The Hospitals of Providence Transmountain Campus

“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: 28421 Based on record review and interview, the hospital failed to comply with 42 CFR 487.24 Special responsibilities of Medicare hospitals in emergency cases. Specifically, the facility failed to provide an appropriate medical screening examination (MSE) within the capability of the hospital’s emergency department to determine whether an emergency medical condition (EMC) existed for 1 of 1 patient (Patient # 1) reviewed that presented to the emergency department on 6/27/25 with complaint of altered mental status. Patient # 1, a female with IDD (Intellectual and Developmental Disabilities) presented to facility A from her group home after being found unconscious and unresponsive on her couch. She was brought to the hospital via EMS without group home staff. Based on record review and staff interviews, the hospital staff failed to provide Patient # 1 a thorough medical screening exam prior to discharging patient back to her group home.”

“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: 28421 Based on record review and interview, the hospital, Facility A, failed to provide Patient # 1 an adequate medical screening on 6/27/25 which resulted in a 2nd visit to the ED later that same day. Findings were: Patient # 1 was transported via EMS to the ED of Hospitals of Providence Transmountain Campus on 6/27/2025 with complaint of altered mental status. Per EMS patient was found unconscious and unresponsive on her couch. Patient had a history of Down Syndrom, CHF and MI. She returned to baseline mentality and was returned to her group home. Later that evening, Patient # 1 was transferred again to the ED after experiencing seizure-like activity. Upon evaluation, she was given a CT scan of the head which indicated a possible left sided hemorrhage. ED Record # 1 dated 6/27/25 at 8:07am BIBA pt coming from foster home for possible seizure like activity as of this morning, no fall or head strike reported. Patient with Hx of Down Syndrome, no family or caregiver present at this time. History of Present Illness: Pt is a 57-years-old female who presents to the ED via ambulance with c/o altered mental state. Onset of symptoms was PTA. Duration of symptoms is constant. Initially sxs were unknown. Presently, sxs are ongoing. Exacerbating factors include: nothing. Improving factors include: nothing. Risk factors include: Pt has a history of Down Syndrome, Hypothyroidism, CHF, MI, PE on Eliquis. Therapy for current sxs consists of: nothing. Associated symptoms: positive for episode of urinary incontinence. Negative for all other ROS. Context: patient is coming from home due to altered mental status. Per EMS, the Pt was found unconscious and unresponsive on her couch. EMS arrived and the patient was only responsive to painful stimuli. Pt is currently more alert. Patient does not have a history of seizures ... Musculoskeletal: Normal ROM, no tenderness, no swelling, no deformity. Resolving ecchymosis to right knee. Moving all four extremities ... RN spoke to staff at the nursing home the patient is staying at. Per staff, the patient was seen by a doctor yesterday as the patient has been having these dizziness/fainting spells for quite some time. At the doctor’s office, the patient could not provide a urine sample, so it is unknown if she has an infection. Staff reports that patient had COVID-19 2 weeks ago and she was presenting similarly to how she is today. Confirmed that the patient does not have a history of seizures. Lab results have been reviewed and independently interpreted by MD # 2, EDMD: No Leukocytosis, no anemia, no electrolyte abnormality, no UTI, negative troponin, normal lactic (screen for recent seizure). Pt recheck. EDMD at bedside. Patient is back to baseline and eating. No evidence of neuro deficit. Patient’s sister speaking to patient on phone and confirms she seems to be at baseline ... Patient given precautions to return. Based on the patient’s history, exam and diagnosis evaluation, there is no indication for emergent surgery or inpatient treatment. It is understood by the patient/guardian that if the symptoms persist or worsen, they need to return immediately for re-evaluation. Patient in NAD, VSS, verbally affirms understanding and agrees with treatment plans, f/u instructions and discharge plans.” ED Record # 2 dated 6/27/25 at 2200 “Chief Complaint: Patient BIBA from foster home for possible seizure. Per EMS, patient is postictal at this time. History of Present Illness: History limited due to clinical condition. History obtained independently by RN who took EMS report. Patient is a 57-year-old female who presents to the ED with c/o altered mental status. Onset of symptoms was today. Character of sxs is “post ictal state.” Risk factors include MI, PE, Down Syndrome. Therapy for current sxs consists of EMS. Context: Patient presented to the ED after being found in a post ictal state. Patient was seen in the ED earlier in the morning for possible stroke and sent home. No family at bedside to provide further information. PMHx: MI, PE, Down Syndrome. PSHx: Open heart surgery. On Eliquis for PE. Patient is coming from a foster home.” Orders: “CBC: mild anemia CMP: WNL/no electrolyte abnormalities/normal kidney function UA: WNL, no UTI Troponin: WNL/negative, r/o ACS Ammonia Level: WNL CT Head: Possible left sided hemorrhage. Pending official radiology read ... 57-year-old female with a PMHx significant for MI, PE, Down Syndrome presents to the ED with c/o altered mental status. Vital signs reviewed: tachypneic. Exam: no unilateral weakness. Difficult to determine change in mental status-unknown baseline status. Large bruise to right knee. Will administer IV fluids for hemodynamic management and order labs, CT head, ECG, x-ray right knee ... RN spoke to home owner. Per foster care owner, two weeks ago patient was dx with COVID -19 and since then, patient would act dizzy and drop to her knees. This morning, they attempted to walk her and she got dizzy so they sat her down and her mouth was moving to the side and eyes were flickering and she wouldn’t come to. Patient was sent to the ED in the morning. Unknown what occurred PTA as staff that witnessed is not available. CT head independently interpreted by EDMD: Possible left sided hemorrhage. Pending official radiology read. EDMD spoke to nursing homeowner. Last dose of Eliquis was at 1900 today. They are denying any recent falls ... Phone consultation with Radiologist. Verbal findings of CT head by Radiologist: Severely limited study due to motion. Posterior medial left parietal 2.6 cm parenchymal hematoma. These verbal findings were relayed to EDMD over the phone. Phone consultation with Neurosurgeon. Discussed the patient’s HPI, PE findings, labs (mild anemia) and imaging results (CT head: severely limited study due to motion. Posterior medial left parietal 2.6 cm parenchymal hematoma.) Neurologist agrees with and accepts consult. Recommends transfer to THOP Sierra Campus ICU. Recommends loading dose of Keppra, PCC if we have it, try and sedate patient to get CTA head and neck, and admit to IM. This does not appear traumatic. Phone consultation with Hospitalist at THOP Sierra Campus. Discussed the patient’s HPI, PE findings, labs (mild anemia), and imaging results. Hospitalist agrees with and accepts patient transfer/admission to THOP Sierra Campus ... XR Knee: Findings: There is no fracture. Joint spaces are preserved. There is moderate diffuse soft tissue swelling. Impression: No acute findings.” ED DON was interviewed on 2/10/26. He reviewed the patient’s medical record and stated that Patient # 1 had come to their ED twice on 6/27/25. The first visit was at 7:26am. She was brought in via ambulance with a complaint of altered mental status. EMS found her unresponsive at her group home and transported her to the ED. She had lab work done and was released when her mental status returned to baseline. A large bruise was noted to her right knee, but she was able to move all of her extremities normally. Her group home was instructed to return if her symptoms persisted. Her second visit was that same day at 10pm. She appeared to have had a seizure. During this visit she had more lab work, a CT scan of her head and neck, an EKG and an x-ray of her right knee which revealed no fracture. She was transferred to another Providence facility where she could be seen by a neurosurgeon for the recent seizure activity. The above findings were confirmed in an interview with with the DCQI on 2/10/26.”