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Based on interviews and record review, it was determined the facility failed to comply with 42 CFR 489.24 related to not providing an appropriate medical screening examination (MSE) to a patient with an Emergency Medical Condition (EMC), for one (1) of twenty-three (23) sampled patients, Patient (P) #1.

P1 presented to facility #2 on the night of 01/28/2025 with nausea and vomiting. P1 was determined to have Influenza A, was treated and discharged. P1 presented again to facility #2 the following morning 01/29/2025 with continued nausea and vomiting.

P1 presented to Facility #1 the night of 01/30/2025 with continued nausea and vomiting, at which time the facility failed to provide an appropriate MSE consisting of blood glucose testing (P1 was a known diabetic) and a repeat Basic Metabolic Panel (BMP).

P1 was brought in by EMS to Facility #1 on the night of 02/07/2025 after suffering a fatal cardiac event.

The findings include:

Cross Refer to A2406 for findings.

Based on interviews and record review, it was determined the facility failed to provide an appropriate medical screening examination (MSE) to a patient with an Emergency Medical Condition (EMC), for one (1) of twenty-three (23) sampled patients, Patient (P) #1.

P1 presented to facility #2 on the night of 01/28/2025 with nausea and vomiting. P1 was determined to have Influenza A, was treated and discharged.

P1 presented again to facility #2 the following morning 01/29/2025 with continued nausea and vomiting. Basic Metabolic Panel (BMP) showed high glucose of 292, and a high anion gap of 18.

P1 presented to facility #1 the night of 01/30/2025, the third day in a row, with continued nausea and vomiting. Facility #1 failed to complete repeat BMP testing to rule out an emergency medical condition. P1 was discharged home without an appropriate MSE.

The findings include:

Review of P1's medical record revealed P1 presented to facility 2's ED on 01/29/2025 at 11:40 AM, just under ten (10) hours since a prior discharge from ED on 01/28/2025. P1's chief complaint was Influenza and emesis. Blood work results at 1:50 PM showed lymph .9 (range 1.2 to 3.9, up from .8 yesterday), glucose at 292 (range 70 to 99), creatinine .66 (range .67 to 1.3), and a high Anion gap of 18 (normal range 7-16) (Anion gap is a calculated measurement that reflects the difference between positively charged ions (cations) and negatively charged ions (anions) in the blood which is used to assess the body's acid-base balance and identify potential underlying causes of acidosis (high acidity) or alkalosis (low acidity). P1 selected for disposition at 3:32, found he had "Eloped," which was disposition on his medical record

Review of P1's medical record revealed P1 presented to facility 1's ED on 01/30/2025 at 7:25 PM. Triage assigned P1 to the PIT (Physician in Triage) at 7:26 PM, acuity level 3, "urgent." There was no documentation on 1/30/25 laboratory testing to rule out other potential EMCs.

Interview on 02/19/2025 at 10:22 AM with MD 1 stated he worked in the physician triage area (PIT) on 01/30/2025. MD 1 stated the PIT is for walk-ins and less acute patients. MD 1 stated P1 had vomiting and hadn't taken his nausea medication. MD 1 stated he gave P1 what had been prescribed and observed him for a bit. MD 1 stated P1 appeared miserable like most of the people coming in with the flu over the past month, he estimated one (1) in four (4) patients that day had similar symptoms. MD 1 stated as P1 had blood work and testing done on the previous two visits which he reviewed, he did not feel there was a need to repeat that process.

Interview on 02/19/2025 at 1:57 PM with the DCEM stated, when P1 returned to facility 1 for his third visit, the MD elected not to repeat labs, as they had been done over the past two days and there was nothing to warrant repeating them. DCEM stated it is her expectation individuals presenting to the ED are evaluated and treated to ensure an emergency condition doesn't exist, and if a condition does exits to treat and stabilize them.