Penn State Health St. Joseph

“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: 43067 Based on review of facility documentation, Emergency Department (ED) logs, and staff interview (EMP), it was determined the facility failed to provide a medical screening examination to a patient that presented to the Emergency Department. Findings include: Review on January 8, 2025, of facility policy, “Hospital Treatment and Transfer of Individuals Who Request Emergency Medical Services (EMTALA)”, last reviewed January 2025, revealed “Policy: It is the policy of St. Joseph Regional Health Network (the “Hospital”) that if an individual comes to the Emergency Department (as defined below): The Hospital will provide an appropriate medical screening examination within the capability of the Hospital’s dedicated emergency department, including ancillary services routinely available to the dedicated emergency department, to determine whether or not an emergency medical condition exists. The examination will be conducted by an individual(s) determined qualified by Hospital Bylaws or rules and regulations; and ... Procedure: 1. The Hospital may follow reasonable registration processes for an individual for whom examination or treatment is required, including asking whether an individual is insured and, if so, what that insurance is, as long as that inquiry does not delay screening or treatment. Reasonable registration processes may not unduly discourage an individual from remaining for further evaluation. Review of facility documents on January 8, 2025, revealed the patient presented to the Emergency Department on December 3, 2024. The patient was not registered, and a medical exam was not completed. Review of facility document on January 8, 2025, revealed EMP3 advised patient to go to Urgent care to avoid the long wait time in facility ED. Interview with EMP3 on January 8, 2025, confirmed information from facility document is accurate and complete. Interview with EMP1 on January 8, 2025, confirmed facility policy was not followed.”

“NURSING SERVICES CFR(s): 482.23 The hospital must have an organized nursing service that provides 24-hour nursing services. The nursing services must be furnished or supervised by a registered nurse. This Condition is not met as evidenced by: 43067 Based on the seriousness of the non-compliance and the potential effect on patient outcome, the facility failed to substantially comply with this condition. The findings were: 482.23(b)(6) Tag A-0398 Nursing Services: Supervision of Contract Staff The information reviewed during the survey provided evidence the facility failed to ensure staff followed approved policy for ensuring patient telemetry monitoring is not removed without a doctor’s order and to ensure a patient had IV access at all times while on telemetry. A discussion took place with the survey team and the facility’s administrative staff (EMP1 and EMP2) regarding the survey team’s concerns related to Nursing Services on February 2, 2024, at 09:30 AM. Cross reference 482.23(b)(6) Nursing Services: Supervision of Contract Staff .”

“SUPERVISION OF CONTRACT STAFF CFR(s): 482.23(b)(6) All licensed nurses who provide services in the hospital must adhere to the policies and procedures of the hospital. The director of nursing service must provide for the adequate supervision and evaluation of all nursing personnel which occur within the responsibility of the nursing service, regardless of the mechanism through which those personnel are providing services (that is, hospital employee, contract, lease, other agreement, or volunteer). This Standard is not met as evidenced by: 43067 Based on review of facility documents, medical record (MR), staff interview (EMP) and observation it was determined the facility failed to ensure staff followed hospital policies and procedures for ensuring telemetry patients have intravenous (IV) access at all times and remain on continuous monitoring according to the doctors order. Findings include: On January 25, 2024, review of facility policy “Continuous Cardiac Monitoring Guidelines via Telemetry” effective August 2023 revealed “Scope and Purpose - To provide guidelines for telemetry monitoring. Policy - To provide skilled nursing care to patients who require cardiac monitoring. ... C. Care of the Patient ... 6. Patients are not to be taken off telemetry during a.m. care, ambulating to the bathroom, or in the hall, dialysis treatments, etc. (unless an order is written by a physician). 7. All telemetry patients must have a patent intravenous catheter. ...” On January 25, 2024, review of MR1 revealed an order entered by EMP7 on December 30, 2023, at 4:40 AM for Continuous Cardiac Monitoring. On January 4, 2024, at 8:55 AM the patient’s monitor rhythm alarmed asystole (heart stop beating) patient was unresponsive and a code blue was called. The patient first dose of epinephrine had to be given via intraosseous access (IO) (drilling a hole through the bone cortex) due to patient not having intravenous (IV) access. Interview with EMP6 on January 24, 2024, EMP6 revealed upon starting shift at 6:55 AM it was reported to EMP6 that patient did not have IV access due to the patient pulling it out during night shift. Further interview confirmed a message was not sent to the IV team to re-insert IV access on night shift or by EMP6. Interview with EMP1 on January 25, 2024, EMP1 confirmed all information above is accurate and complete. ------------- Observation on January 25, 2024, on unit 1 North at 10:40 AM, MR2 telemetry monitor alarm was sounding with the message “Leads off” from 10:40 AM until 10:45 AM. Interview with EMP3 on January 25, 2024, EMP3 confirmed MR2 leads were off because MR2 was returning from having a Magnetic Resonance Image (MRI) scan appointment and MR2 was taken off telemetry to go have MRI scan done. Review of MR2 on January 25, 2024, revealed an order entered by EMP4 on January 19, 2024, at 1:54 PM for Continuous Cardiac Monitoring; an order entered by EMP5 on January 24, 2024, at 3:14 PM for MRI of pelvis with and without contrast for January 25, 2024, at 9:00 AM. There was no order found in MR2 to take the patient off telemetry to go to the appointment. Interview with EMP1 on January 25, 2024, EMP1 confirmed MR2 did not have an order for the patient to be taken of telemetry to go for the MRI scan and the facility policy was not followed.”