Conemaugh Nason 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: 29411 Based on review of facility documents and interview with facility staff (EMP), it was determined that the facility failed to provide a medical screening examination to one of one patient (PT1) who presented to the Emergency Department. Findings inlcude: Review of “Nason Hospital Medical Staff Bylaws” dated March 16, 2023, revealed, “... Article III-Medical Staff Membership ... 4.2 Active Staff 4.2(c) Responsibilities Each member of the Active Staff shall: ... (3) Actively participate: (iii) in the emergency department on-call rotation, as more specifically described in the Medical Staff Rules and Regulations and as recommended by the MEC and, approved by the Board, including personal appearance to assess patients in the emergency department when deemed appropriate by the emergency department physician ... Appendix ‘B’-Rules and Regulations ... Article VI-Emergency Medical Screening, Treatment, Transfer & On-Call Roster Policy 6.1 Screening, Transfer, & Transfer 6.1(a) Screening (1) Any individual who presents to the Emergency Department of this hospital for care shall be provided with a medical screening examination to determine whether the patient is experiencing an emergency medical condition. Generally, an ‘emergency medical condition’ is defined as active labor or as a condition manifesting such symptoms that the absence of immediate medical attention is likely to cause serious dysfunction or impairment to bodily organ or function, or serious jeopardy to the health of the individual or unborn child. (2) Examination and treatment of the emergency medical medical conditions shall not be delayed on order to inquire about the individual’s method of payment or insurance status, nor denied on account of the patient’s inability to pay. (3) All patients shall be examined by qualified medical personnel, which shall be defined as a physician, or in the case of a woman in labor, a registered nurse trained in obstetric nursing, where permitted under state law and Hospital policy, who may determine true, false or no labor but will not make a medical diagnosis. ... .” Conemaugh Nason Medical Center ... PolicyStat ID 14195680 policy and procedure date September 2023. “EMTALA-Medical Screening and Treatment of Emergency Medical Conditions ... B. Purpose: To ensure that individuals coming to an affiliated Hospital’s Dedicated Emergency Department seeking assessment or treatment for a medical condition or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination as required by the Emergency Medical Treatment and Labor Act (‘EMTALA’), 42 U.S.C., section 1395 and all Federal regulations and interpretive guidelines promulgated there under, and, if an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment within the Hospital’s capabilities and/or are transferred if appropriate, all without regard to the patient’s insurance coverage or ability to pay. ... C. Definitions: ... K. Hospital Property or Premises means the entire Hospital campus, including the parking lot, sidewalk, driveway, and common areas in the Hospital-owned MOBs on campus as well as any organization that is located off the Hospital campus but satisfies the definition of Dedicated Emergency Department. ... L. Medical Screening Examination is the process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an Emergency Medical Condition exists or a woman is in labor. Such screening must be done within the facility’s capability and available personnel, including on-call physicians. The Medical Screening Examination must be performed by a physician or other Qualified Medical Personnel. The medical screening is an ongoing process and the medical records must reflect continued monitoring based on the patient’s needs and must continue until the patient is either stabilized or appropriately transferred. ... D. Policy Any individual who comes to the Hospital Property or Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exist. If an Emergency Medical Condition is found to exist, the Hospital will (without regard for the patient’s insurance coverage or ability to pay) provide: (a) stabilizing treatment within capabilities of the Hospital and its staff (including on-call physicians and diagnostic services), and/or (b) an appropriate transfer to another medical facility (if required for the patient’s treatment or requested by the patient). ... E. Procedures: 1. Facility Policies ... A. General Requirements: Registration, Triage, and MSE ... 3. Medical Screening Examination (MSE)-In general, when an individual (who is not a Hospital inpatient or registered outpatient in the course of an appointment) ... B. Who May Perform Medical Screening Exam- ... Medical Screening Examinations must be performed by an emergency department physician, another physician, or a non-physician practitioner who is qualified to conduct such examination. ... Hospitals must establish a process to ensure that an emergency department physician examines all patients whose conditions or symptoms require physician examination. ... .” Review of EMS trip sheet dated April 21, 2024, revealed, “... Patient requested to be transported to CMMC Nason ER. After report and arrival at ER doors after unloading the patient CMMC Nason Ear [sic] physician advised they couldn’t cafe [sic] for patient because they didn’t have blood and crew was to load patient up and divert to UPMC ER. ... Radio report was given to CMMC Nason with a 10 minute ETA. Medic 12-1 arrived at CMMC Nason ER. Patient was unloaded from rig and attempted to be taken inside. CMMC Nason ER physician met crew at doors and advised they would not accept patient since they did not have blood products and patient was on blood thinners. Crew was advised to reload patient and transport to UPMC Altoona ER. Patient was reloaded back into rig and transported to Altoona. ... .” Medical Staff meeting minutes dated May 1, 2024, revealed, “... Code of Conduct and EMTALA-It is important to sign the Code of Conduct and EMTALA attestation ... We did have a self-report EMTALA violation to CMS in April. A locum physician, first night on shift, Board Certified in Emergency Medicine had a patient come to hospital via ambulance who was stable with a possible GI Bleed. Provider interrupted EMS workers and patient in breezeway, had a short conversation with them and then had the EMS put patient back on ambulance to transport to UPMC Altoona, they were here less than two minutes. ... Rule is anyone within 250 yards of corner of building that is presenting here for help or care, we must perform a medical screening. ... .” Interview with EMP2 on June 4, 2024, at approximately 10:40 AM stated that EMS arrived at the ambulance entry where the physician met them and told the crew to pick up and move to another facility and confirmed that the normal process would be to evaluate the patient and transfer if they were not able to treat the patient there.”