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Based on interviews and record review, the hospital failed to enforce its policy to ensure compliance with 489.24 for 1 of 1 patient (Patient #1) in that (Patient #1) was denied a medical screening on 08/04/14 per Physician #1. Upon arrival to Hospital A2 Patient #1 was not provided a medical screening and told to go to Hospital A1 or Hospital B. Patient #1 left the Emergency Department (ED) of Hospital A2 on 08/04/14. Hospital A2 had both capacity and capability to accept Patient #1 on 08/04/14.

Cross refer to A2406.

Based on interviews and record review, Hospital A2 failed to provide a medical screening for 1 of 1 patient (Patient #1) in that (Patient #1) was denied a medical screening on 08/04/14 per Physician #1 after presenting to the Emergency Department (ED) with complaints of abdominal pain, nausea, and vomiting. Upon arrival to Hospital A1's off campus ED(Hospital A2) Patient #1 was not provided a medical screening. Patient #1 left the ED. The hospital had both capacity and capability to accept Patient #1 as a patient on 08/04/14.

Findings included:

During a phone interview on 10/14/14 at 08:00 AM with Physician #1 he said on the morning of 08/04/14 the computer system went down and the software to document clinical findings could not be accessed. He said, "I thought all systems were locked down." He said he told a female patient she couldn't be taken care of at the ED. He said it was an "accident" that shouldn't have happened. Physician #1 said he greeted the female patient after she walked in and explained the circumstances to her. He apologized to her and advised her to go across the street to Hospital B or to Hospital A1. Patient #1 complained of abdominal pain, nausea and vomiting. Physician #1 confirmed the female patient didn't receive any medical screening exam. The patient did not sign any consent forms. He didn't know her name. Physician #1 confirmed the ED had the capacity and the capability to screen patients during the time the computer and phone systems were down.

During a phone interview on 10/13/14 at 9:10 PM with Personnel #2 she said she had worked in the hospital's ED for more than 4 years. On 08/04/14 at approximately 2:00 AM the ED's computer system and phones went down except for an emergency landline phone. The "tech support" was immediately informed and they arrived at the ED at approximately 4:30 AM. Physician #1 was under the impression the the medication station system was locked down and medications couldn't be retrieved. The computer software could not be utilized to enter clinical notes. Personnel #2 told Physician #1 the medication station could be overridden and medications could be retrieved. The ED had printed downtime forms that could be used for clinical notes and physician's orders. She told Physician #1 that patients could be seen. Personnel #2 said the ED had the capacity and the capability to provide a medical screen to any patient during the downtime of the computer and phone systems.

The hospital policy and procedure entitled, "EMTALA-Texas Transfer Policy of Patients Between Hospital With and Without Emergency Medical Conditions" with a revision date of 07/14 reflected, "...Each individual who comes to the emergency department of the hospital will be evaluated by a physician who is present in the hospital at the time the individual presents ...The individual will be personally examined and evaluated by a physician before an attempt to transfer is made ...