all pregnancies is initially unknown, PUL does not present an final diagnosis, but rather an entity that requires continued evaluation until the location can be established or the pregnancy is resolved. Some pregnancies will be ectopic and can result in organ rupture and massive hemorrhage. Delay in diagnosis of an ectopic pregnancy can result in severe maternal morbidity and even mortality. Patients with PUL may present with symptoms of early pregnancy (eg, nausea,vomiting, fatigue, etc) or those more consistent with ectopic pregnancy (irregular vaginal bleeding, abdominal pain). Initial evaluation should include ultrasounds as the mainstay of imaging in patients in whom PUL is suspected. A single value of serum human chorionic gonadotropin (hCG) does not confirm the location of a pregnancy. Subsequent testing with both serial serum human chorionic gonadotropin (hCG) and ultrasound assessment should be completed. The document recommendation for hemodynamically stable patients with an undesired pregnancy “proactive intervention rather expectant management..., with either uterine evacuation (with or without laparoscopy in patients with an adnexal mass) or medication... [to] decrease the risks associated with a progressing ectopic pregnancy.” A phone interview on 12/15/25 at 9:35 AM with Physician Staff F revealed there is no on-site ultrasound at the Meigs location of the Holzer emergency department. The Meigs location does not even have on-call ultrasound staff. All emergency cases needing ultrasound are sent to the Gallipolis location of the Holzer emergency department. If there is a significant amount of pain the patient would be sent to the Gallipolis emergency room location for further imaging. Physician Staff F revealed the ED physicians follow the UpToDate references when providing care. A phone interview on 12/15/25 at 9:53 AM with Physician Staff G revealed he/she most often work in the Gallipolis location of the Holzer emergency department. Staff G confirmed the Meigs location of the Holzer emergency department does not have imaging so those patients are sent to Gallipolis location of the Holzer emergency department when imaging is indicated. Physician Staff G revealed the ED physicians follow the UpToDate references when providing care. Review of policy titled “EMTALA Compliance,” dated 11/2025, revealed a policy statement that included if an individual comes to the Dedicated Emergency Department (DED): The Hospital shall provide an appropriate medical screening evaluation within the capability of The Hospital’s DED, including ancillary services routinely available, to determine whether or not an emergency medical condition exists; and The Hospital must: (a) provide to an individual who is determined to have an emergency medical condition such further medical examination and treatment as is required to stabilize the emergency medical condition, or (b) arrange for transfer of the individual to another medical facility capable of completing the evaluation and treatment required for the emergency condition. Review of the policy titled “Emergency Department Provision of Care,” dated 01/11/17, revealed the Holzer Health Systems Emergency Departments are committed to the provision of high quality, efficient emergency medical services to each and every patient who resents to the department. Objectives included to promote good working relationships with other hospital departments, and other community services so that the continuity of care and efficient disposition of patients may be provided and to strive for patient centered continuity of care in the provision of the emergency medical services.”

“OPERATING ROOM POLICIES CFR(s): 482.51(b) Surgical services must be consistent with needs and resources. Policies governing surgical care must be designed to assure the achievement and maintenance of high standards of medical practice and patient care. This Standard is not met as evidenced by: 33020 Based on record review, interviews, and policy/procedure review, the hospital failed to ensure surgical services were consistent with needs and resources for one of 10 patients reviewed (Patient #1). The census was 73. Findings include: On 02/12/24 at 9:57 A.M. an interview with Staff A revealed Patient #1 had been seen at the provider’s offsite Emergency Department (ED) on 12/21/23. On 02/12/24 at 12:22 P.M. a review Patient #1’s medical record revealed she reported to the ED staff on 12/21/23 of potentially being exposed to COVID-19 a couple weeks back and reported she had similar signs and symptoms, but felt she had recovered from the signs and symptoms. Further review revealed it was recommended that Patient #1 have surgery after a computed tomography (CT) concluded a thick-walled gall bladder with stones, fluid, and suspected acute cholecystitis. Further review revealed Patient #1 did test positive for COVID-19 in the ED on 12/21/23, and the case was discussed with a general surgical resident at this hospital at 7:30 A.M. The resident at this hospital agreed to accept Patient #1 for surgical intervention and an order was written to transfer Patient #1 to this hospital. On 12/21/23 at 9:45 A.M. the anesthesia department at this hospital refused to do the surgery because the patient tested positive for COVID-19, and she was referred to another hospital system for surgery. An interview with Staff E during the medical record review confirmed the findings, and reported the surgery should not have been refused because the patient had COVID. On 02/12/24 at 2:39 P.M. an interview with Staff F revealed there was an increased risk of performing surgery on a patient that had tested positive for COVID, but the anesthesia staff explained this risk to every COVID positive patient and the staff did the surgery as scheduled based on the surgeon’s discretion. Further interview with Staff F after a review of Patient #1’s medical record revealed the operation should not have been “refused” and this was the first time he had heard about this situation. On 02/13/24 at 8:10 A.M. an interview with Staff G revealed it was the responsibility of the surgeon to determine if a surgical procedure was to be conducted or not after he/she had discussed the risks/benefits with the anesthesia staff. Staff G stated the role of the anesthesia staff was to collaborate with the surgeon, but the surgeon made the final determination/decision to do the surgery or not. On 02/13/24 at 8:45 A.M. a review of the Peri-Operative COVID-19 Planning protocol, revised 10/22, revealed it recommends that the health care organizations perform surgeries (including urgent surgeries) and other procedures on COVID-19 positive patients following the same guidelines for active Tuberculosis patients. The protocol defines specific parameters for doing surgery on those patients and recommends delaying elective surgeries for COVID-19 patients. On 02/13/24 at 9:01 A.M. a review of the Scheduling Policies for Peri-Operative Services, effective 11/09/22, revealed the policy defines urgent and emergent surgeries, and an interview with Staff H during the review revealed Patient #1’s gall bladder surgery would have been an urgent surgery. This deficiency represents non-compliance investigated under Substantial Allegation OH00149740.”