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Based on observations, interviews, and records review, the hospital failed to meet the requirement under 42 CFR 489.24(a) in that it failed to provide a medical screening examination that was timely and appropriate on a patient with critical presenting symptoms.


On October 2, 2017, at 08:31 PM, a 50-year old, ambulatory male patient presented to the Emergency Department (ED) with complaints of chest pain. Any individual who present to the ED asking for an examination of a medical condition will be seen first by a reception desk staff. The staff assigned in the reception desk are non-professional staff and does not have the knowledge or experience to determine the severity of the presenting symptoms of individuals. The reception staff simply ask and record basic demographic information of the individual as well as presenting symptoms, then instruct the individual to sit in the waiting room. The individual lost consciousness in the waiting room, awaiting for an examination, and subsequently died.

Based on observation, interviews, and records review, the hospital failed to conduct a timely medical screening examination on an individual who presented with complaints of chest pain.


On October 2, 2017, at 08:31 PM, an ambulatory, 50-year old male presented to the Emergency Department (ED) with complaints of chest pain. The reception staff entered his information on the log and told him to go sit in the waiting area. The reception area of the ED is staffed with non-professional individuals. The staff at the reception area do not have the knowledge or experience to determine the severity of the presenting complaints of individuals.


At 8:49 PM on October 2, 2017, the Security Officer recognized the individual and went to talk to him and suddenly, the individual lost consciousness. Help was summoned, and the staff from the Main ED responded, found the patient with no pulse or respirations. Cardio-Pulmonary Resuscitation (CPR) was initiated.


At 08:54 PM, the patient was transferred via stretcher from the waiting area to the Main ED. Resuscitation efforts continued. The individual was finally intubated at 09:31 PM. Pulses were regained at 9:39 PM. At 11:08 PM, transfer arrangements were made to a hospital located 141 miles away. There was no listed accepting physician. There was no certification of transfer completed.


At 1:10 a.m. on October 3, 2017, the patient was placed on a ground ambulance enroute to an Air Ambulance at Gallup airport. The patient, however, developed asystole at 1:33 a.m. He was then returned back to the hospital. At 1:38 a.m., the patient was pronounced dead by the emergency department physician.


There was no Root Cause Analyses (RCA) conducted on this critical event until the accrediting conducted an onsite complaint survey in November 2017. However, at the time of the survey, no system or process changes has been made to ensure timely medical screening examination is conducted.


Interview with the reception staff on duty on December 12, 2017, informed the surveyors that individuals often tells her that they want to be seen at the Fast Track area, the Urgent Care area, or the main ED. She told the surveyors that any RN assigned as Triage Nurse will come and take the patient for Triage assessment. The timeliness is inconsistent depending if there is an assigned Triage Nurse or not, and the availability of a Triage room. There are only 2 triage rooms where RN's conduct triage on individuals.


Individuals are held in these rooms until there is a bed in the ED for them or sent back to the waiting area to wait for examination and/or treatment. As long as individuals are in the triage rooms, no other individuals can be triaged.