HospitalInspections.org

Based on a review of records and interviews, the facility failed to perform and document an appropriate medical screening examination in the emergency department (ED) to determine if the patient was stable or had an emergency medical condition.

Findings included:

A review of the policy titled EM004 EMTALA - Medical Screening Examination and Stabilization, stated in part,
"...Purpose: To ensure that all individuals who Come to the Emergency Department (as defined in #7 of Definitions in the policy EM001 Hospital Compliance with EMTALA-CDCorp) receive an appropriate Medical Screening Examination and further examination and Stabilizing treatment as required by EMTALA and all Federal regulations and interpretive guidelines promulgated thereunder.
Policy:

1) Any individual who comes to the Emergency Department will be provided an appropriate Medical Screening Examination performed by a Physician or Qualified Medical Person to determine if the individual has an Emergency Medical Condition. If an individual is determined to have an Emergency Medical Condition, Seton Medical Center Harker Heights will provide further examination and treatment necessary To Stabilize the Emergency Medical Condition, within Seton Medical Center Harker Heights's Capability and Capacity.

2) Seton Medical Center Harker Heights will not delay the Medical Screening Examination in order to inquire about an individual's method of payment or insurance status. Seton Medical Center Harker Heights is discouraged from asking any questions about payment or insurance status until after the Medical Screening Examination is completed and appropriate, any Stabilizing treatment initiated..."

A review of the medical record on January 3, 2023, for patient #1 revealed the patient presented to the emergency department on 11/23/22 at approximately 12:09 pm with complaints of a hand injury. The patient was triaged upon arrival, became combative, and security was called. There is no evidence that the patient received a medical screening exam amid the patient's behaviors while police and security were present.

An interview was conducted with Staff #3 RN, who is the Emergency Room Director, on January 3, 2023, at 9:15 am regarding the process for triage and providing medical screening exams; when asked if the patient volume is high and wait times are extended, how do you ensure patients are getting the Medical Screen Exam (MSE) and not leaving without being seen? Staff #3 stated in part, "We follow our triage policy, and based on complaints or changes in the patient's condition, the triage nurse will perform additional vital sign checks and reassess as necessary and per policy. We are working on trying to get providers to see patients in triage and get the MSE completed as soon as possible, but it is difficult when you are seeing the volume of patients we are encountering."