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 670068 (X3) Date Survey Completed 06/25/2024
Name of Provider or Supplier Texas Health Presbyterian Hospital Flower Mound Street Address, City, State 4400 Long Prairie Road, Flower Mound, 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)
A2400 COMPLIANCE WITH 489.24
CFR(s): 489.20(l)

[The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24.


This STANDARD is not met as evidenced by:
. Based on record review and interview the facility failed to abide by the provider's agreement that required a hospital to comply with 42 CFR §489.24, Special responsibilities of Medicare hospitals in emergency cases. . Based on a record review and interview, Facility A failed to provide a complete and accurate medical screening examination (MSE) for 1 of the 20 (Patient #1) whose records were reviewed. Patient #1 was a 27-year-old male patient with a history of spinal epidural abscess and intravenous drug use who presented with stated complaints of back pain, "going cross-eyed" from the back pain medicine he is on, and a dental infection on 04/05/2023. There was also reported concern for suicide for Patient #1's safety expressed by Patient #1's mother and grandmother. Facility A failed to obtain the needed laboratory screening and radiological screenings to determine if an emergency medical condition (EMC) existed for Patient #1. . Cross refer A2406. .