POULSBO — The Centers for Medicare & Medicaid Services has “accepted” Harrison Medical Center’s plan to correct deficiencies that led to a violation of the Emergency Medical Treatment and Labor Act, according to Stephanie Magill, director of public affairs for CMS.

CMS will make an unannounced visit to Harrison to ensure the medical center is complying with the treatment and labor act.

Details of the CMS investigation and Harrison’s plan of correction were not available Tuesday from CMS or Harrison. On Tuesday, the Herald submitted to CMS a Freedom of Information Act request for the investigation report and the plan of correction.

“We are looking forward to their upcoming unannounced visit to conclude this investigation,” Harrison spokeswoman Jacquie Goodwill said.

The plan was filed after CMS determined the medical center failed to identify a couple’s injuries from a vehicle collision and provide adequate care. It was the medical center’s second violation of the Emergency Medical Treatment and Labor Act since 2000, Magill said Tuesday.

Joseph and Debra Snowden were taken to Harrison after a car crash on Hansville Road in Kingston Dec. 30. Mr. Snowden said his left leg received 30 stitches, but doctors failed to diagnose a broken right foot. He said his wife’s injuries were overlooked and they were sent home with a prescription for medication.

“We were told all was fine and released shortly after,” Mr. Snowden wrote. Four days later, they returned to Harrison because Mrs. Snowden’s pain hadn’t subsided and she was having difficulty breathing.

“My wife had to have an emergency operation because she had been bleeding internally and had four broken ribs and a fractured sternum,” injuries not diagnosed during the first visit to the emergency room, according to his complaint. In addition, her spleen had ruptured and had to be removed. Mr. Snowden had a smashed right foot, which was not recognized “because they refused to X-ray it, they said nothing was wrong” and he had to have reconstructive surgery at a Seattle hospital.

The Snowdens complained to the U.S. Department of Health and Human Services, of which CMS is a part. On the department’s behalf, the state Health Department investigated Feb. 8; the investigation included “a review of … policies and procedures, interviews with staff, review of a sample of emergency room medical records, and a (Quality Improvement Organization) case review by a physician who is a specialist in the area under review,” according to a letter from CMS.

In a March 15 letter to Harrison CEO Scott W. Bosch, CMS found the hospital “failed to enforce policies to ensure compliance” with the Emergency Medical Treatment and Labor Act and “failed to provide an appropriate medical screening exam.”

“We are responding to this aggressively,” Bosch said March 23. “We have a very strong commitment to patient safety and obeying the laws of the land. We do not turn anybody away based on their ability to pay. From May 1 through February, we have provided $17 million worth of free care to those who don’t have the ability to pay. That demonstrates a massive commitment to all patients.”

Harrison had until March 25 to respond in writing to the state Department of Health and CMS. Harrison choices were to prove “that the deficiencies didn’t exist,” or provide a plan for correcting those deficiencies, according to the CMS letter. Failure to prove or correct could have led to termination of Harrison’s participation in Medicare effective June 13.

Harrison Medical Center has 2,400 employees and its emergency room treats 70,000 patients a year, Bosch said. Ninety-two percent of emergency room nurses are certified in emergency nursing, and all ER doctors are board-certified in emergency medicine, Bosch said.

The Snowdens, 57 at the time of the crash, are self-employed organic gardeners and maintenance workers with a business office in Seattle, Mr. Snowden said. They live in Poulsbo. The couple has not been able to work since the collision.

“I’m still unable to walk. I’m in a cast,” Mr. Snowden said. His wife sleeps in a chair. “She can’t lay down very well because of the broken ribs. She’s healing real slow. We’re doing the best we can do.”

Of Harrison’s correction plan, Mr. Snowden said, “It’s a start,” but he’d like others who’ve had similar experiences to come forward “so we can get the bad apples out of there.”

“I want these people who caused our problems held accountable. We were told everything was OK with us. If I hadn’t brought (my wife) in, she would have died.”

Mr. Snowden said the medical center emergency room wasn’t busy when he and his wife were brought in after the crash. He said he and his wife were “in there for hours” before they were discharged.

Goodwill said Harrison’s emergency room is always adequately staffed.