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Based on record review and interview, the hospital failed to provide services per policies and procedures to ensure compliance with the requirements of EMTALA (Emergency Medical Treatment and Labor Act) screening for one (Pt #16) of 20 patients reviewed.

This failed practice had the potential to place patients at risk of life threatening outcomes due to hospital staff, including medical staff, failure to uphold responsibilities under the EMTALA requirements.

Findings:

Cross Referrenced
See Tag C-2406

Based on record review and interview, the hospital failed to ensure appropriate medical screening was completed for 1 patient (Patient #16) of 20 patients presenting to the ED requesting an examination for symptoms of an acute medical condition.

This failed practice had the potential to place all patients presenting to the Emergency Department in harm of missed diagnoses, worsening of symptoms, and potential death.

Findings:

A review of the clinical record showed Pt #16 was seen in the Emergency Department on 06/25/24 with primary complaints of coughing up blood for two days. Documentation showed a blood presure of 145/105 (not addressed by the hospital), pulse of 109 (not addressed by the hospital), respiratory rate of 18, temperature of 97 (fahrenheit) and oxygen saturation of 93% on room air. Clincial documentation showed a history of GI bleed and pulmonary arterial hypertension and a review of labs drawn after admission showed the following:
1. Hemoglobin of 7.7 (normal range 11.5-15.5);
2. Hematocrit of 28 (normal range 35-45);
3. MCV of 68.3 (normal range 82-89);
4. MCH of 18.8 (normal range 27-34);
5. MCHC of 27.5 (normal range 31-35;
6. RDW-CV of 22.7 (normal range 11.5-15.0);
7. Sodium of 128 (normal range 136-145);
8. Cloride of 95 (normal range 98-107);
9. CO2 of 20 (normal range 21-32);
10. Albumin of 3.1 (normal range 3.5-5.0).

A chext x-ray was completed which showed:
1. Heart size large;
2. Pulmonary vasculature normal;
3. Lungs Clear;
4. No pneumothorax;
5. No osseous findings.
6. Radiologist impression: Cardiomegaly without overt failure. No acute cardiopulmonary process.

Documentation showed Patient #16 presented to the Hospital #1 ED with complaints of coughing up blood, a documented elevated heart rate and hypoxia but there was no D-dimer or CT-angiogram to rule out a pulmonary embolism and no differential diagnoses noted in physician documentation. Documentation showed no additional screening for chief complaints. Patient #16 was discharged (the same day) with a diagnosis of anemia.

Hospital #2
A review of the clinical record showed Patient #16 arrived at Hospital #2 ED on 06/26/24 at 1:32 pm with chief complaints of dizziness and weakness that began the previous day (06/25/24) and hemoptysis which began four days ago. Documentation showed a past medical history included anemia, chronic kidney disease, pulmonary hypertention, a history of multiple GI bleeds and at one time requiring a blood transfusion every two weeks. Diagnoses for Patient #16 at Hospital #2 was hemoptysis, cardiomyopathy, abdominal ascites, hyponatremia, and anemia.

At 5:38 pm on 06/26/24 DO #1 documemented: several episodes of hemoptysis for Patient #16 and that the patient remained mildly tachycardic (heart rate of 104) and that patient was hypertensive throughout her ED stay with a blood pressure of 129/96. DO #1 further documented: "1. the patient would benefit from a higher level of care including GI, pulmonology, cardiology and possibly nephrology; 2. the case was discussed with Hospital #2 transfer center; 3. the patient was accepted by Dr. (name omitted) in the ED and patient would be transported by Hospital #2 ground EMS."

Patient #16 was transferred to Hospital #3 for a higher level of care on 6/26/24.

In an interview with Staff AA (Hospital #1) on 07/12/24 at 12:00 pm, Staff AA stated, Everyone has the right to emergency room treatment even though they may not be able to pay.

In an interview with Staff SS (Hospital #1) on 07/12/24 at 12:20 pm, Staff SS stated, there is no denying of treamtent when presenting to the Emergency Departent.