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Based on interview and record review, the hospital failed to abide by the provider's agreement that required a hospital to comply with §42 CFR 489.24, Special responsibilities of Medicare hospitals in emergency cases. The hospital was not in compliance with the EMTALA (Emergency Medical Treatment and Labor Act) requirements, citing 1 of 20 patients (Patient #4) that presented in the emergency department.

Cross Refer to Tags 2405 and 2406.

Based on record review and interview, the facility failed to maintain a Central Log of all patients who presented to the hospital for evaluation, in that,

Findings included

Patient #4 was brought to the hospital by her mother for an Incision and Debridement of a peritonsillar abscess on 7/2/2018 and she was not logged on the Central/Emergency Log.

During an interview on 7/30/2018, Personnel #7 was asked about the incident. Personnel #7 stated, that they don't always log the patient because they have to refer children that are needing more indepth treatment and need to be transferred out.

Based on record review and interview, the facility failed to provide a Medical Screening Examination to determine if there was an Emergency Medical Condition for all patients that present to the hospital for evaluation, in that,

1 of 1 Emergency Department patients (Patient #4) was brought to the hospital by her mother for an incision and drainage of a peritonsillar abscess and the hospital did not ensure a Medical Screening Examination.

Findings included

On 7/2/18, a 12 year old patient presented to the ED with her mother. They were sent to the ED for incision and drainage of a peritonsillar abscess. The ER Tech gave the mother a form to fill out for the patient. The ER Tech had the mother and child wait while she informed the nurse what the patient was there for. The mother and child were told that this hospital did not admit children and they would be transferred if they needed treatment. The mother and child left the hospital and went to another hospital without a medical screening examination.

During an interview on 7/30/18 at 2:25 PM, Personnel #7 was asked about the incident. Personnel #7 stated, she did remember the mother and daughter (Patient #4) coming into the emergency room and they said they had been sent to the ER to have an I&D of a peritonsillar abscess. Personnel #7 stated that when a child presents for care that they ask for the parent's ID. If the child presented with a peritonsillar abscess, then they know they are probably going to transfer the child and they do not log them in. Personnel #7 stated that she does remember a child that came in with peritonsillar abscess and they did leave and go to another hospital, but she does not remember all the details."

During an interview on 7/30/18 at 2:30 PM, Personnel #6 searched the system to see if a medical record was documented. No record was registered in their electronic medical record for Patient #4. Then Personnel #6 searched all Baylor facilities to see if the patient had gone to a different facility. Patient #4 was not registered at any Baylor facility and no medical record was found at any Baylor facility.