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Review of Emergency Department (ED) medical records, the ED Central Log, and interview, revealed the hospital failed to comply with 489.24 in that:

The hospital did not provide a medical screening within the hospital's capability for 1 of 1 patient (Patient #1) who presented to the ED, and made a request to be examined for "palpitations."

The ED Triage Registered Nurse (Personnel #5), had taken Patient #1 to the Triage area to obtain basic identifying information for completing the pre-registration process, but did not perform a triage assessment, and a subsequent medical screening examination was not completed for Patient #1.

In a telephone interview at 3:10 PM on 12/11/12, Personnel #5 confirmed that Patient #1 had not given the requested information needed to complete the pre-registration process, and had left the ED after their discussion. Personnel #5 verified that she had not performed a triage assessment, and that Patient #1 had not received a medical screening examination.

This hospital's ED provided medical services continuously during 2012, the year Patient #1 presented.

Based on record reviews, and interviews, the hospital's dedicated emergency room (Hospital A), did not provide an appropriate medical screening examination within their capability, to determine whether or not an emergency medical condition existed for 1 of 1 patient (Patient #1) who had requested to be examined for "palpitations."

Findings included:

Review of Hospital A's computerized, and hard copy medical record for Patient #1, revealed the following during her Emergency Department (ED) visit on 12/04/12:
-Patient #1 partially filled out the Sign-in Form, in the Adult ED area, but refused to give her first name (only wrote first initial), her date of birth, her address, her telephone number, or her social security number.
-The Emergency Department Continuation Sheet that documented the ED Triage Registered Nurse's (Personnel #5) Progress Notes revealed the following:
"1329 (1:29 PM), Patient refuses vital signs, patient is breathing normally, skin is dry, appears to be in no distress. Patient arrives at triage and refuses to give name, birthdate, or any other identifying information. Patient brought back to triage room. Explained to patient that in order to check her in and triage her, we would need her ID information. Patient states it is her right to withhold any information she pleases. Patient states, 'Just put me in as ..." Informed patient that we could only do that as a last resort when all attempts to verify identity have been exhausted. Patient still refuses to give name or birthday. Patient is awake, alert, oriented. Mentating appropriately. Asked patient to have a seat in the waiting room and informed her that we would be glad to check her in when willing to provide her name and birthday. Patient pulls out cell phone and begins to attempt filming staff at triage. Patient states the correct time and date to the camera on her cell phone and states 'Come on, I want to hear you say you are refusing to treat me.' DPD (Dallas Police Department [officer]) escorted patient out of triage. Hospital Security and Supervisor (Personnel #4) notified of situation."
-The Waiver of Right to Medical Screening Examination form was blank, except for the patient sticker for Patient #1.
-Review of the ED Central Log (Hospital A), noted the following:
"Patient's name - First initial, Last name; age 11; Reason for visit - Palpitations; ER Physician - (Personnel #11); Arrival date/time - 12/04/12/ 1325 (1:25 PM); Disposition - Left Prior to Triage."
The ED Central Log for Patient #1 did not document if "She Refused Treatment," or "Was Refused Treatment" by Hospital A.

Telephone interview of Personnel #5, at 3:10 PM on 12/11/12, confirmed her documentation noted above. She stated that Patient #1 was not being triaged at that point, but that she had documented her observations of the patient. Personnel #5 said the front desk staff was just trying to complete the pre-registration process to get her checked in to be triaged, but that Patient #1 would not give them even the minimum information (her full name, and date of birth). She said that she had taken Patient #1 out of the waiting room and into the triage area, hoping Patient #1 would feel more comfortable to give information in private, but that had not worked. Patient #1 would not give any identification, wouldn't tell her "why" she was there, and wanted to be put in as "..."

Interview of ED Paramedic (Personnel #6), at 2:40 PM on 12/10/12, confirmed he worked at the Triage window as a Tech to pre-register patients. He said he recalled Patient #1, who did not write in her first name, date of birth, address, or social security number. He had informed Personnel #5, who then took Patient #1 back to the triage area to try to get the basic information from Patient #1. After a couple of minutes Patient #1 came back out, and then pulled out her phone and started videotaping Personnel #5. Personnel #5 then asked the DPD officer to walk the patient out to the waiting room, and Patient #1 left.

Review of Hospital A's "Patient Access, Procedure for Emergency Registration & Admission" policy, dated 07/01/06, noted the following:
-"Individuals presenting to the dedicated emergency department shall be triaged by a nurse, medically screened, and stabilized as necessary by a physician or qualified medical person according to the order assigned by the triage nurse without regard to their ability to pay."

Review of Hospital A's "EMTALA - Texas Medical Screening Examination and Stabilization Policy," dated 07/2008, noted under "Extent of the MSE (Medical Screening Examination) ...hospitals are obligated to perform the MSE to determine if an EMC exists ...it is not appropriate to merely "log in" or triage an individual with a medical condition and not provide an MSE ...Triage is not equivalent to an MSE ...triage merely determines the "order" in which individuals will be seen, not the presence or absence of an EMC."