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Based on interview and record review, the hospital was not in compliance with §42 CFR 489.24, Special responsibilities of Medicare hospitals in emergency cases, in that, 1 of 20 patients was not provided an appropriate medical screening examination.

Cross Refer to Tag 2406

Based on interview and record review, the hospital failed to provide an appropriate medical screening examination to 1 of 20 patients (Patient #1) who presented in the emergency department (ED) on 02/16/23.

Findings included:

Patient #1 presented in the ED on 02/16/23 at 2148 after a single motor vehicular accident. Attending physician noted in the HPI (history of present illness) "27-year-old patient...presents to the emergency department with EMS and PD after a single vehicle MVC in which his car struck a concrete pillar. Upon PD arrival the patient immediately started screaming that he wanted to die, apparently, he has been struggling with depression for some time and had previous suicidal attempts...He has no complaints apart from depression. He states that he wrecked his car intentionally in an attempt to take his life...the patient is withdrawn, hesitant to answer questions."

"Clinical Impression: Primary Impression: MVC (motor vehicle collision). Secondary Impressions: Alcohol intoxication, Cocaine abuse, Head injury, Suicide attempt.
Disposition Decision: Discharged to Home Yes. Time 2353. Date 02/16/23."

Abnormal results included Urine Cocaine Screen (NEGATIVE) = POSITIVE H and Alcohol, Quantitative (0 - 10 mg/dL) = 289 H.

Rapid Initial Assessment - Date/Time 02/16/23 21:48 by Personnel #4 indicated "Arrived by: AMB: EMS service: American Medical Response. Patient's description of reason for visit: Patient was restrained driver of a MVC where he tried to harm himself with running into a concrete barrier."

Nurse's Note on 02/16/23 23:34 reflected "SUICIDE ASSESSMENT - - Wish to be dead or to not wake up in the past month: Yes.
Wish to be dead or to not wake up in your lifetime: Yes
Non-specific active suicidal thoughts in the past month: Yes
Non-specific active suicidal thoughts in your lifetime: Yes
Active ideation without method, plan or intent in the past month: Yes
Active ideation without method, plan or intent in your lifetime: Yes
Active ideation with some intent and without plan in the past month: No
Active ideation with some intent and without plan in your lifetime: No
Active suicidal ideation with plan and intent in the past month: Yes
Active suicidal ideation with plan and intent in your lifetime: Yes
Attempted, plan to attempt, or prepared to end life in your lifetime: Yes
Attempted, plan to attempt, or prepared to end life in the past 3 months: Yes
Calculated suicide risk level: High risk
Document suicide safe environment: Yes

- - SUICIDE SAFE ENVIRONMENT - -
Patient room safe environment action items: Belongings removed/secure...
Nursing safe environment action items: Bed position for safety. Safety attendant-physical. Every 15-minute checks. Use paper scrubs.

Nurse's Note on 02/17/23 00:02 showed "Patient disposition: Discharge ...Discharge information provided: Discharge instructions given to and verbalized understanding by: Patient. Patient left to: Jail/court. Patient left with: Police. Mode patient left: Ambulatory. Patient left via: Public transportation. Comments: APD CUSTODY (Arlington Police Department).

During an interview on 03/30/23 at 2:09 PM via telephone call in a conference room (with Personnel #1 in attendance) the attending physician was asked if a behavioral health practitioner was consulted to evaluate Patient #1. The attending physician responded "in my understanding" the police officer would bring the patient to jail once medically cleared. In jail, they have a behavioral health provider who would conduct the assessment. I felt confident the patient would be safe under police custody. The physician stated this type of situation has happened before. A physician discharges a patient to police custody and have their behavioral health provider assess the patient in jail.

During an interview on 03/30/23 at 2:30 PM via telephone call in a conference room (with Personnel #1 in attendance) Personnel #4 was asked if she remembered the patient. She responded she did. She stated the patient came in via EMS. The patient wrecked his car intentionally to take his life. The patient did not want help. Police Officer was with him. The officer stated they have capabilities for suicidal patients. Police told her we will get him help. The officer mentioned Hospital B, but the patient ended up in our hospital. A few hours later, Hospital B called and told us the police brought the patient to their hospital. A detention warrant (DW) was made, but we did not see a DW when the patient was in our ED. Personnel #4 was asked if she was the one who handled Hospital B's call. She responded it was not her. She was just informed about the conversation. Personnel #4 was asked about the patient's demeanor. She responded the patient was initially crying. When he left the ED, he was thankful to "us and even to the police."

#PCS 208 "EMTALA-TX Medical Screening Examination and Stabilization," Reviewed 04/2022, pages 1, 6, and 7 reflected "IV Policy: A. An EMTALA obligation is triggered when an individual comes to a dedicated emergency department (DED)...or representative acting on the individual's request an examination of treatment for medical condition...then an appropriate MSE (medical screening examination), within the capabilities of the hospital's DED...C. Extent of the MSE...5...c. Individual with psychiatric or behavioral symptoms: The medical records should indicate both medical and psychiatric or behavioral components of the MSE...The psychiatric MSE includes an assessment of suicidal or homicidal thoughts or gestures..."