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8550 HUEBNER ROAD

SAN ANTONIO, TX 78240

MEDICAL SCREENING EXAM

Tag No.: A2406

Based on record reviews and interviews, one of one patients (Patient #1) did not receive an appropriate psychiatric evaluation/screening to rule out an emergency psychiatric emergency when brought to Hospital A by a city policeman.

Findings included:

Review on 06/05/2018 of Hospital B's written EMTALA complaint revealed but was limited to the following: "Hospital A refused to perform an imminent risk assessment on Patient #1 after she was brought to their facility by a city policeman (on 05/13/2018). Hospital A reportedly told law enforcement they had no beds and to take the patient to Hospital B. Law enforcement and a group home administrator brought Patient #1 to Hospital B requesting an assessment and reported the above details.

On 05/13/2018, Patient #1 was picked up from her group home by ambulance and police after hitting staff and biting a peer at the group home. Patient #1 has a diagnosis of intellectual development disability and was demonstrating hypersexuality, aggressiveness and agitation.

After being turned away from Hospital A, a city policeman brought the patient to Hospital B. An imminent risk assessment was performed and Patient #1 was admitted for treatment. It was during this assessment interview that Hospital B staff learned that patient had just been seen at Hospital A an hour earlier and were instructed to bring Patient #1 to Hospital B."

Review of Hospital A's Emergency Medical Treatment and Active Labor Act (EMTALA) Policy and Procedure, last revised 01/25/2017, revealed but was not limited to the following: " As Hospital A does not have a Dedicated Emergency Department, under EMTALA the hospital is obligated to: Conduct an assessment that identified the potential need for emergency and the evaluation, stabilization, treatment and/or transfer shall be applied in a non-discriminatory manner without regard to age, gender, race, disability, religion, ethnicity, sexual orientation or identity, national origin, citizenship, medical or pregnancy status or ability to pay.

Management of a Psychiatric Emergency: 1. When an individual presents at the facility with a potential Emergency Psychiatric Condition, techniques for managing psychiatric crises shall be implemented to maintain the patients and others safety. 2. As soon as possible, a routine medical screening shall be conducted by a QMHP (qualified mental health professional). If a potential EMC (Emergency Medical Condition) is detected, the QMHP, if not a registered nurse, shall summon a nurse or physician and follow the procedure outlined in Section A above. 3. If an EMC (emergency medical condition) is not present, the QMHP shall assess the individual per Policy #PC 1.05, Intake Assessment of Patient.

Documentation: 1. All individuals presenting for emergency services shall be documented on the EMTALA Log as specified in Policy #PC 1.02, titled Documentation of Emergency Treatment.

Interview on 06/05/2018 at 11:00 AM in the facility conference room with Hospital A's Director of Risk Management/Performance Improvement revealed but was not limited to the following: She confirmed that Patient #1 had been brought by a city policeman to Hospital A on 05/13/2018 around 9:00 AM. She stated that Staff A who was working as an assessor in Hospital A's admissions department called up to the receptionist and told her to tell the city policeman to take Patient #1 to another hospital because Hospital A does not have the capacity to treat her due to her intellectual developmental disability. She reportedly had a diagnosis of Down Syndrome. She confirmed that Hospital A's administrator was later contacted by Hospital B's administrative staff and informed of the EMTALA concerns. She further stated that Staff A's employment with Hospital A was terminated due to the EMTALA violation. She stated Hospital A's admissions office staff held a mandatory staff meeting on 05/26/2018 to discuss the recent EMTALA concern."

Review of Admissions Department Mandatory Meeting, dated 05/26/2018, revealed but was not limited to the following: " Every single patient that comes to (Hospital A) will be assessed no matter bed capacity, doctor capacity, staff capacity, funding source, age, exclusionary criteria, etc. Employee denied a patient at the door. Patient was brought by city policeman and refused due to Downs Syndrome and told city police that we didn't have the capacity to treat the patient. (Hospital A) did not offer an assessment. The patient was taken to (Hospital B) by the city policeman. Employees will be terminated immediately for an EMTALA violation."