Childrens Medical Center Plano

“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: 45521 Based on record review and interviews Facility A failed to provide a medical screening exam in 1of 20 (Patient #1) patients whose records were reviewed. Patient #1 presented to Facility A on 12/27/2025 at 12:20 PM with a complaint of a fever and cough. Patient #1’s record diagnoses were Influenza A, fever, mild intermittent asthma with acute exacerbation, and cough. The facility failed to order and complete diagnostic tests to rule out respiratory infection, and air in the thorax or between the lungs. The patient presented to Facility B on 12/28/2025 at 8:08 AM and was diagnosed with pneumonia and admitted for treatment for two days. Refer to A2406”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) 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 §482.55 of this chapter concerning emergency services personnel and direction; and (ii) 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)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer 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 if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) 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 under 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: 45521 Based on record review and interviews, the facility failed to comply with 42 CFR §489.24(a) Special responsibilities of Medicare hospitals in emergency cases. Based on record review and interviews, Facility A failed to provide a medical screening exam in 1of 20 (Patient #1) patients whose records were reviewed. Patient #1 presented to Facility A on 12/27/2025 at 12:20 PM with a complaint of a fever and cough. Patient #1’s record diagnoses were Influenza A, fever, mild intermittent asthma with acute exacerbation, and cough. The facility failed to order and complete diagnostic tests to rule out respiratory infection, and air in the thorax or between the lungs. The patient presented to Facility B on 12/28/2025 at 8:08 AM and was diagnosed with pneumonia and admitted for treatment for two days. Findings included: A review of Patient # 1, a 4-year-old male, medical record revealed he arrived to the facility on 12/27/2025 at 12:20 PM with his mother. Patient #1’s chief complaints were a fever and a cough. The medical record noted the patient was seen by his primary care physician (PCP) in the morning, and his parents were told to take him to the Emergency Room. Dexamethasone 4 mg was given in the PCP’s office. His emergency department admission diagnosis was documented as respiratory failure with hypoxia. The patient’s temperature ranged from 100 to 98.8°F, pulse 136-159, respirations 30 to 61 breaths per minute, SPO2 91-100% on room air, blood pressure 103-109/59-76. Discharge vital signs completed on 12/27/2025 at 5:43 pm were: Blood pressure-105/65, pulse-151, respirations-30 breaths per minute, and temperature was 98.8F. A review of the document titled “ED Provider Notes” by Staff #5, the ED physician, on 12/27/2025 at 12:35 PM revealed the following: The physical exam notes that the patient was in acute respiratory distress, with nasal congestion present, swelling of the throat, tachycardia, and increased respiratory rate. Expirations were longer than inspirations. Diminished breath sounds were noted on inspiration and expiration. The patient exhibited signs of respiratory distress, including intercostal retractions (skin sinking around his chest). The differential diagnoses included: page 10/70, “moderate to severe acute asthma exacerbation, uviral respiratory infection (including influenza or COVID-19), viral or bacterial pneumonia, pneumothorax, pneumomediastinum, airway foreign body, allergic reaction,” Additionally, the medical record revealed, “The patient is at risk for the following: progression of illness, respiratory distress, respiratory failure, development of pneumonia, death” The patient’s illness was treated with albuterol 15mg/Atrovent 1500 mcg nebulizer treatment, close monitoring, oral steroids, a respiratory panel, oral fluids, and reassessment. Additional medication administered was dexamethasone 5mg oral, provided at 12:49 PM. The respiratory panel revealed a positive result for Influenza A H3 The patient was reassessed by the physician at 4:40 PM and was noted as resting comfortably; no distress was observed. No problems breathing, but the bronchial tubes contract during coughing. The patient is planned for discharge after a dose from the inhaler is completed. Visit diagnoses were Influenza A, fever, mild intermittent asthma with acute exacerbation, and cough. Patient # 1 was discharged from the facility on 12/27/2025 at 5:51 PM with instructions to return to the facility if symptoms worsen and to schedule an appointment with the patient’s PCP as soon as possible. Patient # 1 Patient # 1 arrived to the facility on 12/28/2025 at 8:08 AM, with chief complaints of asthma and vomiting that started yesterday. The patient was seen at the facility on 12/27/2025 for difficulty breathing. Staff # 4 and # 7 placed the patient on 3 L O2 via nasal canula. An X-ray was done at the bedside. Vital signs on 12/28/2025 at 8:30 AM were Temperatuer-98.1 F, pulse-126, respirations-62. A physical exam by Staff # 4 on 12/28/2025 at 8:30 AM revealed the patient was in acute respiratory distress with wheezing present. Oxygen saturation was 82% on room air. Rapid breathing with retractions and nasal flaring was noted. The patient had diminished breath sounds, and wheezing in both lungs was noted. The patient was given albuterol 15 mg/Atrovent 1500 mcg nebulizer treatment and dexamethasone 8.9 mg orally for respiratory distress. The patient had improved aeration but continued to have increased work of breathing with retractions and nasal flaring. The patient was provided with oxygen at 9 L/min via nasal canula. The chest x-ray revealed right mid-lobe pneumonia, and Rocephin was administered. Tamiflu was also administered, secondary to the flu. The patient was admitted to the pediatric intensive care unit (PICU) and was discharged on 12/30/2025 at 4:55 PM. Policies: A review of the Policy titled, “AD 2.29.02 Emergency Medical Treatment (EMTALA) and Patient Transfer -Plano” pages 5 and 6/15 Section B, subsection D revealed the following: ... “The physician’s or QMP’s documentation of the MSE should address the elements of the examination that support the evaluation of whether or not the emergency medical condition exists and addressing the Patient’s presenting signs and symptoms, including, but not limited to, past medical history, physical exam of the patient, ordered and completed laboratory and/or diagnostic testing and/or procedures, inquiries or consults with on-call physician specialists, the medical decision making regarding the differential diagnosis and reasoning and final assessment results of the MSE and whether or not an emergency medical condition exists, address any unresolved items that were determined to be non-emergent medical conditions, the discharge plan (including outpatient referrals for follow up and/or continuum of care services to address the Patient’s signs and symptoms and any non-emergent medical condition for further evaluation and treatment, or transfer of the Patient to another medical facility to care and treatment of the Patient’s emergency medical condition, and disposition.” The facility failed to follow its own policy by not evaluating all medical emergencies listed in the differential medical diagnoses for treatment of an emergency medical condition. Interviews: 1. An interview with Staff # 4 , on 03/03/2026 at 11:25 am revealed the following: The patient was in severe respiratory distress on arrival. The patient was given an asthma treatment to see if that would help. It improved, but he still had to work very hard to breathe. He was hypoxemic, needing 60 % of oxygen. The advantageous sounds remained in the lungs, and I ordered an X-ray that showed pneumonia in the right lung. Tamiflu and antibiotics were ordered. He was stable upon admission to the facility. He was not on Tamiflu before arrival because he was outside the recommended time window. It should be given within 48 hours. An exception is children who are hospitalized secondary to the flu. This was day 5 of the flu.”