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)
A2406 MEDICAL SCREENING EXAM
CFR(s): 489.24(r) and 489.24(c)

Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) "comes to the emergency department", as defined in paragraph (b) of this section, the hospital must (i) 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 exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of ยง482.55 of this chapter concerning emergency services personnel and direction; and (b) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital's obligation under this section ends, as specified in paragraph (d)(2) of this section. (2) Nonapplicability of provisions of this section. Sanctions under this section for inappropriate transfer during a national emergency or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department located in an emergency area, as specified in section 1135(g)(1) of the Act. A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided for by section 1135(e)(1)(B) of the Act. (c) Use of Dedicated Emergency Department for Nonemergency Services If an individual comes to a hospital's dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition.


This STANDARD is not met as evidenced by:
Based on interview, and record review, the facility's Emergency Room (ER) staff failed to provide an appropriate medical screening examination by a Qualified Medical Personnel( QMP) to determine if an emergency medical condition exist for patients #s 1&2. Two (2) of six (6) women in labor were informed there was no labor and delivery services at the facility and were told to go to facility "B" in their own private vehicles. 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". Patient # 1 stated she was not examined by any one, she said "no one put hands on her." During an interview on 7/29/10 at 2 pm in the ER with Staff # 50 (Charge Nurse at North Cypress Hospital) ,he stated the patient came to the ER but he was not sure if the patient was triaged. According to Staff # 50, the ER physician ( Staff # 54) went to the waiting room and spoke to the patient in Spanish. The physician explained the plan of care to the patient. The patient was told that there were no delivery services at the facility. The patient decided she wanted to go in her own vehicle. According to Staff # 50 the ER Physician instructed him to call "Hospital B" and give them a " heads up that the patient was coming", which he did. Staff # 50 said he did call the facility later that morning to ensure the patient got there ok During the interview Staff # 50 further stated he wrote a note immediately after the patient left the facility and the physician wrote a history and physical. Staff # 50 stated when an OB patient comes to the ER they are checked in at registration. The ER physician is informed and he/she will go to the front and check the patient. Patients who have a pregnancy greater than twenty (20)weeks will be informed that there was no OB services and they have the option to leave in their own vehicle or be transported. The Staff was not able to tell whether or not the facility had offered the patient transportation. Review of a report on a single sheet of paper dated 7/16/10 at 7:21am written by Staff # 50 revealed the following information: "Patient present with parent, states she is pregnant and having contractions. Patient appears uncomfortable, clutching stomach and moaning, Abdomen appears distended. Patient does not know how far long she is. Reports contraction began 0400 and is now 5 minutes apart. Dr. # 54 to ER Lobby to speak with patient. Patient advised by Dr. #54 that no ob services are available and patient decides to drive to "Hospital B". Leaves with family " . Review of a History of present illness written by Dr. #54 revealed the following information: " Patient with abdominal cramping no prenatal care advised patients we did not have ob and advised her family did not refuse care but informed them we had no ob and L&D patient did not know what an ob doctor was and did not understand what prenatal care was and where she was to deliver directions given to "Hospital B" by myself and registration in Spanish and family opted to go there directly they preferred to leave directly and not be triaged and wanted to leave immediately." Patient # 2 Review of complaint narrative revealed allegations that Patient # 2 went to the ER on 7/19/10 with complaints of shortness of breath, she was also pregnant. The patient was told by a " staff in a white lab coat" that the hospital did not have Gynecological services and the patient should drive to "Hospital B" in her own private car. Review of the facility's ER Logs dated 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 patient. During an interview on 7/29/10 at 10:30 am with Staff # 51 (Registration Clerk) in the ER, regarding registration procedures at the facility It was revealed that all patients who came to the ER were registered and that the facility kept the registration records. It was later discovered that the patient was registered as entering the ER on 7/16/10. Review of the registration information for Patient # 2 revealed date of arrival, complaint of difficulty breathing and that she was seven (7) months pregnant. There was no information regarding assessment, examination, vital signs or treatment. There was no information regarding 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 # 52 , Medical Director for the ER, he stated the patients should have been triaged, examined, monitored and appropriately transferred as needed. The Medical Director further stated systems would be implemented to correct the problem. Review of the facility ' s Medical Screening Guidelines dated January 2009 documented that: " Any individual who comes to the Hospital Emergency Department requesting examination or treatment shall be provided with an appropriate medical screening examination. " " In providing a medical screening examination, the Hospital shall not discriminate against any individual because of diagnosis, financial status, race, color, and national origin or handicap. "