CMS cites University of Maryland hospital for EMTALA violations

The CMS cited the University of Maryland Medical Center for violating the Emergency Medical Treatment and Labor Act for its handling of a mentally ill patient earlier this year. The patient was found in just a gown and socks outside the medical center's midtown campus in Baltimore on a freezing night last January.

The agency determined that the hospital's emergency department staff failed to open a new encounter form for the woman on its electronic health record system when she returned within an hour after being discharged, resulting in her not being captured on the EMTALA log, the CMS disclosed Tuesday.

According to the CMS investigative report, the hospital kept the entrance door to the ED waiting room and registration area locked, and only security staff could open it. But the two security guards on duty at the time of the incident did not know the requirements of the federal EMTALA law, even though they had received training.

No information was immediately available on whether the hospital agreed to pay civil monetary damages in connection with the EMTALA violations.

A passing psychotherapist videotaped hospital security guards escorting the woman to a bus stop and called 911, after which an ambulance crew took her back to the hospital. The Jan. 9 incident elicited widespread outrage as an example of patient dumping. UMMC CEO Dr. Mohan Suntha quickly apologized, saying his hospital did not provide "basic humanity and compassion."

The CMS said there was "no relevant reason as to why non-clinical staff such as security guards would be placed in a position to determine who could and could not enter the locked door to the ED." In addition, it found the hospital did not identify which medical staffers were qualified to conduct a medical screening exam.

As a condition of participation in Medicare, the 1986 EMTALA law requires hospitals to screen patients for emergency medical conditions and provide stabilizing treatment, regardless of their ability to pay. Hospitals found in violation of the law potentially face a $50,000 civil fine per incident and can be barred from the Medicare and Medicaid programs. The law also gives dumped patients or their families the right to sue the provider.

In the CMS report, the hospital said the incident "clearly represented an aberration from our commitment to high quality patient care." It said it conducted an immediate internal root cause analysis, engaged outside experts to perform an independent analysis, and received an audit from the Joint Commission. UMMC said it established a corrective plan to address the deficiencies, which has been accepted by the CMS.

The hospital said it had discontinued its informal rule of not opening a new encounter form on the EHR when patients returned within two hours, a practice it has used with patients who repeatedly returned to the emergency department.

"We take responsibility for the combination of circumstances in January that failed to compassionately meet our patient's needs beyond the initial medical care provided," Karen Lancaster, UMMC's vice president of corporate communications, said in a written statement. "We pledged to our community and patients to do and be better, and we are confident that we already are."