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.

TIMBERLAWN MENTAL HEALTH SYSTEM 4600 SAMUELL BLVD DALLAS, TX Jan. 11, 2018
VIOLATION: COMPLIANCE WITH 489.24 Tag No: A2400
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, the hospital failed to ensure compliance with 489.24 (a) Medical Screening Exam in that 1 of 1 patient (Patient #1) walked across the street to the hospital on [DATE] at approximately 1235 and was not provided a medical screening examination and the MOT (Memorandum of Transfer) was left incomplete with no facility listed as the receiving hospital.

Cross reference to A2406 and A2409
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on record review and interview, 1 of 1 patient (Patient #1) did not receive an appropriate medical screening exam when presenting to Hospital A. Patient #1 disclosed to hospital personnel she had overdosed on Seroquel tablets (antipsychotic medication). Hospital A failed to document evidence of a medical screening examination for Patient #1.

Findings included:

The 10/05/17 written Multidisciplinary Progress Note, non-patient identified timed at 1345 reflected, "Patient presented to (Hospital A) was brought back into intake where she divulged that she had overdosed on 100 mg (milligram) Seroquel 20-30 minutes prior while at (other facility)...911 was called...to obtain MOT (Memorandum of Transfer)...Dr. and House Supervisor notified...all safety checks had been properly conducted prior to assessment..." No medical screening was found which included vital signs was documented.

A type written Hospital A Inquiry Call Note, non-dated for Patient #1 reflected, "Patient presented for assessment as walk-in 10/05/17 around 1235, vital signs taken, based on patient stating she had completed overdose prior to this hospital, patient was sent to medical hospital via MOT to be medically cleared..as of 10/07/17 at 1600 patient has not returned." No documentation was found which indicated the patient was assessed and/or vital signs were documented.

On 01/09/18 at 1138 Personnel #6 was interviewed by telephone. Personnel #6 stated she did not work on 10/05/17. Personnel #6 was asked about a type written note with her type written signature on it regarding Patient #1. Personnel #6 stated she remembered when she came to work there was a whole lot of papers on the desk which the information had not been inputed in the computer so that is what she did. Personnel #6 stated that is how her name showed up on the document. Personnel #6 stated she just entered the information in the computer did not see Patient #1. Personnel #6 questioned regarding the document indicating vital signs were taken. Personnel #6 stated she was not sure what documents she obtained the information form.

On 01/10/18 at 0922 Personnel #1 was interviewed. Personnel #1 verified Patient #1 did not have a medical screen exam. Personnel #1 provided the surveyor a written progress note. The note had no patient identification information on the document nor any documentation which indicated the patient was medically screened. Personnel #1 further verified the MOT (Memorandum of Transfer) was left incomplete.

On 01/10/18 at approximately 0950 Personnel #4 was interviewed by telephone. Personnel #4 stated she remembered Patient #1. Personnel #4 stated she called the physician and told him the patient had come on property after taking some Seroquel tablets. Personal #4 was asked if the physician saw Patient #1. Personal #4 stated no but he told her to send the patient to the emergency room . Personnel #4 stated at the time the patient appeared drowsy. Personnel #4 verified she wrote a progress note but did not remember writing anything about the patient being drowsy. Personnel #4 stated she asked Personnel #5 to come and assess the patient. Personnel #4 stated she was not sure if a medical screening was documented. Personnel #4 stated the patient was supposed to go to Hospital C. The surveyor asked Personnel #4 why the MOT was not completed with all information. Personnel #4 stated she must have not completed the document after the surveyor read off the blank sections of the MOT to her.

On 01/10/18 at 1000 Personnel #5 was interviewed. Personnel #5 was asked if she assessed Patient #1. Personnel #5 stated she could not remember and offered the surveyor no other information.

The Emergency Services and Patient Transfer Policy and Procedure with a review date of 02/17 reflected, "Medical Screening...an appropriate medical screening examination; necessary stabilization treatment...if necessary, an appropriate transfer to another facility even if the patient cannot pay...prior to transfer, the transferring physician shall secure a receiving physician and a receiving hospital that are appropriate to the medical needs of the patient and that will accept responsibility for the patient's medical treatment and hospital care..."
VIOLATION: APPROPRIATE TRANSFER Tag No: A2409
Based on interview and record review Hospital A failed to ensure 1 of 1 patient (Patient #1's) MOT (Memorandum of Transfer) to Hospital B was complete and documented. Hospital B was unaware Patient #1 was being transferred from Hospital A for an alledged overdose of Seroquel (antipsychotic medication) tablets on 10/05/17.

Findings included:

The 10/05/17 written Multidisciplinary Progress Note, non-patient identified timed at 1345 reflected, "Patient presented to (Hospital A) was brought back into intake where she divulged that she had overdosed on 100 mg (milligram) Seroquel 20-30 minutes prior while at (other facility)...911 was called...to obtain MOT (Memorandum of Transfer)...Dr. and House Supervisor notified...all safety checks had been properly conducted prior to assessment..."

The MOT addendum dated 10/05/17 reflected, "The individuals condition has not stabilized, however the individual will benefit from higher level of care...stabilization...(next of kin left blank)...date of arrival 10/05/17 timed at 1235...initial contact with receiving hospital 10/05/17 timed at 1327...accepting physician secured by transferring hospital 10/05/17 (no time, nor name of accepting physician)...(name of accepting hospital administration left blank)...diagnosis overdose..."

On 01/10/18 at 0922 Personnel #1 was interviewed. Personnel #1 verified further verified the MOT (Memorandum of Transfer) was left incomplete with documentation of the receving hospital (Hospital C) information left blank.

On 01/10/18 at approximately 0950 Personnel #4 was interviewed by telephone. Personnel #4 stated she remembered Patient #1. Personnel #4 stated she called the physician and told him the patient had come on property after taking some Seroquel tablets. Personal #4 was asked if the physician saw Patient #1. Personal #4 stated no but he told her to send the patient to the emergency room . Personnel #4 stated at the time the patient appeared drowsy. Personnel #4 verified she wrote a progress note but did not remember writing anything about the patient being drowsy. Personnel #4 stated she asked Personnel #5 to come and assess the patient. Personnel #4 stated she was not sure if a medical screening was documented. Personnel #4 stated the patient was supposed to go to Hospital C. The surveyor asked Personnel #4 why the MOT was not completed with all information. Personnel #4 stated she must have not completed the document after the surveyor read off the blank sections of the MOT to her.

The Emergency Services and Patient Transfer Policy and Procedure with a review date of 02/17 reflected, "An appropriate transfer to another facility even if the patient cannot pay...prior to transfer, the transferring physician shall secure a receiving physician and a receiving hospital that are appropriate to the medical needs of the patient and that will accept responsibility for the patient's medical treatment and hospital care..."