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Based on observation, interviews and record reviews, the hospital's Governing Board failed to ensure the emergency needs of the patients presenting to the hospital were met in that:

1) The hospital failed to ensure that all patients presenting to the Emergency Department (ED) from 01/01/11 to 07/19/11 received an appropriate medical screening examination to determine whether or not an emergency medical condition existed, stabilizing treatment was provided and appropriate transfers were initiated if needed. The Registered Nurse's (RN's) and Medical Residents who performed the medical screening examinations (MSE's) in the ED were not appointed through the hospital's credentialing process as Qualified Medical Professional (QMP). The RN's and Medical Residents performing MSE's were not recommended by the Medical Staff, nor appointed by the Governing Board to provide MSE as QMP.
Cross refer: A2406.

2) The hospital failed to adopt and enforce a hospital policy to ensure EMTALA requirements are met in order to provide for all patients presenting to the ED for emergency care an appropriate medical screening examination by a QMP to determine whether or not an emergency medical condition exists, provide stabilizing treatment and appropriate transfers. The hospital EMTALA policy does not meet EMTALA compliance requirements in that it directs medical staff and hospital personnel to refer children under the age of 14 who present to the ED for emergency medical treatment to be triaged, medically screened and treated at a different acute care facility that is not part of the Parkland Health System.
Cross refer: A2406.

It was determined this deficient practice created an Immediate Jeopardy situation and placed the health of the individuals in serious jeopardy.

During the follow-up survey from 08/29/2011 through 08/31/2011, it was determined that the Immediate Jeopardy situation previously cited remained at that level based on direct observation, interviews, and record reviews in that:

1) On 08/29/11, a 54-year old woman presented to the hospital with complaints of chest pain (8 out of 10 pain scale, 10 being the worst), numbness of left arm that radiates to left side, upper back pain, shortness of breath and tingling of left side of her head. She was triaged as "ESI Level 3" but according to the ESI Triage system being used by this hospital, this patient should have been assigned the ESI Level 2 - High Risk category. This patient was not seen by a physician until 11:52 AM.
Cross Refer: A2406.