Arbor Health Morton Hospital

“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: 42740 . Based on interview, record review and review of hospital policies and procedures, the hospital failed to develop and implement policies and procedures for evaluation, treatment and appropriate transfer or discharge of patients presenting for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA). Failure to ensure patients receive a medical screening examination by a qualified medical professional and stabilizing treatment prior to transfer or discharge risks poor health care outcomes, injury, and death. Findings included: 1. The hospital failed to provide medical screening examinations and stabilizing treatment for 3 of 23 patients (Patient #2, Patient #10, Patient #20) presenting to the emergency department (ED). Cross Reference Tag A-2407 .”

“STABILIZING TREATMENT CFR(s): 489.24(d)(1-3) (1) General. Subject to the provisions of paragraph (d)(2) of this section, if any individual (whether or not eligible for Medicare benefits) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either- (i) within the capabilities of the staff and facilities available at the hospital, for further medical examination and treatment as required to stabilize the medical condition. (ii) For for transfer of the individual to another medical facility in accordance with paragraph (e) of this section. (2) Exception: Application to inpatients. (i) If a hospital has screened an individual under paragraph (a) of this section and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual (ii) This section is not applicable to an inpatient who was admitted for elective (nonemergency) diagnosis or treatment. (iii) A hospital is required by the conditions of participation for hospitals under Part 482 of this chapter to provide care to its inpatients in accordance with those conditions of participation. (3) Refusal to consent to treatment. A hospital meets the requirements of paragraph (d)(1)(i) of this section with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the individual of the examination and treatment, but the individual (or a person acting on the individual’s behalf) does not consent to the examination or treatment. The medical record must contain a description of the examination, treatment, or both if applicable, that was refused by or on behalf of the individual. The hospital must take all reasonable steps to secure the individual’s written informed refusal (or that of the person acting on his or her behalf). The written document should indicate that the person has been informed of the risks and benefits of the examination or treatment, or both. This Standard is not met as evidenced by: 42740 . Based on interview, document review, and review of hospital policies and procedures, the hospital failed to provide medical screening examinations and stabilizing treatment for patients presenting to the emergency department (ED) for 3 of 23 (Patient #2, Patient #10, Patient #20) records reviewed. Failure to provide medical screening examinations and stabilizing treatment for patients presenting to the ED for care risks patients not receiving care resulting in illness, injury, or death. Findings included: 1. Review of the hospital’s policy titled, “Emergency Medical Treatment and Labor Act (EMTALA),” number 11228, revised 06/18/24, showed that the hospital provides a medical screening examination (MSE) to determine whether an emergency medical condition (EMC) exists to anyone who presents to the ED. Review of the hospital’s policy titled, “Process When Patients Leave Without Being Seen,” number 20579, revised 11/28/23, showed that if an individual chose to withdraw their request for examination or treatment, the triage nurse or provider should offer the individual further medical examination and inform the patient the benefits of exam and the risks of leaving prior to examination. Clinical staff should take all reasonable steps to secure the individual’s written informed consent which indicated that they refused examination and treatment. 2. Review of the hospital’s document titled, “Medical Staff Rules and Regulations,” revised 2024, showed the following: a. Every patient who comes to the hospital, on whose behalf a request is made for examination or treatment for a medical condition, will be provided with a medical screening examination. b. If a patient is offered a medical screening exam, but refuses, they will be asked to sign form(s) acknowledging that they have refused the MSE. The refusal will be documented. 3. Investigator #1 and Investigator #2 reviewed a sample of medical records. The review showed the following: Patient #10 a. On 02/07/25 at 1:47 PM, Patient #10 registered for care in the ED with a request for amphetamines. The patient notified a registration staff member that he was going to leave because his urine drug screen was going to be positive. Documentation of registration staff notifying clinical staff, clinical staff reviewing risks of leaving with patient, and a signed refusal of care could not be found. Patient #2 b. On 02/27/25 at 2:26 PM, Patient #2, a 34-year-old female with a history of intellectual disability and selective mutism, arrived in the ED accompanied by her mother. The mother requested that Patient #2 be seen for throat pain and inability to eat. The patient was registered for care, and the nurse (Staff #14) brought the patient to triage. During the triage process, the mom requested a referral to a gastro-intestinal (GI) specialist. Staff #14 stated that the ED did not give outpatient referrals to GI specialists. The patient’s mom responded by saying that she would drive Patient #2 to another town and get her own referral. Patient #2 then gave Staff #14 a hug and left the ED with her mom. Documentation of clinical staff reviewing the risks of leaving with patient and a signed refusal of care could not be found. Outside medical record review showed that Patient #2 was triaged at another hospital less than 4 hours later. The patient agreed to be evaluated and was admitted for malnutrition. Patient #20 c. On 04/23/25 at 4:55 PM, Patient #20 registered for care in the ED with the chief complaint of back pain. The patient was triaged and then asked to wait in the waiting room. The patient refused to wait, despite her family’s encouragement, and the family used a wheelchair to wheel the patient out. Documentation of registration staff notifying clinical staff, clinical staff reviewing risks of leaving with patient, and a signed refusal of care could not be found. Patient #20 returned to the ED the following day with the complaint of increased back pain. The patient agreed to care and was diagnosed with a cardiac event and transferred to a higher level of care. 4. On 06/04/25 at 12:30 PM, Investigator #1 interviewed the Quality Management, Risk, and Regulatory Compliance Officer (Staff #3). Staff #3 stated that signed documentation of Patient #2 refusing care or refusing to sign documentation could not be found for the visit that occurred on 02/27/25. Staff #3 stated that there wouldn’t be an against medical advice (AMA) form for patients who chose to leave before being seen because AMA was only after they’ve been seen by a provider. Staff #3 stated that they don’t have a refusal form for before a MSE because patients have the right to choose not to be seen. 5. On 05/28/25 at 11:00 AM, Investigator #1 and Investigator #2 interviewed the Assistant Chief Nursing Officer (CNO) (Staff #1). Staff #1 confirmed that Patient #2, Patient #10, and Patient #20 chose to leave the hospital without completing their MSE process. .”

“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: 27347 . Based on interview and document review, the hospital failed to implement their policies and procedures for evaluation and treatment of a patient that presented for emergency care in accordance with the Emergency Medical Treatment and Labor Act (EMTALA). Failure to ensure patients receive a comprehensive medical screening examination by a qualified medical professional and stabliizing treatment prior to transfer or discharge risks poor health outcomes, injury and death. Findings included: The hospital failed to ensure that a patient received a medical screening exam before they left the emergency department (ED). Cross Reference: 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: 27347 . Based on interview and document review, the hospital failed to implement its policy under Emergency Medical Treatment and Labor Act (EMTALA) to provide a medical screening exam to a patient that presented to the emergency department (ED) for 1 of 21 patient records reviewed (Patient #1). Failue to implement their policy put patients at risk for poor outcomes when a medical screening exam is not completed that may reveal a medical emergency that requires care and treatment. Findings included: 1. Document review of the hospital policy titled, “Emergency Medical Treatment and Labor Act (EMTALA),” revised 10/23, showed that all patients that presented to the ED were to be given a medical screening exam to rule out a medical emergency. 2. On 05/21/24 at 10:30 AM, the investigator interviewed the ED registration specialist (Staff #5). Staff #5 stated that in April a patient came into the ED complaining of kidney pain. The ED physician on duty came out and told the paitent the CT scan machine was not working. The physician did not offer a medical screening exam (MSE). The patient left the ED before Staff #5 could get their name. 3. On 05/21/24 at 11:30 AM, the investigator interviewed the ED physician on duty (Staff #7). Staff #7 remembered telling a patient with flank pain that the hospital CT scan was not working. The patient left the ED without getting a MSE. Staff #7 stated that the patient should have received a MSE and if warranted, transferred to another hospital after the MSE. 4. On 05/21/24 at 1:30 PM, the investigator interviewed Patient #1. Patient #1 stated that on 04/21/24, they came to the hospital to get help for pain for their kidney stones. Patient #1 stated they were told by the ED physician the CT scan was not working. The patient was not offered a MSE and left with their family member. The pain intensified on the way to another hospital and 911 was called. The fire department ambulance came and transported the patient from their car on the side of the road to another hospital for care. 5. Document review of Emergency Response records showed that on 04/21/24 they/them (Patient #1) was picked up from their car on the side of the road by the local fire department. Patient #1 was on their way to the hospital when the pain increased causing the patient to pass out. The patient was transported to the another hospital by ambulance. 6. On 05/21/24 at 2:00 PM, the investigator interviewed the Manager of Quality/Risk & Regulatory (Staff #11). Staff #11 verified the investigator’s findings. Staff #11 stated that all patients presenting to the ED were to receive a MSE to rule out a medical emergency. Staff #11 stated that on 04/21/24 the ED staff self-reported that a patient had not been given a MSE. There was no name of the patient as the patient had left the ED before a name could be obtained. 7. Document review of the ED visit where Patient #1 was transported showed the patient was treated and released for a kidney stone on 04/21/24.”