Generations Behavioral Health-Youngstown LLC

“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: 44810 Based on record review, interview and policy review, the facility failed to provide a medical screening and admission for a patient transferred from an acute care hospital. This affected one (Patient #2) of 20 records reviewed. Findings include: Review of the sending facility run report dated 09/04/24 revealed Patient #2 was picked up at the sending facility without incident. They arrived at the facility on 09/04/24 around 7:30 P.M. The facility rejected Patient #2 and would not let her into the building. After negotiations between the facility a squad was called to transport Patient #2 to another emergency room. Review of the formal transfer forms revealed Patient #2 had an application for emergency admission and was noted as pink slipped by the sending facility. Review of the squad run report dated 09/04/24 at 8:00 P.M. revealed the squad was called to the facility to transport a patient to the local emergency room. The patient was found sitting outside the facility on a bench because the facility would not accept her. Patient #2 walked to the cot and was transported to the local emergency room. Review of the local emergency room history and physical for Patient #2 revealed she was discharged from an emergency room and was transported to the psychiatric facility. Squad was called to the psychiatric facility and Patient #2 was standing outside of the facility. The facility reported they did not have a bed for her. Review of the local emergency room social worker note dated 09/05/24 at 9:07 A.M. revealed that she contacted the psychiatric facility intake department. The facility reported that Patient #2 came from the sending facility with no communication from them and they could not accept her due to her type of medical insurance. The facility reported to the social worker that Patient #2 came to the facility without proper proof of insurance. The facility reported that she could be admitted if her insurance was verified. Patient #2 was eventually transferred to the facility from the local emergency department and admitted to the facility on 09/05/24 at 3:30 P.M. Patient #2 was treated at the facility and discharged back to her nursing home on 09/13/24. During an interview on 10/22/24 at 9:38 A.M., Sending Facility Unit Clerk Staff D revealed that she did set up the transfer for Patient #2 on 09/04/24. She faxed all the information to the facility due to the physician request. The facility called back to the emergency department at 1:38 P.M. on 09/04/24 with questions for the physician and accepted the patient at that time. Staff D reported that later that evening she received a phone call from the transportation company that the facility would not accept the patient due to them not receiving any paperwork. Staff D then reported she had to reach out to her manager at home to find another option for treatment for Patient #2 and Patient #2 was transferred to another medical facility’s emergency room. During an interview on 10/22/24 at 10:14 A.M., Director of Intake Staff E revealed that she remembers Patient #2 well. She reported she had left for the day, but Patient #2 was accepted by the facility if the facility sent her pink slip, her voluntary admission form, and history and physical. She informed the sending physician of this, and he confirmed that it would be sent. Before she left the facility for the facility, they still had not received the information. Staff F received a phone call from the nursing manager stating Patient #2 was at the door. Patient #2 did not come with any paperwork or pink slip and staff attempted to get Patient #2 to sign a voluntary admission form, but Patient #2 refused stating she was not going into the facility. She informed the nursing supervisor that they could not admit her without the paperwork or the voluntary form because that would be considered kidnapping. Patient #2 was then sent to the local emergency room. Staff E reported that she spoke with the local emergency room and explained the situation and that since it was after five o clock no one was available to pins slip her and she was refusing to sign the voluntary form, and they would accept her if they had either of those forms. Patient #2 did sign the voluntary form the next day in the local emergency room and was then transferred to the facility. Staff E also reported she spoke the next day with the sending facility and informed them she never received the paperwork, and they insisted it was faxed. A staff member from their facility had to go and physically pick up the documentation and deliver it to the facility. During an interview on 10/22/24 at 1:30 P.M., Nursing Supervisor Staff F reported she was the nursing supervisor the night Patient #2 arrived at the facility. She reported the nurses were explaining to the driver that Patient #2 could not be admitted without paperwork and the facility never sent any and he did not have any. She reported she then called Staff E who informed her that Patient #2 could be admitted if she signed a voluntary admission form and Staff F then went to speak to Patient #2 who refused to sign or enter the building. She reported the driver was upset and left Patient #2 at the facility. Staff F did call emergency medical services, and they transported Patient #2 to the local emergency room and when she returned to work the next day Patient #2 had been admitted. During an interview on 10/23/24 at 8:04 A.M., Registered Nurse (RN) Staff G and RN Staff H revealed Staff H was the one who answered the door the night Patient #2 arrived at the facility. Staff H reported the bell at the intake doors rang and a driver was there with Patient #2. Patient #2 was not listed on her census, and she had no admission packet for her so she called Staff E. Staff E informed Staff H that Patient #2 was not accepted to the facility, and they could not admit her. The driver stated he was not taking Patient #2 back and then Staff E reported she would meet the driver and spoke to him to inform him that Patient #2 was not accepted. Staff H confirmed Patient #2, and the driver had no paperwork on them, just Patient #2’s belongings. During an interview on 10/23/24 at 9:10 A.M., Staff E and Senior Leader of Intake Staff M revealed that the facility does not generally accept traditional state Medicaid patients. Staff M reported that traditional state Medicaid does not pay for services at a free-standing psychiatric facility like theirs unless the patient is younger than the age of 21 or older than the age of 65. Staff E reported that the local emergency room assumed the facility was not going to take the patient due to this because Staff E reported that if state Medicaid was not going to pay then they would need to set up a self-pay arrangement. Review of the facility policy titled “EMTALA Community Call Plan”, created 02/06/18, revealed the facility maintains their own physicians who are on the hospital’s medical staff to provide treatment necessary after their initial examination to stabilize their medical conditions. The facility does not accept patients with emergency medical conditions. A referral/transfer shall be recommended to a local hospital for emergency medical care. Review of the facility policy titled “Admission Process and Documentation”, created 02/06/24, revealed the nurse will contact the referral source with determination and, if accepted, will guide the referral source with the next steps. Direct admissions must have a signed voluntary admission for or a telephone approval by the legal guardian/healthcare power of attorney. Emergency department admissions must have an application for emergency admission, or a signed voluntary admission form completed.”