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Based on policy review, closed medical record review and staff and physician interview the hospital failed to stabilize Patient #3's identified emergency medical condition prior to discharge from the Emergency Department.

The findings included:

Cross Refer to 489.24 (d)(3) Stabilizing Treatment -Tag A 2407

Based on review of hospital policy, closed medical record review, and physician and staff interviews, the hospital failed to provide stabilizing treatment within its capability and capacity for one (1) of 29 sampled patients (Patient #3) that presented to the hospital's dedicated emergency department with an emergency medical condition.

The findings include:

A policy related to Emergency Medical Treatment and Labor Act (EMTALA) procedures was requested on 07/22/2025. Hospital administrative staff presented an "EMTALA compliance, Including Patient Transfers (Emergency Medical Treatment and Labor Act)" policy that was approved October 28, 2024. revealed " ...stable ...means that no material deterioration of the individual's condition is likely, within a reasonable medical probability, to result from or occur during the transfer of the individual ..."

Dedicated Emergency Department (DED) record review for Patient [Pt] #3, revealed the 7-year old patient arrived at Hospital A, Campus 4 Emergency Department on 05/05/2025 at 0651 by car with mother with a chief complaint of "shortness of breath" used albuterol 2 [two] hours ago, didn't help." Pt #3 was triaged as a level 3 at 0702 and had an a MSE was initiated (medical screening exam) at 0754 with vital signs of T (temperature)-99.2, respirations of 24, bp- (blood pressure) of 126/51, pulse oxygenation of 91 on room air, weight was 50.8 kg (kilograms). Treatment orders: DuoNeb (medication to relax the airway and improve breathing) 2.5 mg (milligram) /3 ml (milliliter) order via nebulizer at 0706, prednisolone phosphate (steroid medication to assist with breathing) 3 mg/ml orders at 0707. Respiratory assessment at 0725 noted with inspiratory wheezing. 0725 chest Xray ordered. Vital signs at 0800 HR-126, bp 129/66, 02 sat on room air 95%. 0824 Tylenol (medication for pain, fever) 650mg given by mouth. Discharge prescription for prednisolone given to mother. Patient discharged home with mother at 0847.

Review of the provider progress note for 05/05/2025 "7 year old with history of asthma presents with shortness of breath per mom at bedside patient has had 1 [one] day of cough, shortness of breath and worsened overnight, and had an episode of vomiting denies abdominal pain- history of asthma has been using albuterol (medication to help with breathing) with no significant improvement, mild sore throat yesterday, no reported fevers, mom states that family members at home have been sick with viral symptoms". Exam- mildly uncomfortable appearing tachycardia present- pulmonary- mildly increased work of breathing diffuse expiratory wheezes in bilateral lung fields, no stridor, abdominal- flat, soft, non-distended, no guarding. Discharge disposition- patient report significant improvements of symptoms following breathing treatments- he continues to have very mild extra wheezes, but breath sounds are much clear at this time. He is tolerating po (by mouth) ... Given improvement of symptoms do feel as though patient is safe for discharge. Will discharge with steroid course and strict return precautions. Instructed mom to follow up with primary care physician within the next several days.

Interview with Physician #1 on 07/24/2025 at 1015 revealed, "my decision making status is that I look at respiratory rate, work of breathing, breath sound and general appearance, and prior history" after he got breathing treatments, and steroids, was breathing much better, no accessory muscles, no oxygen was room air clinically alright for discharge and follow up with primary care provider".

Patient #3 presented to Hospital B on 05/05/2025 at 0903 in the DED with triage vital signs of blood pressure 127/73, pulse- 146, R-62 02 saturation of 93%, temperature 98.5. ED provider note presents in extreme respiratory distress with an exacerbation that started last night- here in extreme distress, anticipate admission unless he is to make significant improvement and maintain that, will treat aggressively with IV steroids, a 2 gram bolus of magnesium, on normal saline bolus, 20 mg of albuterol and reevaluate-1147 after completion of hour long patient states that he is starting to feel better, he is moving air anteriorly, still very decreased and wheezy posteriorly, second hour long ordered- 1300 patient completed second hour long- hypoxic at 88% on room air, placed on 2 liter nasal cannula. On reevaluation he still has increased work of breathing. Mild flaring around nasal cannula. Very tight posteriorly moving minimal air- third hour long ordered and will admit to pediatric ICU (intensive care unit). Pulmonary consulted and aware of admission- patient remained NPO (nothing by mouth) until respiratory status improved. Weaned albuterol per protocol and was able to space to 10mg/hour by the morning of 5/6/2025. His diet was advanced and transferred to the pediatric floor on the afternoon of 05/06/2025. He was weaned off support the morning of 05/07/2025 and remained stable on room air with comfortable respiratory status since that time- he has been taking po well and remained afebrile. Mother is comfortable with discharge home and close PCP follow up this week. An asthma action plan was completed prior to discharge home on 05/07/2025.

In summary, Patient #3 presented to Hospital B with parent on 05/05/2025 at 0903 16 minutes after discharge from Hospital A's DED in extreme respiratory distress. Review of the DED record from Hospital A, Campus 4 revealed no reassessment of respirations after the initial respirations recorded at 0754 and prior to discharge at 0847. Review of the patient's respirations from Hospital B at 0903 were 62. Patient #3 was admitted to Hospital B and discharged on 05/07/2025.

NC00232546