Based on observation, record review, and interview, the facility failed to comply with §489.20 and 489.24 - EMTALA, in that, §489.20: A) Patient #8 was brought to the hospital by police for emergency evaluation on 3/21/18 and he was not logged on the Central/Emergency Log. Cross Reference A2405 §489.24: B) Patient #8 was brought to the hospital by police for emergency evaluation on 3/21/18 and he did not have a Medical Screening Examination to determine if there was an Emergency Medical Condition. Cross Reference A2406

Based on record review and interview, the facility failed to maintain a Central Log of all patients who presented to the hospital for evaluation, in that, Findings included Patient #8 was brought to the hospital by police for emergency evaluation on 3/21/18 and he was not logged on the Central/Emergency Log. During an interview on 7/25/18 ending at 2:20 PM, Personnel #5 was asked about the incident. Personnel #5 stated, "DPD (Dallas Police Department) brought him in ambulatory. I asked if he needed medical clearance. The Officer was defensive. I told him I did not currently have a room; it was going to be a minute. He (Officer) stated- We'll go somewhere else. I had 4 ambulances at that time and him. We had been on disaster level for a while." Personnel #5 was informed the patient was not logged. Personnel #5 stated, "My mistake. He fell through the cracks." During an interview on 7/25/18 at 12:49 PM, Personnel #3 (Risk Manager) was informed of the policy to log all patients and what intervention had been done after she realized the patient had not been logged. Personnel #3 stated, "No. Nothing."

Based on record review and interview, the facility failed to provide a Medical Screening Examination to determine if there was an Emergency Medical Condition for all patients that present to the hospital for evaluation, in that, 1 of 1 Emergency Department patients (Patient #8) was brought to the hospital by police for emergency evaluation on 3/21/18 and the hospial did not ensure a Medical Screening Examination. Findings included Patient #8 was brought to the hospital by police for emergency evaluation on 3/21/18 and the hospial did not ensure a Medical Screening Examination (MSE). During an interview on 7/25/18 ending at 2:20 PM, Personnel #5 was asked about the incident. Personnel #5 stated, "DPD (Dallas Police Department) brought him in ambulatory. I asked if he needed medical clearance. The Officer was defensive. I told him I did not currently have a room; it was going to be a minute. He (Officer) stated - We'll go somewhere else. I had 4 ambulances at that time and him. We had been on disaster level for a while." During an interview on 7/25/18 at 12:49 PM, Personnel #3 (Risk Manager) was asked to verify that there was no patient record including MSE for Patient #8. Personnel #3 stated, "No."

Based on record review and interview, the hospital failed to readmit the patient on the day of discharge once the Police department Nurses informed the police they could not take care of the patient because he was not weight bearing and could not take care of his activities of daily living. The hospital stated that the patient did not have an emergency medical condition and refused to readmit the patient. Findings include: Patient #1 medical record documents the patient was discharged on [DATE] at 4:13 PM. Patient #1 was discharged to the police and was taken to jail. When Patient #1 arrived at the jail, the nursing staff advised since the patient was non weight bearing and could not take care of his own activities of daily living and they could not admit him to the jail as they could not care for him. Patient #1 was taken back to Hospital A by police and was registered and had a medical screening exam. The patient reported pain in his legs but was determined to not have an emergency medical condition. The patient was discharged back to the police. The police took the patient to Hospital B emergency room and he was registered and given a medical screening exam and was admitted . He was admitted to their trauma unit around 2:22 AM. for pain control and rehabilitation. Orthopedic services saw Patient #1 on 5/5/2018 and stated that he needed to go back to Hospital A and the orthopedic service that has been taking care of the patient for continuity of care. Patient #1 was transferred back to Hospital A and arrived in their trauma unit on 5/5/2018 at 5:19 PM and received pain control and physical therapy during his stay. Patient #1 was discharged back to the jail on 5/11/2018 with a wheelchair provided to the patient. An interview on 7/25/2018 at 1:00 PM with Personnel #3 confirmed the patient came back to Hospital A due to non-weight bearing status and inability to transfer to toilet. Personnel #3 stated the trauma ER physician did a medical screening exam and did not find an emergency medical condition to readmit the patient. Personnel #3 stated that the sheriff deputy sitting with patient had told them the Sheriff Department had wheelchairs for the patient. Patient #1 was discharged and the police took him to Hospital #2. Hospital #2 admitted Patient #2 for pain control and rehabilitation. Once Hospital B trauma surgeon saw Patient #1 he said Patient #1 needed to be transferred back to Hospital A and be cared for the ortho team that has been treating patient for continuity of care. Patient #1 was sent back and was here until 5/11/2018. Patient #1 was discharged back to jail.