HospitalInspections.org

Based on interview, record review and policy review, the hospital failed to provide within its capability and capacity, an appropriate medical screening exam (MSE) sufficient to determine the presence of an emergency medical condition (EMC) for one patient (#5) of 22 Emergency Department (ED) records reviewed from 09/26/24 through 03/26/25. These failed practices had the potential to cause harm to all patients who presented to the ED seeking care for an EMC. The hospital's average monthly ED census over the past six months was 3,954.

Findings included:

Review of the hospital's policy titled, "Emergency Medical Treatment and Labor Act (EMTALA, an act/law that obligates the hospital to provide medical screening, treatment and transfers of individuals with an EMC)," revised 12/13/23, showed:
- A MSE shall be provided to any individual who presents to the ED and/or hospital and requested emergency care regardless of diagnosis, financial status, race, color, national origin, and/or disability.
- A MSE is an examination which is sufficiently detailed to reveal whether an EMC exists and must include medically indicated screens, tests, mental status evaluations, and a history and physical examination within the capability of the hospital's ED.
- The MSE must be provided within the capability of the hospital's ED, including ancillary services routinely available to the ED, to determine whether or not an EMC exists. If an EMC is determined to exist, all ministries shall provide any necessary stabilizing treatment.
- The patient must continue to be monitored until it is determined whether or not the individual has an EMC, they are stabilized or appropriately transferred.

Please refer to 2406 for further details.

Based on interview, record review and policy review, the hospital failed to provide, within its capability and capacity, an appropriate medical screening exam (MSE) sufficient to determine the presence of an emergency medical condition (EMC) for one patient (#5) of 22 Emergency Department (ED) records reviewed from 09/26/24 through 03/26/25. This failed practice had the potential to cause harm to all patients who presented to the ED seeking care for an EMC.

Findings included:

Review of the hospital's policy titled, "Emergency Medical Treatment and Labor Act (EMTALA, an act/law that obligates the hospital to provide medical screening, treatment and transfers of individuals with an EMC)," revised 12/13/23, showed:
- A MSE shall be provided to any individual who presents to the ED and/or hospital and requested emergency care regardless of diagnosis, financial status, race, color, national origin, and/or disability.
- A MSE is an examination which is sufficiently detailed to reveal whether an EMC exists and must include medically indicated screens, tests, mental status evaluations, and a history and physical examination within the capability of the hospital's ED.
- The MSE must be provided within the capability of the hospital's ED, including ancillary services routinely available to the ED, to determine whether or not an EMC exists. If an EMC is determined to exist, all ministries shall provide any necessary stabilizing treatment.
- The patient must continue to be monitored until it is determined whether or not the individual has an EMC, they are stabilized or appropriately transferred.

Review of Patient #5's medical record, dated 03/22/25, showed:
- At 8:33 AM, a 49-year-old male presented to the ED via Emergency Medical Services (EMS, emergency response personnel, such as paramedics, first responders, etc.) and law enforcement after having seizure-like (sudden, uncontrolled electrical disturbance in the brain which cause changes in behavior, movements and/or in levels of consciousness) activity at the St. Louis City Justice Center, where he was in custody. He was alert, awake, and oriented times three (A&O x 3, refers to being alert and oriented to person, place and time) upon arrival.
- EMS reported that he was given Narcan (a medication used to counter the effects of narcotic overdose) prior to their arrival at 7:59 AM by jail staff. He was A&O X 3, stated he had heartburn for two weeks, and there were multiple emesis piles on the floor around him.
- He did not have a significant past medical history.
- At 8:40 AM, he was assessed by a physician. His vital signs (VS, measurements of the body's most basic functions), blood and urine were obtained. His urine drug screen (UDS, a test that analyzes urine for the presence of certain illegal drugs and prescription medications) and laboratory tests were within normal limits, no drugs were detected.
- At 8:44 AM, a troponin-I high sensitive baseline (a type of blood test that measures whether or not a person is experiencing a heart attack, normal is less than 35) blood test was drawn, and the result was less than three.
- At 9:23 AM, a troponin-I high sensitive plus one-hour blood test was drawn, and the result was four.
- A head computed tomography (CT, a combination of x-rays [test that creates pictures of the structures inside the body-particularly bones] and a computer to produce detailed images of blood vessels, bones, organs and tissues in the body) scan, brain Magnetic Resonance Imaging (MRI, test that uses a magnetic field and radio waves to create images of the organs and tissues within the body), chest x-ray (test that creates pictures of the structures inside the body-particularly bones), and an electrocardiogram (ECG or EKG, test that records the electrical signal from the heart to check for different heart conditions) were completed and were negative for a myocardial infarction (MI, heart attack).
- A Neurology (a branch of medicine concerned with the study and treatment of disorders of the nervous system) consultation was ordered. They recommended an electroencephalography (EEG, a recording of brain activity, often used to evaluate presence of seizure activity) in addition to the MRI.
- At 4:07 PM, report was called by the ED RN to inpatient unit 5N. He was admitted to unit 5N at 4:17 PM under the Neurology service. An admission assessment was charted at 4:30 PM. The EEG was performed and was negative.
- The seizure like activity reported at the jail was not observed during the patient's visit and he remained A&O x 3.
- Patient #5 was not evaluated by a cardiologist (a physician that specializes in the care of your heart and blood vessels) or worked up further for chest pain.
- At 7:16 PM, he was discharged from unit 5N to the custody of the St. Louis City Justice Center.

Review of Patient #5's Hospital B medical record, dated 03/23/25, showed:
- At 4:45 AM, he presented to the ED via EMS and law enforcement from the St. Louis City Justice Center in cardiac arrest (when the heart suddenly and unexpectedly stops pumping) after he was found unresponsive by jail staff.
- Jail staff initiated Cardiopulmonary Resuscitation (CPR, emergency life-saving procedure performed when a person's breathing or heartbeat has stopped). EMS continued CPR upon their arrival, which continued until they transferred care of the patient to ED staff.
- The ED staff continued CPR and provided Advanced Cardiac Life Support (ACLS, specific life saving measures taken by certified health professionals when a patient's heartbeat or breathing stops) measures until he expired at 5:00 AM.

During a telephone interview on 03/27/25 at 10:30 AM, Staff N, Physician, stated that Patient #5 received treatment consistent with the signs and symptoms he presented with. He considered an electrolyte (minerals in the blood and other body fluids that carry an electric charge) imbalance or heart disease in addition to seizures as the cause of the patient's symptoms. Imaging by CT and MRI, lab tests, and examination did not indicate the cause of the patient's unresponsive episode. His VS were stable, and the patient did not exhibit any seizure like activity. He followed the neurologist's recommendation and admitted the patient for additional tests including an electroencephalography (EEG, a recording of brain activity, often used to evaluate presence of seizure activity).