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Based on observation, record review, and interview, the Hospital failed to ensure compliance with EMTALA regulations as an appropriate medical screening examination was not provided timely to one Patient (#1) who presented to the Hospital Emergency Department and was accepted as a patient transfer from another Hospital's Emergency Department out of a total sample of 30 patients. Patient #1 presented to the Hospital's Emergency Department on 7/1/24 at 3:37 P.M. by ambulance as a transfer for concerns of a ST-Segment Elevation Myocardial Infarction (STEMI) (a severe type of heart attack when blood flow to the heart is blocked). Patient #1 arrived to the hospital with heparin (a medication used for thinning the blood) running Intravenously (IV) and complaining of chest pain 5/10. Patient #1 was not seen by a provider for 2.5 hours after arriving to the hospital, and an Electrocardiogram (EKG) was not completed for 3 hours after arriving to the hospital. Patient #1 expired after being brought to the Cath Lab 5 hours after arrival to the ED.

Findings include:

Review of hospital policy titled, "Emergency Medical Treatment and Labor Act of 1986 (EMTALA)" effective date 8/23/2021, included the following:

Purpose ensures individuals presenting to the Hospital's emergency department receives an appropriate Medical Screening Examination (MSE) and stabilizing treatment or an appropriate transfer in accordance with and that requests for transfers to the Hospital are accepted or declined in accordance with EMTALA.

The Hospital's Internal Investigation, dated 7/03/24, indicated that Patient #1 arrived to the Emergency Department (ED) by ambulance on 7/1/24 at 3:37 P.M. Patient #1 was triaged by Registered Nurse (RN)#1 at 4:10 P.M. and complained of chest pain 5/10. Patient #1 had heparin infusing IV on arrival and it was stopped after arriving to the ED and not restarted until 7:31 P.M. Patient #1 was not seen by a Physician until 5:56 P.M. Patient #1 was brought to the Cath Lab at 8:10 P.M. and was pronounced dead at 9:19 P.M.

The Hospital's Internal Investigation indicated the Hospital failed to initiate an EKG within 5 minutes of arrival and a delay in medical screening exam.

Further review of the Internal Investigation indicated there was no documentation to support the Hospital developed or implemented any system wide corrective actions to prevent a like occurrence in the future.

Review of Ambulance run report indicated Patient #1 was being transported to an outside hospital with Cardiac-STEMI/PCI capable. Further review indicated Patient #1 had sub-sternal squeezing chest pain for duration of one day.

During the Survey on 9/6/24 at 10:00 A.M., the Surveyors reviewed the transfer call recording received from the Transfer Center on 7/1/24, which revelated Physician #1 accepted the transfer of Patient #1 for a STEMI. Further review of the recording indicated Patient #1 had a cardiac history, had concerning EKG changes, active chest pain, and initial troponin was below diagnostic limit.
Review of Patient #1's medical records included an ED Triage Form dated 7/1/2024 at 4:05 P.M. indicated Patient #1 was transferred from an outside Hospital for chest pain with concern for a Myocardial Infarction (MI). Patient #1 was assigned an ESI Level score of a 3 by RN#1. Further review indicated a physician order for a stat EKG dated 7/1/24 at 6:17 P.M.

Review of ED Physician Note, dated 7/1/2024 at 6:10 P.M., indicated Patient #1's chief complaint was concern for an MI and was brought in on a Heparin drip of 1200 units/hour. Impression indicated a STEMI and heart failure. Review of documentation of outside Hospital indicated an EKG at 1:00 P.M. showed ST elevation in V2-V6, T Inversions in V1. Further review indicated an EKG at the Hospital at 6:55 P.M. indicated progression of acute anterolateral infarct.

During an interview on 9/6/24 at 12:47 P.M., the Emergency Department Director said that a patient arriving to the Emergency Department with chest pain should have an immediate EKG within five minutes. The ED Director said if a patient arrives to the ED on IV Heparin the expectation would be for the nurse to get an order immediately from a physician to continue that medication. During an interview on 9/6/24 at 1:31 P.M. Registered Nurse (RN) #1 said she recalled taking report from the Emergency Medical Technicians (EMTs) on 7/1/2024 for Patient #1. RN #1 said she had been working alone in the Annex (a holding area generally used for patients waiting for an inpatient bed) part of the ED. RN #1 said she tried to get a physician to order the Heparin for Patient #1 but was unable to obtain an order to continue the medication. RN #1 was unable to recall if she notified a physician that Patient #1 was complaining of chest pain. RN #1 said she never got an EKG on Patient #1. RN #1 said she was taught how to triage in a classroom setting at the Hospital and everyone assigns ESI levels differently.

During an interview on 9/11/24 at 1:00 P.M. RN #3 said she took the Resource Nurse (also referred to as the Charge Nurse) assignment on 7/1/2024. RN #3 said that during shift change at 3:00 P.M., she received a report that Patient #1 would be coming to the ED as a transfer for a Non-ST segment elevation myocardial infarction (NSTEMI). RN #3 said she recalled assigning Patient #1 to RN #1. RN #3 said there should have been an EKG completed on Patient #1 immediately upon arrival but she was unsure if there was one completed. RN #3 said triage and ESI levels can have some variability but someone with a cardiac history and active chest pain should be assigned an ESI 1 or a 2.

During an interview on 9/10/24 at 11:26 A.M. Physician #1 said he doesn't recall receiving a STEMI transfer on 7/1/24. Physician #1 said he recalled accepting Patient #1 as an NSTEMI. Physician #1 said a STEMI was more urgent and time sensitive as heart muscles are at risk of damage. Physician #1 said if he was notified of a STEMI prior to the transfer to the ED, he would alert the Resource Nurse to ensure there was an EKG machine and a tech ready when the patient arrived. Physician #1 said a patient complaining of chest pain should receive an EKG within 5 minutes of arriving and the results immediately brought to a physician.

The Hospital failed to ensure compliance with EMTALA regulations as Patient #1 never received an appropriate medical screening examination timely despite being an accepted transfer from an outside hospital.

Based on observation, record review, and interview, the Hospital failed to ensure compliance with EMTALA regulations as an appropriate medical screening examination was not provided timely to one Patient (#1) who presented to the Hospital Emergency Department and was accepted as a patient transfer from another Hospital's Emergency Department out of a total sample of 30 patients. Patient #1 presented to the Hospital's Emergency Department on 7/1/24 at 3:37 P.M. by ambulance as a transfer for concerns of a ST-Segment Elevation Myocardial Infarction (STEMI) (a severe type of heart attack when blood flow to the heart is blocked). Patient #1 arrived to the hospital with heparin (a medication used for thinning the blood) running Intravenously (IV) and complaining of chest pain 5/10. Patient #1 was not seen by a provider for 2.5 hours after arriving to the hospital, and an Electrocardiogram (EKG) was not completed for 3 hours after arriving to the hospital. Patient #1 expired after being brought to the Cath Lab 5 hours after arrival to the ED.

Findings include:

Review of hospital policy titled, "Emergency Medical Treatment and Labor Act of 1986 (EMTALA)" effective date 8/23/2021, included the following:

Purpose ensures individuals presenting to the Hospital's emergency department receives an appropriate Medical Screening Examination (MSE) and stabilizing treatment or an appropriate transfer in accordance with and that requests for transfers to the Hospital are accepted or declined in accordance with EMTALA.

The Hospital's Internal Investigation, dated 7/03/24, indicated that Patient #1 arrived to the Emergency Department (ED) by ambulance on 7/1/24 at 3:37 P.M. Patient #1 was triaged by Registered Nurse (RN)#1 at 4:10 P.M. and complained of chest pain 5/10. Patient #1 had heparin infusing IV on arrival and it was stopped after arriving to the ED and not restarted until 7:31 P.M. Patient #1 was not seen by a Physician until 5:56 P.M. Patient #1 was brought to the Cath Lab at 8:10 P.M. and was pronounced dead at 9:19 P.M.

The Hospital's Internal Investigation indicated the Hospital failed to initiate an EKG within 5 minutes of arrival and a delay in medical screening exam.

Further review of the Internal Investigation indicated there was no documentation to support the Hospital developed or implemented any system wide corrective actions to prevent a like occurrence in the future.

Review of Ambulance run report indicated Patient #1 was being transported to an outside hospital with Cardiac-STEMI/PCI capable. Further review indicated Patient #1 had sub-sternal squeezing chest pain for duration of one day.

During the Survey on 9/6/24 at 10:00 A.M., the Surveyors reviewed the transfer call recording received from the Transfer Center on 7/1/24, which revelated Physician #1 accepted the transfer of Patient #1 for a STEMI. Further review of the recording indicated Patient #1 had a cardiac history, had concerning EKG changes, active chest pain, and initial troponin was below diagnostic limit.
Review of Patient #1's medical records included an ED Triage Form dated 7/1/2024 at 4:05 P.M. indicated Patient #1 was transferred from an outside Hospital for chest pain with concern for a Myocardial Infarction (MI). Patient #1 was assigned an ESI Level score of a 3 by RN#1. Further review indicated a physician order for a stat EKG dated 7/1/24 at 6:17 P.M.

Review of ED Physician Note, dated 7/1/2024 at 6:10 P.M., indicated Patient #1's chief complaint was concern for an MI and was brought in on a Heparin drip of 1200 units/hour. Impression indicated a STEMI and heart failure. Review of documentation of outside Hospital indicated an EKG at 1:00 P.M. showed ST elevation in V2-V6, T Inversions in V1. Further review indicated an EKG at the Hospital at 6:55 P.M. indicated progression of acute anterolateral infarct.

During an interview on 9/6/24 at 12:47 P.M., the Emergency Department Director said that a patient arriving to the Emergency Department with chest pain should have an immediate EKG within five minutes. The ED Director said if a patient arrives to the ED on IV Heparin the expectation would be for the nurse to get an order immediately from a physician to continue that medication. During an interview on 9/6/24 at 1:31 P.M. Registered Nurse (RN) #1 said she recalled taking report from the Emergency Medical Technicians (EMTs) on 7/1/2024 for Patient #1. RN #1 said she had been working alone in the Annex (a holding area generally used for patients waiting for an inpatient bed) part of the ED. RN #1 said she tried to get a physician to order the Heparin for Patient #1 but was unable to obtain an order to continue the medication. RN #1 was unable to recall if she notified a physician that Patient #1 was complaining of chest pain. RN #1 said she never got an EKG on Patient #1. RN #1 said she was taught how to triage in a classroom setting at the Hospital and everyone assigns ESI levels differently.

During an interview on 9/11/24 at 1:00 P.M. RN #3 said she took the Resource Nurse (also referred to as the Charge Nurse) assignment on 7/1/2024. RN #3 said that during shift change at 3:00 P.M., she received a report that Patient #1 would be coming to the ED as a transfer for a Non-ST segment elevation myocardial infarction (NSTEMI). RN #3 said she recalled assigning Patient #1 to RN #1. RN #3 said there should have been an EKG completed on Patient #1 immediately upon arrival but she was unsure if there was one completed. RN #3 said triage and ESI levels can have some variability but someone with a cardiac history and active chest pain should be assigned an ESI 1 or a 2.

During an interview on 9/10/24 at 11:26 A.M. Physician #1 said he doesn't recall receiving a STEMI transfer on 7/1/24. Physician #1 said he recalled accepting Patient #1 as an NSTEMI. Physician #1 said a STEMI was more urgent and time sensitive as heart muscles are at risk of damage. Physician #1 said if he was notified of a STEMI prior to the transfer to the ED, he would alert the Resource Nurse to ensure there was an EKG machine and a tech ready when the patient arrived. Physician #1 said a patient complaining of chest pain should receive an EKG within 5 minutes of arriving and the results immediately brought to a physician.

The Hospital failed to ensure compliance with EMTALA regulations as Patient #1 never received an appropriate medical screening examination timely despite being an accepted transfer from an outside hospital.