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Based on interview and document review, the hospital failed to meet an EMTALA obligation by not providing a Medical Screening Examination to Patient #1 on 06/06/11 as required. Patient #1 was forced to go to another hospital to obtain the Medical Screening Examination and treatment. (Refer to A2406.)

Based on interview and document review the hospital failed to meet an EMTALA obligation by not providing a Medical Screening Examination to Patient #1 on 06/06/11 as required. Patient #1 was forced to go to another hospital to obtain the Medical Screening Examination and treatment. The findings are:

A. On 06/06/11 at approximately 11:00 pm Patient #1 (Pt.) presented to the hospital Emergency Department (ED) complaining of intense pain on his right side. He was registered in the ED central log and was then triaged by an ED Registered Nurse (RN #1).

B. The ED notes for the Pt. indicate that RN #1 found the following medical issues: (1) Pt. had intense pain on his right side registering a 10 on a scale of 1 to 10 pain; (2) Pt. had blood in his urine; (3) Pt. had long standing cardiac problems and had 14 stents; (4) Pt. was a diabetic; and (5) Pt. had repeat blood pressures taken with the same reading, 224/101.

C. Based on the hospital ED triage policy dated 02/10, the Pt. was a Category II - Urgent which was defined as: high risk situation, new onset confusion, lethargy or disorientation: severe pain or distress; and patients requiring two or more resources/ heart rate, respiratory rate or oxygen saturation in danger zone. The policy then states, "Level I and Level II patients should be taken to a treatment area immediately, physician intervention requested and complete primary nursing assessment performed without delay."

D. Once Pt. #1 was triaged by RN #1, RN #1 went and talked to two other ED nurses concerning the ability of the ED to treat another patient. She did not talk to any physician or manager. In a written statement given to the hospital, RN #1 admitted that she and two other ED nurses made the decision that they would not be able to see or treat Pt. #1 for some indeterminate period of time. Based on her written statement, she did not consult the ED physician, the ED manager, the House Shift supervisor, or the hospitalist physician. She then returned to Pt. #1 and his wife and told them that the ED was full with an ambulance on the way with another patient. She told them that there would be a significant delay in Pt. #1 being seen for the Medical Screening Examination and treatment. RN #1 was asked by the patient's wife how long would the wait be before her husband was seen. She told them that she did not know how long it would be before Pt. #1 would be seen. The patient's wife then asked if he could have some medication for the intense pain. RN #1 told her that all she could offer would be Tylenol until he was seen by a physician and medications were ordered. At this point the patient's wife said to Pt. #1, "Come on, let's just go to Espanola [town with the nearest hospital] and if you die on the way, we'll sue." Pt. #1 and his wife then left the hospital and drove 30 minutes to the next hospital. It should be noted that RN #1 did not get them to sign a leaving against medical advice (AMA) form prior to leaving.

E. Although RN #1 knew from doing the triage that Pt. #1 was classified by the hospital triage system as being Category II - Urgent and requiring immediate attention, she made no effort to talk with a physician or manager about getting the Medical Screening Exam and treatment even after she was aware that Pt. #1 and his wife were preparing to travel to the next hospital in the middle of the night.

F. Pt. #1 and his wife went to the hospital in the next town where he was given the Medical Screening Examination and treatment was provided.