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Based on interviews, review of the Emergency Department (ED) Physician Schedules and Nursing schedules, medical record, ED log, policy, and complaint intake, the hospital failed to comply with 489.24 in that the hospital did not provide a medical screening within their capability for 1 of 1 individual (Patient B22) that came to the ED on 01/23/2010.

The ED record of Individual #22 at Hospital B revealed the following: He presented to the ED on 01/23/2010 at 23:08 with the chief complaint "cough and fussy." Individual #B22 was treated for mild bronchiolitis and discharged home in good condition with instructions to follow-up with a pediatrician.

The 02/24/2010 complaint sent to the Department noted the following information: "The parents told...that approximately 30 minutes prior to coming to our facility (22:30) that they had taken their son to the emergency department at Texas Regional Medical Center at Sunnyvale..."

During an interview the evening of 02/25/2010, the ED Registration Clerk at Hospital A that was on duty the night of 01/23/2010 (Personnel #5) was asked if she remembered a Mom and Dad coming to the ED with a baby. Personnel #5 said "yes" she received the last name of the baby from the Dad and tried to take the first name from the Medicaid card placed on the desk by the Mom, but the Mom pulled the card back. The Mom had asked if the hospital took Medicaid. After Personnel #5 said that the hospital was not yet contracted for Medicaid, the Dad became "upset." The Dad asked who took Medicaid. Personnel #5 said that she told him "I don't know." The family "walked out" and left without the baby being seen.

Cross refer to tag A2406.

The hospital representatives were given an opportunity to provide evidence of compliance with those requirements of which non-compliance was found. No further evidence was provided to the surveyor.

Based on review of the emergency department (ED) central log and interviews, the hospital failed to maintain a central log to include 1 of 1 individual (Patient B22) that came to the ED on 01/23/2010.

Individual (Patient #B22) was not included in the 01/23/2010 ED central log information.

During an interview the evening of 02/25/2010, the ED Registration Clerk that was on duty the night of 01/23/2010 (Personnel #5) was asked if she remembered a Mom and Dad coming to the ED with a baby. Personnel #5 said "yes" she received the last name of the baby from the Dad and tried to take the first name from the Medicaid card placed on the desk by the Mom, but the Mom pulled the card back. The Mom had asked if the hospital took Medicaid. After Personnel #5 said that the hospital was not yet contracted for Medicaid, the Dad became "upset." The Dad asked who took Medicaid. Personnel #5 said that she told him "I don't know." The family "walked out" and left without the baby being seen. Personnel #5 was asked if she entered the information in the system. Personnel #5 said she needed more information before this could be done.

The "EMTALA Log Policy" number 1116 dated 10/10/2009 noted "...must maintain a central log to include information on each individual who comes to the dedicated emergency department seeking examination or treatment for a medical condition, or comes on the hospital property requesting evaluation or treatment for what may be an emergency medical condition..."

The hospital representatives were given an opportunity to provide evidence of compliance with those requirements of which non-compliance was found. No further evidence was provided to the surveyor.

Based on interviews, review of the Emergency Department (ED) Physician Schedules and Nursing schedules, medical record, ED log, policy, and complaint intake, the ED failed to provide a medical screening within their capability for 1 of 1 individual (Patient B22) that came to the ED on 01/23/2010.

The ED record of Individual #22 at Hospital B revealed the following: He presented to the ED on 01/23/2010 at 23:08 with the chief complaint "cough and fussy." Individual #B22 was treated for mild bronchiolitis and discharged home in good condition with instructions to follow-up with a pediatrician.

The 02/24/2010 complaint sent to the Department noted the following information: "The parents told...that approximately 30 minutes prior to coming to our facility (22:30) that they had taken their son to the emergency department at Texas Regional Medical Center at Sunnyvale..."

During an interview with the ED physician at Hospital A (Personnel #8) the afternoon of 02/25/2010, Personnel #8 was asked if the Emergency Department could take care of babies. Personnel #8 said "yes" but after being stabilized they would be transferred to a children's hospital.

During an interview the evening of 02/25/2010, the House Supervisor of Hospital A (Personnel #6) was asked if he remembered an incident where he was informed that a Mom and Dad came to the ED with a baby and were told the hospital did not take Medicaid. Personnel #6 said "yes." He said that he investigated the information and told the Registration Clerk (Personnel #5) that the ED can see patients "with or without pay."

During an interview the evening of 02/25/2010, the ED Registration Clerk at Hospital A that was on duty the night of 01/23/2010 (Personnel #5) was asked if she remembered a Mom and Dad coming to the ED with a baby. Personnel #5 said "yes" she received the last name of the baby from the Dad and tried to take the first name from the Medicaid card placed on the desk by the Mom, but the Mom pulled the card back. The Mom had asked if the hospital took Medicaid. After Personnel #5 said that the hospital was not yet contracted for Medicaid, the Dad became "upset." The Dad asked who took Medicaid. Personnel #5 said that she told him "I don't know." The family "walked out" and left without the baby being seen.

The "ED/Respiratory Schedule" for January/February noted that two RN's and 1 Respiratory Therapist were on duty at Hospital A the night of 01/23/2010. The "Emergency Physician Schedule" for Hospital A noted a Physician was available on 01/23/2010 from 7 PM to 7 AM. The "ER Unassigned Call Schedule - January, 2010" for Hospital A noted that a Family Practitioner for referrals and Pulmonary physician were on-call for 01/23/2010. A physician for pediatric needs was also noted on the listing.

The ED's "Daily Log" for Hospital A noted that on 01/23/2010 7 patients ranging in age from 3 months to 48 years were treated between 19:00 PM and 07:00 AM. One of the patients was transferred to a children's hospital and 6 of the patients were discharged home at various times. Five of the seven patients were triaged during that timeframe.

The "EMTALA Medical Screening Policy" number 1117 dated 10/10/2009 noted "Any individual who comes to the Texas Regional Medical Center at Sunnyvale (TRMC) dedicated emergency department requesting examination or treatment is entitled to and will receive an appropriate Medical Screening Examination..."

The hospital representatives were given an opportunity to provide evidence of compliance with those requirements of which non-compliance was found. No further evidence was provided to the surveyor.