Department of Health & Human Services

Centers for Medicare & Medicaid Services
Form Approved

OMB No. 0938-0391
Statement of Deficiencies (X1) Provider/Supplier/CLIA Identification Number 670024 (X3) Date Survey Completed 07/30/2010
Name of Provider or Supplier North Cypress Medical Center Street Address, City, State 21214 Northwest Freeway, Cypress, TX
For information on the provider's plan to correct this deficiency, please contact the provider or the state survey agency.
(X4) ID Prefix Tag Summary Statement of Deficiencies

(Each deficiency should be preceded by full regulatory or LSC identifying information)
A2405 EMERGENCY ROOM LOG
CFR(s): 489.20(r)(3)

[The provider agrees,] in the case of a hospital as defined in §489.24(b) (including both the transferring and receiving hospitals), to maintain a central log on each individual who comes to the emergency department, as defined in §489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged. §489.24 The provisions of this regulation apply to all hospitals that participate in Medicare and provide emergency services.


This STANDARD is not met as evidenced by:
Based on record review, and interview, the facility's Emergency Room (ER) Staff failed to provide documented evidence on the ER central log for two(2) of six (6) women in labor, who came to the Emergency Room seeking Medical attention between the period May 1, 2010 and July 19, 2010. The facility failed to provide information on the ER Logs regarding the condition of the women on arrival to the ER, whether or not they were treated and the final outcome of their visits. Citing Patient #s 1 and 2. Findings: Patient # 1 Review of complaint narrative TX00133533 revealed allegations that patient # 1 was in labor and went to the Emergency Room(ER) at North Cypress Medical Center on 7/16/10. She was informed the facility did not provide Labor and Delivery services and she should go to "Hospital B" in her own private vehicle with the caution light on. During an interview on 7/28/10 at 3:30 pm with Staff # 57 ( Nurse Director for "Hospital B"Emergency Room) she stated the patient arrived at the facility in labor and stated she was sent from North Cypress Hospital. She was told to put the caution lights in her car on. During a telephone interview on 7/29/10 at 9:15am with Patient # 1 she stated she was having labor pain and went to North Cypress Hospital to have her baby. According to Patient # 1 when she arrived at the hospital a Doctor came out and told her "there was no service to deliver babies at that hospital and she should go to "Hospital B". Review of the facility's Emergency Room logs for 7/16/10 revealed the patient's name did not appear on the log. There was no information that the patient came to the hospital. Patient # 2 Review of complaint narrative revealed allegations that Patient # 2 who was pregnant went to the ER on 7/19/10 with complaints of shortness of breath and was told by a " staff in a white lab coat" that Gynecological services was not provided at the facility, the patient was told to go to "Hospital B" in her own private vehicle. Review of the facility's ER Logs for 7/19/10 revealed the patient's name did not appear on the log. There was no information that the patient came to the emergency room. The facility's Medical Records Department had no information on the patients. There was no medical records for the patients. During an interview on 7/29/10 at 10:30 am with Staff # 51 (Registration Clerk) in the ER, the clerk stated all patients who entered the ER were registered with their name, age and reason for the visit . The registration information was kept. A search of the registration system by Staff # 52 Emergency Room Registered Nurse Director she was able to verify that both patient #s 1 and 2 were registered at the facility on the date of their arrival. The registration information had date of arrival, chief complaint and no information regarding treatment, the patients' condition and the outcome of the visit. During an interview on 7/29/10 at 11:40 am in the ER with Staff # 53 , Medical Director for the ER, he stated the patients should have been triaged, examined, and entered into the ER log. He further stated systems would be implemented to correct the problem.