Holdenville General Hospital

“Fire Drills CFR(s): NFPA 101 Fire Drills Fire drills include the transmission of a fire alarm signal and simulation of emergency fire conditions. Fire drills are held at expected and unexpected times under varying conditions, at least quarterly on each shift. The staff is familiar with procedures and is aware that drills are part of established routine. Where drills are conducted between 9:00 PM and 6:00 AM, a coded announcement may be used instead of audible alarms. 19.7.1.4 through 19.7.1.7 This Standard is not met as evidenced by: 46363 Based on record review and staff interview, the facility failed to assure the minimum required number of fire drills were conducted within the past year. This had the potential to affect 7 of 7 patients, that are currently patients in the facility, as identified by the nursing staff on 05/22/25. The facility had a census of 7 patients. Findings: 1. A review of the facilities fire drill reports was conducted on 05/22/25 at 11:15 a.m.. There was no documentation the facility had conducted a fire drill the first or second shifts during the fourth quarter of the year 2024. 2. The maintenance director acknowledged there were missing reports.”

“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: 46714 Based on record review and interview, the hospital failed to provide services per policies and procedures to ensure compliance with the requirements of EMTALA (Emergency Medical Treatment and Labor Act) screening for one (Pt #16) of 20 patients reviewed. This failed practice had the potential to place patients at risk of life threatening outcomes due to hospital staff, including medical staff, failure to uphold responsibilities under the EMTALA requirements. Findings: Cross Referrenced See Tag C-2406”

“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: 46714 Based on record review and interview, the hospital failed to ensure appropriate medical screening was completed for 1 patient (Patient #16) of 20 patients presenting to the ED requesting an examination for symptoms of an acute medical condition. This failed practice had the potential to place all patients presenting to the Emergency Department in harm of missed diagnoses, worsening of symptoms, and potential death. Findings: A review of the clinical record showed Pt #16 was seen in the Emergency Department on 06/25/24 with primary complaints of coughing up blood for two days. Documentation showed a blood presure of 145/105 (not addressed by the hospital), pulse of 109 (not addressed by the hospital), respiratory rate of 18, temperature of 97 (fahrenheit) and oxygen saturation of 93% on room air. Clincial documentation showed a history of GI bleed and pulmonary arterial hypertension and a review of labs drawn after admission showed the following: 1. Hemoglobin of 7.7 (normal range 11.5-15.5); 2. Hematocrit of 28 (normal range 35-45); 3. MCV of 68.3 (normal range 82-89); 4. MCH of 18.8 (normal range 27-34); 5. MCHC of 27.5 (normal range 31-35; 6. RDW-CV of 22.7 (normal range 11.5-15.0); 7. Sodium of 128 (normal range 136-145); 8. Cloride of 95 (normal range 98-107); 9. CO2 of 20 (normal range 21-32); 10. Albumin of 3.1 (normal range 3.5-5.0). A chext x-ray was completed which showed: 1. Heart size large; 2. Pulmonary vasculature normal; 3. Lungs Clear; 4. No pneumothorax; 5. No osseous findings. 6. Radiologist impression: Cardiomegaly without overt failure. No acute cardiopulmonary process. Documentation showed Patient #16 presented to the Hospital #1 ED with complaints of coughing up blood, a documented elevated heart rate and hypoxia but there was no D-dimer or CT-angiogram to rule out a pulmonary embolism and no differential diagnoses noted in physician documentation. Documentation showed no additional screening for chief complaints. Patient #16 was discharged (the same day) with a diagnosis of anemia. Hospital #2 A review of the clinical record showed Patient #16 arrived at Hospital #2 ED on 06/26/24 at 1:32 pm with chief complaints of dizziness and weakness that began the previous day (06/25/24) and hemoptysis which began four days ago. Documentation showed a past medical history included anemia, chronic kidney disease, pulmonary hypertention, a history of multiple GI bleeds and at one time requiring a blood transfusion every two weeks. Diagnoses for Patient #16 at Hospital #2 was hemoptysis, cardiomyopathy, abdominal ascites, hyponatremia, and anemia. At 5:38 pm on 06/26/24 DO #1 documemented: several episodes of hemoptysis for Patient #16 and that the patient remained mildly tachycardic (heart rate of 104) and that patient was hypertensive throughout her ED stay with a blood pressure of 129/96. DO #1 further documented: “1. the patient would benefit from a higher level of care including GI, pulmonology, cardiology and possibly nephrology; 2. the case was discussed with Hospital #2 transfer center; 3. the patient was accepted by Dr. (name omitted) in the ED and patient would be transported by Hospital #2 ground EMS.” Patient #16 was transferred to Hospital #3 for a higher level of care on 6/26/24. In an interview with Staff AA (Hospital #1) on 07/12/24 at 12:00 pm, Staff AA stated, Everyone has the right to emergency room treatment even though they may not be able to pay. In an interview with Staff SS (Hospital #1) on 07/12/24 at 12:20 pm, Staff SS stated, there is no denying of treamtent when presenting to the Emergency Departent.”