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Based on review of documentation and interview, it was determined that patient # 1 did not receive a complete medical screening exam at the facility's ED prior to discharge on 3/17/19.

Findings were:

Facility policy entitled "EMTALA" stated in part, "The purpose of this policy is to set forth policies and procedures for the hospital's use in complying with the requirements of the Emergency Medical Treatment and Labor Act."

Included under "Definitions"

Medical Screening Exam: "means the screening process required to determine with reasonable clinical confidence whether an emergency medical condition does or does not exist."

To Stabilize: "means with respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer or discharge of the individual from the hospital."

"If an individual comes to the Emergency Department

A. The hospital will provide an appropriate medical screening examination within the capacity of the Hospital's Dedicated Emergency Department, including ancillary services routinely available, to determine whether or not an "emergency medical condition" exists; and
B. The hospital will: (a) provide to an individual who is determined to have an emergency medical condition such further examination and treatment as is required to stabilize the emergency medical condition, or (b) arrange for transfer of the individual to another medical facility in accordance with the procedures set forth below."

On March 7, 2019, Patient # 1 presented in the ED of BS&W Sunnyvale with methamphetamine intoxication. Staff attempted to medically screen the patient, but he refused blood draws, IVs and Ativan. Patient eloped from the ED and was arrested by police and placed under an Emergency Detention Order. The arresting officer made the determination that the patient was too violent to remain in the ED and was brought to Parkland Hospital for further treatment and stabilization. Patient's medical screening exam was not complete at the time of discharge.

Written statement by BS&W Sunnyvale Risk Manager:

"Patient presented to the ED at Baylor Scott and White Medical Center at Sunnyvale on 3/7/19 at 1941. The patient refused all medications and interventions. Patient was placed under constant observation/suicide precautions due to stating he "wanted to die" and was resting quietly. Patient suddenly became violent and combative at 2150; striking out at staff and equipment and eloped from the ED and began causing property damage to cars in the parking lot. At that time, the police department was called. When the police arrived, he was loudly stating "I'm going to kill everyone." Patient was loudly stating he wants the police to kill him and threatening the police. The police department arrested the patient, placed the patient in hand cuffs and put him into the sheriff's car. The police department made the decision not to escort the patient back into the ED, stating to the house supervisor they felt the patient was too violent to remain in this ED. The facility had not initiated transfer of the patient at this time, the patient had been in the ED for 2 hours and 9 minutes. The patient's assessment and work up was in progress. Urine drug screen was completed at 2158. The police department provided a notice of Emergency Detention by Peace Officer 19-026193 3/7/19 @ 2219. Officer F. A***** # 10077. Police department stated they were transporting the patient to Parkland."

Based on review of documentation and interview, it was determined that the facility did not appropriately transfer patient # 1 in March 2019.

Findings were:

Facility policy entitled "EMTALA" stated in part, "The purpose of this policy is to set forth policies and procedures for the hospital's use in complying with the requirements of the Emergency Medical Treatment and Labor Act."

Included under "Definitions"

Medical Screening Exam: "means the screening process required to determine with reasonable clinical confidence whether an emergency medical condition does or does not exist."

To Stabilize: "means with respect to an emergency medical condition, that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer or discharge of the individual from the hospital."

"If an individual comes to the Emergency Department

A. The hospital will provide an appropriate medical screening examination within the capacity of the Hospital's Dedicated Emergency Department, including ancillary services routinely available, to determine whether or not an "emergency medical condition" exists; and
B. The hospital will: (a) provide to an individual who is determined to have an emergency medical condition such further examination and treatment as is required to stabilize the emergency medical condition, or (b) arrange for transfer of the individual to another medical facility in accordance with the procedures set forth below."

On March 7, 2019, Patient # 1 presented in the ED of BS&W Sunnyvale with methamphetamine intoxication. Staff attempted to medically screen the patient, but he refused blood draws, IVs and Ativan. Patient eloped from the ED and was arrested by police and placed under an Emergency Detention Order. The arresting officer made the determination that the patient was too violent to remain in the ED and was brought to Parkland Hospital for further treatment and stabilization.

Progress Note dated 3/7/2019 stated "Patient became combative and threatening to ED staff/EMS crews at approx. 2150 hours. Dallas County Sheriff's Department called and responded to find patient outside of EMS bay damaging employee vehicles. Patient was taken into their custody at that time. DCSD felt patient was too violent to remain in this ED and stated they were going to take him to Parkland Hospital. Spoke with M*** D*** (AOC) and advised him of situation and discussed the officer's taking patient to another facility. It was agreed that patient would be too violent, and patient was taken away by DCSD deputies."

There was no memorandum or transfer in the patient record. BS&W could produce no physician certification or proof that the patient was accepted at Parkland Hospital. The "transfer" of Patient # 1 was therefore inappropriate.