Details emerge on HCA Mission's EMTALA violation

CMS has approved HCA Mission Hospital's plan of correction to address a violation of the Emergency Medical Treatment and Labor Act regulators uncovered at the Asheville, N.C., hospital during a visit last November. 

In March CMS notified leadership at Mission Hospital that inspectors with the North Carolina Department of Health and Human Services had uncovered an EMTALA violation during a visit in November. At the time, CMS said Mission had failed to comply with EMTALA standards related to medical screening exams, though no other details were provided. EMTALA is a longstanding federal law that requires Medicare hospitals provide all patients appropriate emergency care, which includes "appropriate medical screening, examination, stabilizing treatment and transfer, if necessary." 

CMS has since issued new documents detailing what led to the EMTALA violation, which were obtained by Blue Ridge Public Radio and the Ashville Watchdog. In October, a 66-year-old patient went into cardiac arrest and died about two hours after he presented to the hospital complaining of chest pain, according to the latest CMS documents. According to inspectors, emergency medical services brought the patient to the ED around 6 p.m. 

He was transferred from EMS to hospital staff care at 7:07 p.m., more than an hour after his arrival. He went into cardiac arrest just before 8 p.m. and died shortly after, according to regulators, who determined "there was a delay in triage, medical screening and interventions" for the patient. The patient's death is one of four mentioned in CMS' initial report detailing what led to an immediate jeopardy sanction at the hospital in December, which has since been lifted.

Audits of the triage system, nursing staff education and increased patient tracking measures are among the measures outlined in Mission's correction plan for the EMTALA violation. The hospital now has until June 5 to fully implement its correction plan and avert the loss of federal funding, according to federal regulators. 

"When the North Carolina State Survey Agency has determined that the noncompliance with EMTALA requirements has been corrected, CMS will withdraw its current termination action," the agency said in a March 26 letter to the hospital's CEO, Chad Patrick, according to the news outlets. "Failure to correct the deficient practice by June 5, 2024, will result in the termination of your Medicare provider agreement." 

The June deadline also applies to the immediate jeopardy status. When it was lifted in late February, federal regulators notified the Mission Hospital it had until June 5 to come back into full compliance. 

"As we continue to state, we take these matters very seriously and have made significant process changes to improve our patient care experience," Nancy Lindell, a spokesperson for the hospital, told Becker's. "Ongoing measurement of various indicators, including EMS offload times and patient satisfaction, validates what we are hearing from our patients, providers and EMS partners — that our care teams are excellent and significant improvement in emergency care has been recognized."

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