HospitalInspections.org

Based on document review and interview, the facility failed to provide care to a minor child that was brought to the emergency room by a guardian. The guardian revealed to the registered nurse (RN) the child had been molested. The child and the care giver were turned away twice by the RN that was providing screenings. According to the facility's policies the RN was not qualified to provide screenings to patients presenting to the facility's ER. The RN had not undergone the required training to provide screening to patients. The RN and facility failed to report child abuse. The care giver took the child to facility #2 for treatment.

A review of a document titled Social Work Progress Note provided by facility #2 revealed once the patient made this outcry of sexual assault last evening (02/11/2016), the caregiver took patient to a hospital in Pittsburg, TX and she was told they don't do exams on children. The care giver called the police, who came to the home and interviewed the patient.

A review of a document provided by facility #1 revealed a doctor from facility #2 had placed a call to the Risk Manager at facility #1. The doctor reported a minor child had come to facility #1 twice with a chief complaint of sexual assault and the child was turned away both times.


A review of staff #5's education file revealed the staff member had not received the required MSE training and was providing MSE screenings on or about 2/11/2016.

A review of the document titled Medical Screening and Referral in the Emergency Department revealed:

"All individuals presenting to be seen in the Emergency Department will be provided an appropriate medical screening examination by a Qualified Medical Person (QMP). A QMP includes qualified physician members of the Medical Staff, and, within the limits established by the Board of Directors, the Medical Staff, the Texas Medical Board, and the Texas Board of Nursing - including the scope of licensure, certification, education and experience - physician assistants, nurse practitioners, or Emergency Department Registered Nurses (RN) who have received specialized training, demonstrated appropriate competence for performing appropriate MSEs, have been approved to conduct MSEs, and are functioning under standardized protocols approved by the Medical Staff Executive Committee.

...This screening examination may be performed in the Emergency Department by a registered nurse who has been determined by the Chief Nursing Officer and Emergency Department Nurse Manager to be qualified and experienced in emergency nursing and who is required to follow standardized protocols approved by the Medical Executive Committee."


A review of a document titled Section 261.101 of the Texas Family Code mandates that anyone who suspects child abuse or neglect must report it immediately. The report may be made to (1) any local or state law enforcement agency; or (2) the Department of Family and Protective Services.

A review of the document titled 42 U.S. Code 13031- Child Abuse Reporting revealed:

" (a)In general

A person who, while engaged in a professional capacity or activity described in subsection (b) of this section on Federal land or in a federally operated (or contracted) facility, learns of facts that give reason to suspect that a child has suffered an incident of child abuse, shall as soon as possible make a report of the suspected abuse to the agency designated under subsection (d) of this section.

(b)Covered professionals Persons engaged in the following professions and activities are subject to the requirements of subsection (a) of this section:

(1)Physicians, dentists, medical residents or interns, hospital personnel and administrators, nurses, health care practitioners, chiropractors, osteopaths, pharmacists, optometrists, podiatrists, emergency medical technicians, ambulance drivers, undertakers, coroners, medical examiners, alcohol or drug treatment personnel, and persons performing a healing role or practicing the healing arts.

(2)Psychologists, psychiatrists, and mental health professionals.

(3)Social workers, licensed or unlicensed marriage, family, and individual counselors.

(4)Teachers, teacher's aides or assistants, school counselors and guidance personnel, school officials, and school administrators.

(5)Child care workers and administrators.

(6)Law enforcement personnel, probation officers, criminal prosecutors, and juvenile rehabilitation or detention facility employees.

(7)Foster parents.

(8) Commercial film and photo processors.


(d)Agency designated to receive report and action to be taken

For all Federal lands and all federally operated (or contracted) facilities in which children are cared for or reside, the Attorney General shall designate an agency to receive and investigate the reports described in subsection (a) of this section. By formal written agreement, the designated agency may be a non-Federal agency. When such reports are received by social services or health care agencies, and involve allegations of sexual abuse, serious physical injury, or life-threatening neglect of a child, there shall be an immediate referral of the report to a law enforcement agency with authority to take emergency action to protect the child. All reports received shall be promptly investigated, and whenever appropriate, investigations shall be conducted jointly by social services and law enforcement personnel, with a view toward avoiding unnecessary multiple interviews with the child.

All persons are required to make the report immediately, and individuals who are licensed or certified by the state or who work for an agency or facility licensed or certified by the state and have contact with children as a result of their normal duties, such as teachers, nurses, doctors, and day-care employees, must report the abuse or neglect within 48 hours."

An interview on 4/20/2016, at approximately 1:00pm with staff #3 revealed staff #3 scheduled staff #5 to do medical screening exams on the day the child presented to the ER. Staff #3 was aware staff #5 did not have the required training to perform medical screening examinations. Staff #3 confirmed it was the practice to rotate all personnel through the triage area where the medical screenings were also provided. If staff had the education to perform the MSE these employees were instructed to screen non-emergent patients out and send them to the rural health clinic or to the patient's primary practitioner. If staff did not have the education to perform the MSE these employees were instructed not to screen out patients and send all the patients back to be seen by the physician.

An interview on 4/20/2016, at approximately 1:17pm with staff #4 revealed staff #4 had not reviewed staff #5's education record and was not aware the staff member did not have the training to provide MSE. Staff #4 had not conducted an investigation and was unaware it was a practice to schedule untrained RN's to conduct MSEs. Staff #4 confirmed there could have been a better job investigating the incident where a child claiming to have been molested was turned away from the facility's ER.

Based on document review and interview the facility#1 failed to investigate the events that led to an eleven year old child being turned away from the facility's Emergency Room by a Registered Nurse after a complaint of sexual molestation was made on behalf of the child. This child did not receive a medical screening. The staff member scheduled to provide the medical screening examination (MSE) on or about 2/11/2016, had not received MSE training.

A review of staff #5's education file revealed the staff member had not received the required MSE training and was providing MSE screenings on or about 2/11/2016.

A review of the document titled Medical Screening and Referral in the Emergency Department revealed:

"All individuals presenting to be seen in the Emergency Department will be provided an appropriate medical screening examination by a Qualified Medical Person (QMP). A QMP includes qualified physician members of the Medical Staff, and, within the limits established by the Board of Directors, the Medical Staff, the Texas Medical Board, and the Texas Board of Nursing - including the scope of licensure, certification, education and experience - physician assistants, nurse practitioners, or Emergency Department Registered Nurses (RN5) who have received specialized training, demonstrated appropriate competence for performing appropriate MSEs, have been approved to conduct MSEs, and are functioning under standardized protocols approved by the Medical Staff Executive Committee."

A review of a document titled Social Work Progress Note provided by facility #2 revealed once the patient made this outcry of sexual assault last evening (02/11/2016), the caregiver took patient to a hospital in Pittsburg, TX and she was told they don't do exams on children. The care giver called the police, who came to the home and interviewed the patient.

A review of a document provided by facility #1 revealed a doctor from facility #2 had placed a call to the Risk Manager at facility #1. The doctor reported a minor child had come to facility #1 twice with a chief complaint of sexual assault and the child was turned away both times.


An interview on 4/20/2016, at approximately 2:30pm with staff #1, #2, #3 and staff #4 of facility #1 confirmed the survey findings that staff #5 had not been trained to provide MSE. Staff #1, #2, #3 and staff #4 confirmed staff #5 had seen a minor child in facility #1's ER twice on or about 2/11/2016 with a chief complaint of sexual assault and the child was turned away both times. Staff #1, #2, #3 and staff #4 confirmed staff had not provided a MSE to the minor patient.

Based on document review and interview the facility #1 failed to investigate the events that lead to an eleven year old child being turned away from the facility's Emergency Room by a Registered Nurse after a complaint of sexual molestation was made on behalf of the child. This child did not receive a medical screening. The staff member scheduled to provide the medical screening examination (MSE) on or about 2/11/2016, had not received MSE training.

A review of staff #5's education file revealed the staff member had not received the required MSE training and was providing MSE screenings on or about 2/11/2016.

A review of the document titled Medical Screening and Referral in the Emergency Department revealed:

"All individuals presenting to be seen in the Emergency Department will be provided an appropriate medical screening examination by a Qualified Medical Person (QMP). A QMP includes qualified physician members of the Medical Staff, and, within the limits established by the Board of Directors, the Medical Staff, the Texas Medical Board, and the Texas Board of Nursing - including the scope of licensure, certification, education and experience - physician assistants, nurse practitioners, or Emergency Department Registered Nurses (RNs) who have received specialized training, demonstrated appropriate competence for performing appropriate MSEs, have been approved to conduct MSEs, and are functioning under standardized protocols approved by the Medical Staff Executive Committee."

A review of a document titled Social Work Progress Note provided by facility #2 revealed once the patient made this outcry of sexual assault last evening (02/11/2016), the caregiver took patient to a hospital in Pittsburg, TX and she was told they don't do exams on children. The care giver called the police, who came to the home and interviewed the patient.

A review of a document provided by facility #1 revealed a doctor from facility #2 had placed a call to the Risk Manager at facility #1. The doctor reported a minor child had come to facility #1 twice with a chief complaint of sexual assault and the child was turned away both times.


An interview on 4/20/2016, at approximately 2:30pm with staff #1, #2, #3 and staff #4 of facility #1 confirmed the survey findings that staff #5 had not been trained to provide MSE. Staff #1, #2, #3 and staff #4 confirmed staff #5 seen a minor child in the facility #1's ER twice on or about 2/11/2014, with a chief complaint of sexual assault and the child was turned away both times. Staff #1, #2, #3 and staff #4 confirmed staff had not provided a MSE to the minor patient.