Lincoln Medical Center

“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: 32777 Based on review of facility policy, hospital security footage, police body camera footage with audio, other documents, medical record review and interview, the facility failed to provide a Medical Screening Exam (MSE) for 1 (Patient #1) of 20 patients reviewed. Patient #1 presented to the Emergency Department (ED) with a genital lesion and a stuffy nose. Patient #1 was trespassed from hospital property when Patient #1 had alleged inappropriate contact with another patient (Patient #2) in the ED waiting room prior to being seen by a physician. The findings include: Patient #1 presented to the ED on 07/31/2025 at 1:23 AM. Patient #1’s chief complaint was a genital lesion and a stuffy nose. Patient #1 arrived by private vehicle and was unaccompanied. Patient #1 was seen by the triage nurse at 1:30 AM. Patient #1 was triaged at a Level 3 (anticipated greater than 2 resources). At 1:45 AM, Patient #1 was placed in the lobby. While in the lobby, Patient #1 allegedly touched Patient #2 inappropriately and the police were called. The police spoke with Patient #1 and Patient #2. The police officer asked the receptionist at the ED desk what they wanted to do about this, and the police were given the direction to trespass (remove from the premises with instructions not to return unless permission is given from hospital security) Patient #1 from the hospital grounds. The police officer spoke with Patient #1 and told him the hospital wanted him to leave the premises. Patient #1 left the hospital via private vehicle on 7/31/2025 at 2:30 AM. Patient #1 never saw a physician while in the ED. Cross Refer to A-2406.”

“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: 32777 Based on review of facility policy, hospital security footage, police body camera footage with audio, facility documents, medical record review and interview, the facility failed to provide an appropriate medical screening exam (MSE) for 1 patient (Patient #1) of 20 patients reviewed. Patient #1 presented to the Emergency Department (ED) with a genital lesion and stuffy nose. Patient #1 was trespassed from hospital property when Patient #2 alleged she was touched inappropriately by Patient #1 in the waiting room. The findings include: Review of the facility’s policy, “EMTALA [Emergency Medical Treatment and Labor Act],” reviewed 11/10/2023, showed “...When an individual comes to the Emergency Department and a request is made on the individual’s behalf for a medical examination or treatment, an appropriate medical screening examination...shall be provided to determine whether an emergency medical condition exists...It must be remembered that a medical screening examination goes beyond initial triage. Triage is not equivalent to a medical screening examination. Triage merely determines the “order” in which patients will be seen, not the presence or absence or an emergency medical condition. Also, a medical screening exam is not an isolated event; it is an on-going process. The record must reflect continued monitoring according to the patient’s needs and must continue until completion of stabilizing treatment and the patient is discharged, admitted, or appropriately transferred. A medical screening exam is provided by...a qualified ED physician...An Emergency Department physician on duty shall be responsible for the general area of all patients presenting themselves to the Emergency Department...” Review of the facility’s policy, “Triage,” revised 9/13/2024, showed “...All patients presenting for care in the Emergency Department are triaged on arrival using the Emergency Severity Index 5-Level Triage Algorithm. Triage is performed by a trained and competent Registered Nurse and is not considered a medical screening exam...During ED triage an Emergency Severity Index [ESI] Level of Acuity is assigned...Level 1- requires immediate life-saving interventions...Level 2- high-risk situation, altered mental status severe pain/distress...Level 3- anticipated > [greater than] 2 resources...Level 4- anticipates 1 resource...Level 5- anticipates no resources...Bed placement will be based on assigned ESI level, not time of arrival...Levels 3-5: bed placement as soon as possible with initiation of appropriate protocols...” Review of the facility’s policy, “Trespass Warnings and BOLO’s [Be On the Look Out],” reviewed 1/2024, showed “...To provide Hospital Security Staff with an overview of the appropriate response and procedure on issuing Trespass Warnings and BOLO’s...Trespass Warnings may be issued on individuals who do not belong on...Health property. Trespass Warnings can be issued by a Security Officer once approved by the Team Leader and/or Supervisor on shift...NOTE...Patients may not be trespassed as long as they are under medical care...The Team Leader is responsible for making sure the appropriate report is filled out for all Trespass Warnings and BOLO’s. These reports...are to list as much detail as obtainable by the responding Officer. This report is to be forwarded to the Security and Central Transport staff immediately through email...When completing a Trespass Warning, the Team Leader is to make sure that pictures of the individual are taken. One picture is to be a close up of their face; the second picture is to be of them standing next to a person or object. Both pictures are to be added to the trespass report. In addition, a valid Trespass Warning requires an Officer from the appropriate local Police Department to be present at the time of trespass...” Review of the hospital outside camera video footage revealed Patient #1 arrived, parked a private vehicle and walked into the ED on 07/31/2025 at 1:23 AM. Review of the hospital outside camera video footage revealed Patient #2 arrived in a private vehicle with an accompanying driver on 07/31/2025 at 1:32 AM. Review of the hospital camera footage inside the ED hallway visualizing the triage room door revealed Patient #1 entered the triage room on 07/31/2025 at 1:37 AM, and at 1:42 AM, went back through the door into the ED waiting room. Review of the hospital camera footage inside the ED hallway revealed Patient #2 was escorted and triaged in room ED1 at 1:51 AM. Review of the Nurses Clinical Report dated 07/31/2025, revealed Patient #1 arrived at the ED on 07/31/2025 at 1:23 AM. He arrived by private vehicle and was unaccompanied. Patient #1’s chief complaint was a genital lesion and a stuffy nose, both had been present 2 years and needed to get “checked out.” Further review revealed, “...Assessment 01:30 [AM] 07/31/2025...Patient appears calm and cooperative...NURSING PROGRESS NOTES...01:45...Pt [Patient] placed in lobby. No acute distress noted...DISPOSITION/DISCHARGE...The patient left the Emergency Department without being seen by a physician...He left the Emergency Department ambulatory and via private vehicle...Departure time: 02:30 [AM] 07/31/2025...” Review of the City Police Department’s “PRELIMINARY INVESTIGATIVE REPORT” dated 07/31/2025 at approximately 2:00 AM, showed Patient #2 was fondled by Patient #1. The summary showed, “...[Named Patient #2] stated that when she was out in the lobby of the Emergency Room waiting to be called back, a male subject [Patient #1] who she did not know came over to her and kept repeatedly touching her shoulder and telling her to breath because she was in pain. She stated that this happened a few times, and at one point the male subject’s hand “wandered down” and he grabbed her left breast. She stated that the front desk receptionist told the male subject that he was not allowed to touch other patients and the subject stopped. She also stated that to her knowledge no one saw the male subject grab her breast. I [K-9 Officer] [K-9 - a police dog specifically trained to assist members of law enforcement] then spoke with the emergency room staff who stated that the male subject has came in intoxicated, and had been giving the front desk receptionist a hard time about wanting to be seen sooner. I then went and spoke with the receptionist...[Named Receptionist] stated that she did in fact see the male subject touching [Named Patient #2], but she did not see him grab her breast. I then made contact with the male subject...[Named Patient #1] stated that all he did was touch her on the shoulder with two fingers and attempt to calm her down, and when he was told to not touch anyone by [Named Receptionist] he stopped...I also spoke with hospital security staff in an attempt to see video footage...I was unsuccessful. At the request of the hospital staff, [Named Patient #1] was trespassed from the property...” The facility verified the cameras in the ED waiting room were not operational on 07/31/2025. Review of the police body camera footage with audio confirmed the above dialogs with Patient #2, the Receptionist and Patient #1. Review of the facility’s “Incident Report” dated 07/31/2025, showed “...Report Title Patient Harasses others in the ER Reception/Waiting Area...Narrative text...At 1:50 AM I [Security Officer C] was called to the ER reception waiting area by Reception Admin [Named Receptionist]...She informed me that she had observed a patient in the reception waiting area [Named Patient #1] touch another patients shoulder [Named Patient #2] and was talking too much to the other patient in the waiting area, with the patient who’s shoulder that had been touched stating to [Named Receptionist] that this patient was making her feel uncomfortable. [Named Receptionist] went on to inform me that when she told [Named Patient #1] not to touch other patients he became argumentative with her, and that is why she was seeking assistance from Security to speak with him and ask him to keep to himself. [Named Patient #1] was not receptive to my conversation with him and claimed that [Named Receptionist] was disrespecting him and he wanted to speak to the Administrator in charge. I let him know I would convey that message to [Named Receptionist] however he needed to comply with the direction that was being given. I then let [Named Receptionist] know what had been said by [Named Patient #1], and she stated she would let the charge nurse know, [Named Charge Nurse A]. I returned to the Security Desk area...I was again asked to respond to the ER Department and I was informed that because [Named Patient #1] had touched another patient, [Named Patient #2], the Police had been notified and were en route...Police already on site in the ER Department. [Named Charge Nurse A] wanted to know how to access the feed from the cameras for the ER Reception Waiting area. I contacted the Command Center to see if they knew how to access the feed, however they stated that they did not have access to that information and to check with the local administrator of the camera system in [Named Hospital County Name]...K-9 Officer stated that should [Named Patient #1]attempt to leave the waiting area to let them know. A few minutes later [Named Patient #1] did go out the ER front door and I informed [Named K-9 Officer] immediately. [Named K-9 Officer] and the two Officers went out after him and were able to detain him. With one of the Officers remaining outside with [Named Patient #1], [Named K-9 Officer] and the other Officer returned to the ER Reception area and asked [Named Receptionist] what action needed to take place. [Named Receptionist stated that [Patient #1] was to be trespassed. The Officers then returned outside, and it appeared that all parties had departed from the Hospital site at 2:55 AM. It is unknown at this time if in fact [Named Patient #1] was trespassed, only that as of the writing of this report he has not returned to [Named Hospital] ...” Review of a handwritten statement by the Receptionist signed and dated 07/31/2025, revealed, “I walked out of the ER door and witnessed [Named Patient #1] touch another patient [Named Patient #2] on the shoulder. I told him not to touch the other patients. He argued a little. I went back and got the patient a blanket and when I came back [Named Patient #2] told me that he was making her uncomfortable so I went and got security to speak with him.” Review of a handwritten statement by Charge Nurse A dated 07/31/2025, revealed “0155 [1:55 AM] Pt reported to her primary nurse...that a male patient in the lobby had touched her breast. [Named Primary Nurse] reported incident to me, house charge. 0157 [1:57 AM] This nurse called comm [Command] center to report incident and patient [Patient #2] also wanted to press charges and file a report...” Review of a handwritten note from the County Mayor dated 07/31/2025, revealed “...[Named Patient #1] came in to complain about hospital when he went last night - had had some alcohol beverage said because...he was mistreated - said woman complained he inappropriately touch her. Said camera footage proved he didn’t. “City police backed him up.” He said Sheriff dept and hospital didn’t & he is to stay away from hospital” Review of the grievance log entry dated 07/31/2025, revealed “[Named Patient #1 states he presented to the ER lobby with a complaint of genital lesion and runny nose. He feels the registration clerk had a bad attitude from the beginning. He stated he was sitting in the lobby waiting to be seen and another patient appeared to be upset. He touched her shoulder in an attempt to calm her. He said the next thing he knew security and city police were asking to speak with him. He was accused of touching the female patient patient in the lobby inappropriately...He was told he was trespassed from the facility. He went and spoke with the mayor this morning as he feels he was falsely accused and is “frightened” at the thought of needing medical care and not being able to come to this hospital. [Named Patient #1] states the registration clerk was discriminatory...” Review of a typed letter sent to Patient #1 from the hospital dated 08/06/2025, revealed “...During your conversation with the Quality Coordinator on August 4th, 2025, you stated you were consulting an attorney regarding your experience in the Emergency Department...From a Customer Service standpoint, we believe the Emergency Department Director answered all your questions to the best of our ability during her conversation with you on July 31, 2025 and are considering this matter closed as of August 6th, 2025. Any further communication regarding this matter will need to be directed to Risk Management...” During a telephone interview on 08/19/2025 at 5:32 AM, Registered Nurse A, who worked as the house supervisor on 07/31/2025 stated she triaged Patient #1 and did not witness anything in the lobby. Registered Nurse A also stated she moved Patient #2 back to a room when she complained of being uncomfortable. The police were called but had trouble getting video footage at that time. She stated Patient #1 left of his own accord and walked out the front door. She stated he was not asked to leave or escorted out. During a telephone conversation on 08/19/2025 at 5:42 AM, the Receptionist stated Patient #1 walked in and she checked him in. She stated he was talking to other patients. She stated she did not call the police. The Receptionist stated she called security to get him [Patient #1] to stop antagonizing her and he wouldn’t leave her alone. She stated he was very upset, and he had already been triaged. She stated the police asked her to let them know if he walked out. During an interview on 08/19/2025 at 12:00 PM, the Director of Quality and Infection Prevention stated there was no written statement from Patient #1 related to this incident on file at the police department and no other report was filed by Patient #1 regarding this incident. At 12:15 PM, the Director of Quality and Infection Prevention stated Patient #1 reported this incident to the mayor. She stated the mayor did come to the hospital and spoke to the president of the hospital. She stated the mayor said he knew him and he was always up here (at the mayor’s office). She stated the mayor communicated to the president that he was not concerned. During an interview on 08/19/2025 at 12:30 PM, the president of the hospital stated Patient #1 did call the mayor. During an interview on 08/19/2025 at 2:05 PM, Security Supervisor stated there was a written trespass policy but it was not set up at that hospital (the hospital location of this incident) at the time of the interview. He stated security is working on getting it implemented at that facility location. The Security Supervisor explained the process and equipment was needed at that location to implement the trespass policy. During an interview on 08/19/2025 at 2:47 PM, Security Guard C stated he did not tell Patient #1 to leave the property and he did not see Patient #1 leave the property. Review of police body cam footage with audio showed the K-9 Officer was at the reception desk in the ED and asked the receptionist, “...What is ya’lls policy on trespassing people...?” The receptionist stated, “I’ve got somebody trespassed before...” The additional comments by the receptionist were not understandable on the footage. The K-9 Officer walked outside the ED Entrance door with another officer to speak with Patient #1. Review of police body camera footage with audio outside the ED entrance, in the driveway, revealed the K-9 Officer speaking with Patient #1, who was sitting on the curb. The K-9 Officer stated to Patient #1, “...The hospital don’t want you here, they want to trespass you, so you may have to go to the hospital somewhere else, I don’t know but they don’t want you here...I have to explain all that to you and they don’t want you here. If you come back on the property, you can be arrested for criminal trespassing ok?” Patient #1 stated, “Ok, yes sir.” The K-9 Officer asked Patient #1 if he still wanted to fill out a statement too. Patient #1 stated, “Yes sir ...I do respect sir, I do respect...nobody should be treated this way...trust me sir, this is not the end sir, trust me...” The K-9 Officer stated, “I understand, I just had to make sure you know they don’t want you back here, so just don’t come back up here...” Patient #1 continued to write his statement while sitting on the curb. The K-9 Officer read over the statement and asked Patient #1 to sign and date it. The K-9 Officer stated to Patient #1, “Alright man, just gotta make sure you leave ok.” Patient #1 stated, “Yes sir...” Patient #1 then left the property. The police department did not provide Patient #1’s written statement to this investigation.”