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Based on interview and record review, Hospital A (Childrens Medical Center) failed to enforce its policy to ensure compliance with 489.24 for 3 of 4 patients (Patient #1, #2 and Patient #6) who were identified in TX00198924 in that 3 of the 4 patients who were transported to Hospital A's ED (emergency department) on 04/19/14 and 05/13/14 per EMS (emergency medical services) did not receive a medical screening. (Patient #1, #2 and Patient #6) left Hospital A escorted by EMS and were taken to Hospital B's ED for a medical screening and/or evaluation. Hospital A had both capacity and capability to accept (Patient #1, #2 and Patient #6) on 04/19/14 and 05/13/14.

Cross refer to A2406

Based on record review and interview, Hospital A (Childrens Medical Center) failed to provide a medical screening for 3 of 4 patients (Patient #1, #2 and Patient #6) who were transported to Hospital A's ED (emergency department) on 04/19/14 and 05/13/14 by EMS (emergency medical services) for a medical screening and identified in TX00198924. (Patient #1, #2 and Patient #6) left Hospital A's ED escorted by EMS personnel and were taken to Hospital B on 04/19/14 and 05/13/14 for a medical screening and/or evaluation. Hospital A had both capacity and capability to accept (Patient #1, #2 and Patient #6).

Findings Included:

1) (Patient #6's) EMS report dated 04/19/14 reflected, "Patient involved in rollover accident...subject thought infant child in back seat was in distress and took infant out of car seat...this panicked driver and caused the accident...subject (Patient #6) refused EMS and transport...rode with...to accompany other patients...upon arrival to (Hospital A's) ER (emergency room)...while being interviewed by (Hospital A's) staff...patient changed her mind on being checked by hospital staff...(Hospital A's) staff state we (EMS) needed to walk patient (Patient #6) over to (Hospital B)...(Patient #6) did have a superficial abrasion to leg...minor abrasions to the left eyebrow..."

The Chaplain Note dated 04/19/14 timed at 1408 from (Hospital A) reflected, "Chaplain visited with the family in response to a trauma page...Mom and Aunt arrived with...Aunt had also been in the accident, and she was feeling pain and anxiety...a few minutes after arrival, Aunt allowed paramedics to go with her to (Hospital B) to address her back pain..."

(Hospital B's) medical record for (Patient #6) dated 04/19/14 timed at 1306 reflected the following:

The physician note dated 04/19/14 timed at 1330 reflected, "(Patient #6) is a 35 year old...MVC (motor vehicle Collision) at 45 miles per hour rollover...ambulatory at the scene...complaining of back pain..."

(Hospital B's) nurse ED (emergency department) note dated 04/19/14 timed at 1332 reflected, "(Patient #6) denies loss of consciousness...presented to ER with child at (Hospital A) and then was escorted to (Hospital B) by EMS...at 1342...cleared for CT scan...at 1434...back pain has reduced to (1/10)...prescription for pain medication...discharged home...to go to (Hospital A) to check on children..."

On 07/01/14 at approximately 1105, Personnel #4 from (Hospital A) was interviewed. Personnel #4 stated he could not provide any documentation that an assessment and/or medical screening had been completed for (Patient #6). Personnel #4 stated (Patient #6) was taken to (Hospital B) by EMS.

On 07/03/14 at 1110 EMS Personnel #26 was interviewed. EMS Personnel #26 stated he arrived at (Hospital A) with (Patient #6) and several children. EMS Personnel #26 stated (Patient #6) refused EMS care but rode along to (Hospital A). EMS Personnel #26 stated after arrival to (Hospital A) (Patient #6) complained of not feeling well to (Hospital A's) staff (unknown names). EMS Personnel #26 stated the ED staff informed (Patient #6) needed to go to (Hospital B) to be seen. EMS Personnel #26 stated he was told to take (Patient #6) to (Hospital B). EMS Personnel #26 stated (Hospital A) did not provide a medical screening for (Patient #6).

2) (Patient #1's) EMS report dated 05/13/14 reflected, "Medics arrived to find a 15 year old male sitting on the ground...complained of being struck by a vehicle...states he and his friend were walking across the street when 2 vehicles got into an accident and one of the vehicles was pushed into them...complained of knee and ankle pain...transported to (Hospital A)..." It was noted no medical record was found at (Hospital A) which indicated (Patient #1) was provided a medical screening.

(Hospital B's) medical record for (Patient #1) reflected the following:

The physician note dated 05/13/14 timed at 1825 reflected, "15 year old male presents for evaluation...patient was thrown...no loss of consciousness or head injury...c-collar in place...abrasions to bilateral knees...left ankle pain at 1832...chest x-ray and left lower extremity and right ankle...at 2034...plan for discharge home..."

On 07/01/14 at 1425 Personnel #6 from (Hospital A) was interviewed. Personnel #6 stated on 05/13/14 she saw a paramedic bringing a patient on a stretcher into the ED (Hospital A). Personnel #6 stated she asked the paramedic about the patient and he said the patient was a 16 year old who was in a motor vehicle collision. Personnel #6 stated she told the paramedic the hospital policy for (Hospital A) would not allow the Hospital to treat children over 14 years old with multi-system trauma. Personnel #6 stated the paramedic said there was another patient on the ambulance. Personnel #6 stated she asked one of the ED physicians if the patient should be sent to (Hospital B) and the physician indicated the patient should be sent to (Hospital B). Personnel #6 stated she did not know either patient's name and acknowledged neither patient had a medical screening.

3) (Patient #2's) EMS report dated 05/13/14 reflected, "Medics arrived to find a 14 year old male lying on the ground complaining of being struck by a vehicle...patient complaining of abdominal pain, pain in upper extremities, pain on right knee, abrasions to both extremities and right lower quadrant of abdomen...transported to (Hospital A)..."

It was noted no medical record was provided for (Patient #2) from Hospital A.

(Hospital B's) medical record for (Patient #2) reflected the following:

The physician note dated 05/13/14 timed at 1854 reflected, "14 year old struck by vehicle...no loss of consciousness...non-ambulatory on scene...tender right flank with a 4 cm (centimeter) laceration/abrasion...pain to left lower leg..."

The nursing note dated 05/13/14 timed at 2151 reflected, "On discharge and transfer to wheelchair...patient had episode of dizziness and nausea...Dr. called...at 2154...became diaphoretic, brief syncope...moved back to bed...change in plan of care..will be admitted to observation since syncope episode..."

On 07/01/14 at 1425 Personnel #6 from (Hospital A) was interviewed. Personnel #6 stated on 05/13/14 she saw a paramedic bringing a patient on a stretcher into the ED. Personnel #6 stated the paramedic said there was another patient on the ambulance. Personnel #6 stated she did not know either patient's name and acknowledged neither patient had a medical screening.

Hospital A's policy and procedure entitled, "Emergency Medical Treatment and Active Labor Act Compliance" with a revision date of 11/11 reflected, "Individual shall be defined as any patient who comes to the emergency department, whether indigent, uninsured, on Medicare, or insured...any individual presented to Children's emergency department requesting medical treatment shall receive a medical screening by QMRP (Qualified Medical Personnel) to determine whether an emergency medical condition exists..."