HospitalInspections.org

Based on observation and interview the facility was not in compliance with 489.24 in that the facility was out of compliance with 489.24(a)(1)(i) medical screening exam and 489.20(r)(3) emergency room log .

Findings included:

On 11/30/22 at 0026 Patient #21 presented to the facility with Police Officer #1 on an emergency detention order, the facility did not perform a medical screening exam on a Patient #21. The facility refused to perform any triage or treatment on the patient, causing Police Officer #1 to take Patient #21 to a different facility causing a delay in treatment and, the facility failed to list the Patient #21 on their Intake Log.

Cross Refer:
2405, 2406, and 2407

Based on observation and interview the facility failed to maintain a central log on each individual who comes to the facility seeking assistance for 1 of 1 (Patient #21) patients, in that on 11/30/22 at 0026 Patient #21 presented to the facility for treatment. Patient #21 is not listed on the facilities central log.

Findings include:

The body camera video contained on AXON BODY3 X60A7825P, body camera for Police Officer #1, reflected that on 11/30/22 at 0026 Police Officer #1 brought Patient #21 to the facility on an emergency detention warrant. Police Officer #1 activated the intercom at the facility to have the patient admitted to the intake area. Personnel #10 refused to admit the patient stating the facility was on divert. No information other then the patient's age and gender were collected by the facility.

The intake log for 11/30/22 does not evidence Patient #21's name as presenting to the facility for treatment.

During an interview on 02/09/23 at 1012 after watching the police body camera video, Personnel #1 verified the patient did present to the facility on 11/30/22 at 0026 for treatment and the patient was refused treatment, no information was collected on the patient, and the patient was not listed on the EMTALA Log.

The police titled EMTALA dated 07/29/22 reflected..."D Documentation. 1. All individuals presenting for emergency services shall be documented on the EMTALA Log..."

Based on observation and interview the hospital failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed for 1 of 1 (Patient #21) patients in that, on 11/30/22 the hospital failed to perform a medical screening exam on Patient #21 when they presented to the hospital for treatment.

Findings include:

AXON BODY3 X60A7825P (police body camera) reflected Police Officer #1 arrived at the facility on 11/30/22 at 0026 and rang the bell.
Transcript from police body camera:
Police Officer #1: "Cedar Hill Police Department, I have an APOWW" (apprehension by police officer without a warrant)
Personnel #10: "What is the age and gender of the patient?"
Police Officer #1: "17-year-old female."
Personnel #10: "We don't have any space for a 17-year-old female right now."
Police Officer #1: "No one told me y'all were on divert. I am here so if I have to sit with her, I sit with her."
Personnel #10: We cannot take her because we are on quarantine for the 17-year-old female."
Police Officer #1: "You can't refuse per the state."
Personnel #10: "Yes we can because we don't have space."
Police Officer #1: "No you can't, per the state you can't refuse. If you want to make me sit with her until you have a bed available or you have transport for her then that is fine, you can do that."
This surveyor was unable to transcribe the next exchange because the officer and the female were talking over each other.
Police Officer #1: "Y'all did not send a message y'all were on divert. I am here, she is going to go with y'all. If you want to refuse you can refuse and I will report it to the state."
At this point there was not a response and Police Officer #1 pushes the intercom button again.
Police Officer #1: "Is somebody going to come up here?"
Personnel #10: "So I told you we don't have space (Personnel #10 says something unintelligible) we just filled our last bed so that is why we haven't placed on divert.
Police Officer #1: "Okay, it doesn't matter."
Personnel #10: "I can't hear you because I am pressing the button, but we are not going to be able to take her. We will send the house supervisor out to talk to you, but we are not going to come up there and we are not going to take her."
Police Officer #1: "Okay, so you are refusing."
Personnel #10: "If that is what you want to call it."
Police Officer #1: "Are you coming up here, and are you going to take her?"
Personnel #10: "I am not coming up there and I am not going to take her because we don't have the space."
Police Officer #1: "Okay, you're refusing, that is fine. I'll report it to the state but send someone up here still. I will still report it to the state because you cannot refuse an APOWW."
At 0028 Police Officer #1 removes the female from the back of the police cruiser and walks her through the first set of doors into the vestibule. Police Officer #1 waits until 0042 for someone to come and speak to them, no one comes to the vestibule to see the patient or speak to Police Officer #1. Police Officer #1 then places the patient back into the police cruiser and drives the patient to Hospital B.

During an interview on 02/06/23 at 1320 Personnel #6 stated they did not recall the alleged incident on 11/30/22. Personnel #6 stated that they had told people that presented to the facility when it was on divert to try somewhere else because it would be faster. Personnel #6 stated they could not provide the care the patients needed in intake. Personnel #6 stated there had been so many cases like this that she could not recall a particular one.

During a telephone interview with Personnel #8 on 02/06/23 at 1351 Personnel #8 stated he vaguely recalled the incident but didn't really remember the incident. Personnel #8 stated that there were many incidents when they would tell patients to go somewhere else if the facility was on divert. They don't have to take the patient if they can't adequately take care of them. People threaten to make reports to the state all the time.

During an interview on 02/09/23 at 1012 after watching the body camera video, Personnel #1 verified the facility did refuse to take the patient and no medical screening exam was performed on Patient #21 when they arrived on 11/30/22 for treatment.

The police titled EMTALA dated 07/29/22 reflected..."General Guidelines...Conduct an assessment that identifies the potential need for emergency treatment outside the scope of the facility...Procedure A. Management of Potential Emergency Medical Condition: 1. When an individual presents to the facility, a medical triage for physical examination (Triage) shall be conducted by QMP (Registered Nurse or physician) to determine if an Emergency Medical Condition exists..."