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Based on observation, interview and record review the hospital failed to comply with 489.24 in that, the hospital was out of compliance on 489.24(a)(1)(i) medical screening exam, 489.24 (e)(2) Appropriate Transfer and 489.24(r)(3) Logs for 1 of 1 (Patient #25) patients on 08/16/23.

Findings Included:

On 08/16/23 at 11:24 AM Patient #25 arrived at Hospital A (Perimeter Behavioral Hospital Dallas) via Mesquite Police Department on an Apprehension by Police Officer Without a Warrant (APOWW). Hospital A did not conduct a medical screen exam. Hospital A did not contact Hospital B (Methodist Health Richardson) to conduct an appropriate transfer, and Hospital A did not enter Patient #25's name on the EMTALA log for 08/16/23.

Cross Refer:
A2405, A2406, and A2409

Based on observation, record review, and interview the hospital failed to maintain a central log on each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged on 1 of 1 (Patient #25) patients in that, on 08/16/23 Patient #25 presented to the hospital for treatment and was not listed on the hospital's central log.

Findings Included:

On 08/16/23 at approximately 11:24 AM Patient #25 arrived at Hospital A (Perimeter Behavioral Hospital Dallas) via Mesquite Police Department. Officer #1 and Officer #2 were observed via undated and untimed body camera video taking Patient #25 into Hospital A. Mesquite Police Department Incident Report 23072015 dated 08/16/23 reflected..."taken into police custody and transported to Hospital A for mental health evaluation..."
A review of the Central Log for 08/16/23 did not evidence Patient #25's name as having come to the hospital to receive treatment.

During an interview with on 08/30/23 at 12:58 PM Personnel #1 verified Patient #25's name was not listed on the Central Log for 08/16/23.

The policy titled Emergency Medical Treatment and Labor Act (EMTALA) revised 02/2022 reflected..."Perimeter healthcare will maintain an EMTALA log as evidence of compliance with the policy..."

Based on observation, record review, and interview the hospital failed to perform a medical screening exam on 1 of 1 (Patient #25) patients that came to the hospital on 08/16/23 in that, when Patient #25 presented to the hospital on 08/16/23 the facility did not perform a medical screening exam.

Findings Included:

Patient #25 was seen via an undated and untimed Mesquite Police Department body camera video being escorted into Hospital A (Perimeter Behavioral Hospital Dallas). Patient #25 was escorted through the lobby to an intake triage room. Personnel #3 enters the room and after police get Patient #25 to sit in a chair. Personnel #3 asked Patient #25 what his name is and Patient #25 refused to answer. Personnel #3 then asked Officer #2 what the patient's name is. Officer #2 shows Personnel #3 his note pad with the patient's name written on it. The transcribed body camera video reflected..."Personnel #3 stated Oh yeah Patient #25. Um we have an issue. Let me go talk to (unintelligible) let me go talk to the CEO for a second and we can have a discussion outside. One of you. ..." Officer #1 steps into the hall with Personnel #3 .Personnel #3 then stated "If that is the Patient #25 I am thinking of he can't be here. He can't be here he has destroyed the place. Let me double check with my CEO and see what we can do with him I know you guys can't keep him (unintelligible)."...Personnel #3 then returns with Personnel #4 and Officer #1 joins them in the hall outside the triage room. Personnel #4 stated "Tell me what is going on." Officer #1: "That officer knows better but he was at the school and this guy I guess is a runaway or something causing a disturbance at the school, no criminal offense, and started making threats that he was going to kill himself. He tried to wrap the seatbelt around his neck on the way here. We used leg restraints and a helmet. He was able to get out of both of those. He was slamming his head onto the wall and onto the cage. We had to make I think three stops on the way here. We couldn't even make it down the road. We had to go lights and sirens down the road to get here just so he wouldn't physically hurt himself and the reason we picked y'all because y'all are the closest. We couldn't afford to get further on the highway to go to like Children's or somewhere else."
Personnel #4 "He has maximized his therapeutic benefit at our facility so we would, we would, have to assess him, but we would still have to transfer him out. We can't treat him here. My only concern is if he was doing all of that cutting up with y'all EMS (Emergency Medical Services) is not going, you know it is going to be an issue, more of an issue for them because they don't have the resources that y'all have. Would there be any options for y'all to take him somewhere else?"
Officer #1:" We can talk about it, but most likely not. It is going to take us two hours to get anywhere else in the metroplex with the way he is acting and pulling over. It is just a constant pull over readjust and then we start it right back up once we get on the highway."
Personnel #3: "All we can do is medicate him and ship him out. (unintelligible)."...
Personnel #4: "You couldn't even get to Methodist Richardson (Hospital B) you think? Up Shiloh it's 10 minutes."
Officer #1: "We came from the north side of Mesquite straight here and like I said it took us about 40 minutes already. The way he was wrapping the seatbelt around his neck and stuff I'm concerned he may do something in the back of our car. We don't want that." Personnel #4: "I hear you. We don't want that."
Officer #2 joins Officer #1 and Personnel #3 and Personnel #4 in the hall outside the triage room.
Personnel #4 to Officer #2: "would there be any options for y'all to take him to (unintelligible) it is the nearest emergency room. Hospital B they're going to have the ability to physically restrain, and we don't. We don't have four points or soft restraints in our ..."...
Officer #2: "Well, um if we have no other choice than that is what we have to do. I get what y'all are saying, you have always helped us out. So, if that's the case."
Officer #1: "Did he respond to the medication last time at all?"
Personnel #4: "Well, it is like Personnel #3 said it's all behavioral, acting out."
Officer #2: "So, it is not going to be an issue with them? Saying well you were here first or something like that?"
Personnel #4: "If we say we can't treat, and you say you think needs ... make it an APOWW. I am assuming that is what you will do." Officer #2: "Yeah"
The patient is yelling in the background and this surveyor is unable to hear the conversation.
13:57 minutes after entering the facility the patient leaves the facility and is placed back in the police vehicle. At 16:15 minutes an officer is heard on the radio stating "Hospital A can no longer treat him; they will not accept him we have to go to Hospital B ..."

The Mesquite Police Incident Report 23072015 reflected on 08/16/23...Patient #25 was deemed a danger to himself and other, and he was taken into police custody and transported to Hospital A...11:24: 08/16/2023...Arrived..."

During an interview on 08/30/23 at 11:57 AM in the Conference Room Personnel #3 stated they did not perform a medical screening exam on Patient #25 because he was defiant. Personnel #3 stated they could see that Patient #25 was awake and alert. Personnel #3 stated the patient had maximized any therapeutic benefit the hospital could provide.

The policy titled Emergency Medical Treatment and Labor Act (EMTALA) revised 02/2022 reflected..."Perimeter Healthcare has an absolute duty to screen any individual that comes to the hospital who may be seeking treatment for an emergency medical condition. Psychiatric disturbances can be emergency medical conditions..."

Based on observation, record review and interview the hospital failed to enact an appropriate transfer of 1 of 1 (Patient #25) patients in that Hospital A (Perimeter Behavioral Hospital Dallas) failed to contact Hospital B (Methodist Health Richardson) on 08/16/23 for a transfer prior to having police transport the patient to Hospital B.

Findings Included:

On 08/16/23 t 11:24 AM Patient #25 was transported to Hospital A for a psychiatric evaluation. Per police body camera video Hospital A told Officer #1 and Officer #2 that the patient had maximized their therapeutic benefits at the hospital. Personnel #4 asked Officer #1 and Officer #2 to transport Patient #25 to Hospital B. Personnel #4 stated..."He has maximized his therapeutic benefit at our facility so we would, we would, have to assess him, but we would still have to transfer him out. We can't treat him here. My only concern is if he was doing all of that cutting up with y'all EMS (Emergency Medical Services) is not going, you know it is going to be an issue, more of an issue for them because they don't have the resources that y'all have. Would there be any options for y'all to take him somewhere else?...You couldn't even get to Methodist Richardson you think? Up Shiloh it's 10 minutes." The police body camera video reflected Officer #2 placing Patient #25 back in the vehicle and leaving the premesis. There was not a documented medical screen exam at Hospital A and no Memorandum of Transfer for Patient #25 to be transferred to Hospital B.

During an interview on 08/30/23 at 11:26 AM in the Conference Room Personnel #4 stated the police had wanted to take the patient to Hospital B.

During an interview on 08/30/23 at 12:58 PM in the Conference Room during a review of the body camera video Personnel #1 confirmed that Personnel #4 had asked police to take Patient #25 to Hospital B. Personnel #1 also confirmed there was no documentation that Patient #25 had received a medical screening exam or had presented to the hospital for treatment.

The policy titled Emergency Medical Treatment and Labor Act (EMTALA) revised 02/2022 reflected..."The hospital will obtain the consent of the receiving hospital to accept the transfer and the name of the individual approving transfer; documentation of the consent must be included in the medical record.