HospitalInspections.org

Based on record review and staff interview the hospital failed to provide one patient (patient #1) out of 21 medical records reviewed from October 2010 to March 2011 with an examination sufficient to determine whether an emergency existed.

Findings include:

- Review of hospital policy "EMTALA Compliance" Reference number ER-463 effective December 10, 2008 revealed "The screening examination will be sufficient to determine whether or not the individual has an emergency medical condition." The hospital failed to follow this policy and did not provide patient #1 with a sufficient exam.

- Review of the ED notes, dictated by ED physician A on 2/20/11, revealed the following:
The patient "had felt entirely normal prior to going to church, when he was eating some food and had a choking spell, and apparently passed out or slumped to the floor...his speech is a little slowed and slurred, history of stroke about 9 years ago." The patient's past medical history was "Significant for insulin dependent diabetes mellitus and hypertension, and peripheral vascular disease with a stroke 9 years ago." The patient smokes about half a pack of cigarettes a day and drinks caffeine routinely.

- ED physician A interviewed on 3/16/11 at 8:35am reported "[Patient # 1's] speech was a little slurred but by the time all our labs and everything came back, it had continued to improve. In fact, his family member said it was back to baseline." ED physician A's plan for the patient was to discharge him home with follow up with the VA doctor about diarrhea. The UA was not collected and "I cannot say for sure there is nothing wrong with that". ED physician A further stated "I suspect the swallowing part of it, he just choked and had a vasovagal, but did recommend he follow up with the VA also on his swallowing disorder. I did recommend other studies, as I cannot say for sure this wasn't a TIA, and that he have carotid doppler and echocardiogram done through the VA, which is where he wished to have all this done for cost purposes". ED physician A confirmed Patient # 1 was at risk for a CVA (stroke) due to his history of CVA, diabetes, hypertension and with the presenting complaint of difficulty swallowing/choking the morning of 2/20/11 while at church. ED physician A confirmed symptoms of a CVA can include slurred speech and possible choking and swallowing difficulties. ED physician A stated he considered admitting the patient for additional testing including carotid doppler and echocardiogram and indicated the patient may be experiencing transient ischemic attack (TIA). ED physician A stated the patient refused to be admitted- he receives his medical care at a VA Hospital and does not have insurance to cover care outside of the VA Hospital.


The hospital did not provide patient #1 with a CT Scan or other imaging studies to verify if the patient was having a stroke. The medical record did not contain evidence that ED physician A attempted to arrange a transfer to a VA hospital where patient #1 could receive a CT scan or other radiological studies to rule out a stroke; or that patient #1 refused a transfer for further testing.


- According to the statutorily mandated QIO review performed on 4/20/2011, the hospital failed to provide patient #1 with an examination sufficient to determine the presence of an emergency medical condition.

Based on record review and interviews the hospital failed to provide one patient (patient #1) out of 21 medical records reviewed from October 2010 to March 2011 with an examination sufficient to determine whether an emergency existed regardless of the patient's ability to pay.


Findings include:

- Review of hospital policy "EMTALA Compliance" Reference number ER-463 effective December 10, 2008 revealed "The screening examination will be sufficient to determine whether or not the individual has an emergency medical condition." The hospital "applies the screening process in a nondiscriminatory manner without regard to individual payment status, method of payment, insurance . . ." The hospital failed to follow this policy and did not provide patient #1 with a sufficient exam.


- Review of the ED notes, dictated by ED physician A on 2/20/11, revealed the following:
The patient "had felt entirely normal prior to going to church, when he was eating some food and had a choking spell, and apparently passed out or slumped to the floor...his speech is a little slowed and slurred, history of stroke about 9 years ago." The patient's past medical history was "Significant for insulin dependent diabetes mellitus and hypertension, and peripheral vascular disease with a stroke 9 years ago." The patient smokes about half a pack of cigarettes a day and drinks caffeine routinely.

- ED physician A interviewed on 3/16/11 at 8:35am reported "[Patient # 1's] speech was a little slurred but by the time all our labs and everything came back, it had continued to improve. In fact, his family member said it was back to baseline." ED physician A ' s plan for the patient was to discharge him home with follow up with the VA doctor about diarrhea. The UA was not collected and "I cannot say for sure there is nothing wrong with that". ED physician A further stated "I suspect the swallowing part of it, he just choked and had a vasovagal, but did recommend he follow up with the VA also on his swallowing disorder. I did recommend other studies, as I cannot say for sure this wasn't a TIA, and that he have carotid doppler and echocardiogram done through the VA, which is where he wished to have all this done for cost purposes". ED physician A confirmed Patient # 1 was at risk for a CVA (stroke) due to his history of CVA, diabetes, hypertension and with the presenting complaint of difficulty swallowing/choking the morning of 2/20/11 while at church. ED physician A confirmed symptoms of a CVA can include slurred speech and possible choking and swallowing difficulties. ED physician A stated he considered admitting the patient for additional testing including carotid doppler and echocardiogram and indicated the patient may be experiencing transient ischemic attack (TIA). ED physician A stated the patient refused to be admitted- he receives his medical care at VA Hospital and does not have insurance to cover care outside of the VA Hospital.

- Family member A interviewed on 3/14/11 at 4:30pm stated that the patient was treated at the CAH on 2/20/11 at 11:00am. Family member A said she was not with the patient at the CAH, but saw him prior to going to the ED. She stated the patient was having problems swallowing and would "drift away" if he was not engaged in conversation and would 'bob' his head. Family member A stated the patient has a history of diabetes and a stroke 8-9 years ago, but had no residual problems following the stroke. Family member A stated patient # 1's behavior and appearance prior to arriving at the ED was not typical for him and she was concerned he was having a stroke. Family member A stated the patient was discharged from the ED and was taken home by another family member. The patient was subsequently taken to Emergency Care at a Hospital B on 2/23/11 and was admitted to the Intensive Care Unit for treatment for a stroke.


- The hospital did not provide patient #1 with a CT Scan or other imaging studies to verify if the patient was having a stroke. The medical record did not contain evidence that ED physician A attempted to arrange a transfer to a VA hospital where patient #1 could receive a CT scan or other radiological studies to rule out a stroke; or that patient #1 refused a transfer for further testing.


- According to the statutorily mandated QIO review performed on 4/20/2011, the hospital failed to provide patient #1 with an examination sufficient to determine the presence of an emergency medical condition.