HospitalInspections.org

Based on review of twenty emergency department records from hospital #1, hospital #1's internal review and documentation, patient #1's emergency department record from hospital #2, review of hospital #1's bylaws, and review of the policies and procedures for patients who present to the emergency department/request service, it was determined that in one (patient #1) of twenty-one patients who either presented to hospital #1 or called requesting emergency services from hospital #1, the hospital failed to ensure compliance with 489.24. Patient #1's ED record from hospital #2 and interviews indicated patient #1 had a history of hypertension, coronary artery disease and a heart attack and stent placement in 2002 and 2014. The ED record from hospital #2 stated patient #1 arrived by car at hospital #2's ED on April 19, 2017 at approximately 7:00 p.m. Patient #1 was accompanied by family member (H) who had driven patient #1 to hospital #2's ED after being refused care, via phone, at hospital #1. The patient complained of having chest pain that radiated to the left scapula and shoulder that had been present since noon on April 19, 2017. The patient had taken three nitroglycerin tablets at 3:00 p.m. on April 19, 2017 with some relief from the pain which the patient described as sharp and constant. The patient's condition was determined to be critical when patient #1 arrived at hospital #2. The patient was admitted to hospital #2, had double bypass surgery and remained in the hospital for an extended period of time following surgery. Interviews indicated family member (H) had used her cell phone to call hospital #1 and request care for patient #1 who was in pain and appeared to be having a heart attack. Family member (H) and patient #1 were approximately ten miles from hospital #1 and forty miles from hospital #2 when (H) called hospital #1. Family member (H) called hospital #1's general number on April 19, 2017 at 5:18 p.m., which is indicated on (H's) April 19, 2017 cell phone record, and (H's) call was transferred to the ED. Family member (H) spoke to an unknown staff person in the ED, and (H) expressed concerns about the patient #1's condition, briefly discussed patient #1's insurance and requested care for patient #1 at hospital #1. The unknown staff person denied having knowledge about patient #1's insurance and told (H) to continue driving and take patient #1 to hospital #2 for care.

Based on review of patient #1's ED record from hospital #2, interviews and review of cell phone records, hospital #1 failed to ensure that each patient who enquired about care in the emergency department via the phone and presented to the emergency department received a medical screening examination, to determine whether or not an emergency medical condition existed, in one of twenty-one patients reviewed (patient #1).

Findings include:

Review of patient #1's April 19, 2017 ED record from hospital #2 indicated patient #1 arrived by car at the ED at approximately 7:00 p.m. An April 19, 2017 nurse's note written at 7:06 p.m. indicated patient #1 was accompanied by family member (H). The patient's condition was determined to be critical when patient #1 arrived at hospital #2. The patient complained of having chest pain that radiated to the left scapula and shoulder that had been present since noon on April 19, 2017. The patient had taken three nitroglycerin tablets at 3:00 p.m. on April 19,2017 with some relief from the pain, which the patient described as sharp and constant. The record indicated the patient had tachycardia (rapid heart beat), chest pain and an abnormal EKG that indicated the patient required evaluation, intervention and stabilization due to the patient's life threatening condition. Interventions, including oxygen and intravenous medications were provided to the patient in order to stabilize the patient's condition. The patient was admitted to hospital #2 for further care.

When interviewed by phone on September 19, 2017 at 9:00 a.m., family member (H) stated patient #1, who lives many miles from (H), was visiting (H) at her home on April 19, 2017. During the visit on April 19, 2017, patient #1 said he was having chest pain, and he thought he was having a heart attack. Family member (H) knew that patient #1 had a history of heart problems and that patient #1 needed to be evaluated by a physician. Family member (H) and patient #1 got into (H's) car and began to drive to the hospital. Patient #1's chest pains began to worsen while they were driving, and (H) used her cell phone to call hospital #1 (approximately ten miles away) and request care for patient #1. Family member (H) called hospital #1's main line and requested to be transferred to hospital #1's ED. Family member (H) spoke to an unknown staff person in hospital #1's ED. Family member (H) told the person that patient #1 was having chest pains, mentioned patient #1's insurance provider and requested to bring patient #1 to ED #1 for immediate care. The person on the phone denied having any knowledge about medical insurance and told (H) to bring patient #1 to hospital #2 (approximately 40 miles away) for care. Family member (H) said she and patient #1 were very scared, but they proceeded on to hospital #2 for care for patient #1.

When interviewed by phone on September 19, 2017 at 9:30 a.m., patient #1 stated hospital #1 refused to care for him when (H) called and explained his condition and asked to bring him there for care on April 19, 2017. Patient #1 stated family member (H) transported him to hospital #2 following hospital #1's refusal to care for him. Patient #1 was in hospital #2's Intensive Care Unit for four days and had double bypass surgery on April 21, 2017 and remained in the hospital for twenty days following the surgery.

A copy of family member (H's) cell phone record for April 19, 2017 was reviewed. Review of the record confirmed that family member (H) made a phone call to hospital #1's main number on April 19, 2017 at 5:18 p.m.

The hospital's EMTALA policy, dated August 16, 1999 and revised in September 2012, states "Medical Screening Examination mean a physical assessment of the individual within the capability of the hospital, sufficient to determine if an Emergency Medical Condition exists. The Medical Screening Examination must be the same Medical Screening Examination that would be performed on any individual coming to the Emergency Department, regardless of their ability to pay for care. The Medical Screening Examination must be applied in a nondiscriminatory manner (i.e. a different level of care must not exist based on payment status, race, and national origin)."