The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

METHODIST HOSPITAL 7700 FLOYD CURL DR SAN ANTONIO, TX 78229 Oct. 13, 2015
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
1. Based on reviews of emergency room : medical records, reports, and staff interviews, Metropolitan Methodist Hospital failed to conduct a medical screening examination within its capabilities to determine if an emergency medical condition existed and to provide stabilizing treatment prior to transferring patients to another hospital.

The findings included:

a. A review of medical record #9 in the presence of staff members S1 and S3 revealed a patient with a history of mental illness who presented for medical examination and treatment after threatening suicide and expressing homicidal ideation. The emergency department records are absent of any evidence the patient received treatment for his chief complaint prior to being transferred to another hospital.

b. A review of the emergency room reports presented by staff member S1 revealed patients seeking treatment for mental health complaints had completed medical screenings to include diagnostic and psychiatry consultative services and inpatient admission when necessary within Methodist Health Care System in the past. Staff member S1 acknowledged record #9 is incomplete for a medical screening examination for the patient's chief complaint, as well as consultations to Psychiatry services, and a discharge diagnosis.

c. Interviews conducted on 10/13/15 in the emergency department with P2 revealed Psychiatry services were available when this patient was transferred. Follow on interview with emergency room staff member D2 revealed that combative patients are often encountered in the emergency department and Metropolitan Methodist hospital can provide for aggressive patients as well as those with mental health issues. D2 acknowledges the record is incomplete for Psychiatry intervention.
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
1. Based on reviews of the central log, medical records, and staff interviews, Metropolitan Methodist Hospital failed to follow patient transfer guidelines to obtain a Memorandum of Transfer agreement prior to transferring patients to another hospital.

The findings included:

a. A review of the Emergency Department's Central Log revealed within the past six months patients seeking treatment with similar chief complaints have completed medical screenings to include diagnostic and consultative resources within Methodist Health Care System.

b. A review of 9 medical records of patients presenting for behavioral issues to include threats of suicide revealed records #1-8 the patients received treatment that included consultations with Tele-Pyschiatry and inpatient admission when necessary. Prior to discharge the patients were documented to be stable. A review of medical record #9 revealed a patient with a history of mental illness presented for medical examination and treatment after threatening suicide and expressing homicidal ideation. This patient became combative and the police were called to assist. A decision was made to release the patient to receive treatment at another hospital.

c. Interviews conducted with staff members of the emergency department revealed the record was incomplete for documentation indicating the patient's treatment for his chief complaint and his final disposition. No consultative results or written transfer agreement with an accepting physician were in the record. Interview conducted on 10/13/15 in the emergency department with P2 revealed Metropolitan Methodist Hospital had Psychiatry services available when this patient was transferred.

Interview with D1 revealed the patient was released at the request of the police department. Interview with D3 revealed police suggested the patient be released for transfer to a higher level of care however could not provide any evidence of consulting with an administrator within Methodist hospital or the receiving hospital's emergency department physician.

Interview with P1 revealed staffing, beds, and consultative services were all available at the time the patient was transferred. P1 and P4 acknowledged they could not provide evidence of a Memorandum of Transfer with the receiving hospital.