BREMERTON — Harrison Medical Center is investigating allegations made by a Seattle couple that the medical center failed to identify their injuries from a vehicle collision and provide adequate care.

In a March 15 letter to Harrison CEO Scott W. Bosch, the Centers for Medicare and Medicaid Services — a division of the U.S. Department of Health and Human Services — 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 examination.

“We are responding to this aggressively,” Bosch said Friday. “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 spokeswoman Jacquie Goodwill said Friday the allegations, if true, are a “complete departure from our mission.” She said Harrison is working with the Centers for Medicare and Medicaid Services, or CMS, “to find out what the truth is.”

“We’re working to determine why CMS came to those conclusions,” she said. “If we did something wrong, we’ll own it.”

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 that 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. 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 the CMS letter.

Harrison has until March 25 to respond in writing to the state Department of Health and the Centers for Medicare and Medicaid Services. Harrison must either prove “that the deficiencies didn’t exist,” or provide a plan for correcting those deficiencies, according to the letter.

A plan of correction must be submitted no later than April 14, according to the letter. Failure to prove or correct could lead to termination of Harrison’s participation in Medicare effective June 13.

Bosch declined to discuss details of the Snowdens’ complaint because of the investigation. He said that to the best of his knowledge, “This is our only EMTALA violation,” using the abbreviation for the Emergency Medical Treatment and Labor Act. Asked if he was saying there had been a violation, he said, “I can’t say that. It’s part of the investigation. I can’t comment on it because we’re investigating it.”

After a story about the Snowdens’ case was posted on NorthKitsapHerald.com March 22 (it was published in the Herald March 23), Harrison issued a summary of the notification to its department heads.

“As you may know, Harrison Medical Center was recently surveyed by the Department of Health due to an allegation from a patient of non-compliance with the Emergency Medical Treatment and Labor Act (EMTALA). This act requires us to provide screening and treatment of patients, regardless of their ability to pay.

“On March 15, Harrison received a notice from the Center for Medicare and Medicaid Services (CMS) stating that, based on this survey and subsequent investigation, that there were grounds for a determination of non-compliance. With this determination, Harrison must respond with a plan of corrective action to address each of the allegations/deficiencies by March 25.

“Harrison takes any complaints about the quality of care provided very seriously and we have completed our own investigation. We have responded fully to the CMS notice and will continue working with them to reach a satisfactory resolution. Harrison is absolutely committed to complying with all state and federal laws in all that we do.

“The North Kitsap Herald ran a story on this issue yesterday. Unfortunately, HIPAA patient privacy rules do not allow us to share the specifics of this case, so we are limited in our public response.”

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.

Because the notice has not been made public by CMS, the agency could not comment Thursday, except to confirm that Harrison was placed on a termination track, CMS employee Stephanie Magill said.

The Snowdens, 57 at the time of the crash, are self-employed. Their medical bill is about $200,000, Mr. Snowden said. The couple has not been able to work since December after the collision, and are “getting around by the graces of our friends.”