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Based on a review of facility documents, medical records (MR) and staff interview (EMP), it was determined that the facility failed to ensure a patient received a complete Medical Screening Examination to determinate if an Emergency Medical Condition exists in one out of 23 medical records reviewed (MR1).

Findings Include:

A review of the facility's policy and procedure "Emergency Medical Treatment and Active Labor Act EMTALA" last approved March 10, 2023, stated, "PURPOSE: To ensure that each WellSpan Hospital that participates in the Medicare program complies with the relevant requirements (to the extent they are applicable to that specific Hospital) of the Emergency Medical Treatment and Active Labor Act (" EMTALA "), 42 U.S.C. 1395dd, and all regulations promulgated thereunder. ... DEFINITIONS: ... d) Emergency Medical Condition means: (i) A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, active labor, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: (1) Placing the health of the individual in serious jeopardy; (2) Serious impairment to bodily functions; or (3) Serious dysfunction of any bodily organ or part ... h) Stabilized means that a physician or QMP has documented the performance of an appropriate MSE and the determination that, with reasonable clinical confidence: with respect to an "Emergency Medical Condition" as defined in this section under paragraph (i) of that definition, that the individual's Emergency Medical Condition has been resolved or that no material deterioration of the condition is likely to occur, although the underlying medical condition may persist ... i) Stable for transfer means that a physician or QMP has documented the performance of an appropriate MSE and the determination that, with reasonable clinical confidence, no material deterioration of the individual's condition is likely to result from or occur during the transfer of the individual. ..."

Further review of the facility's EMTALA policy revealed, "RESPONSIBILITIES OF HOSPITAL, HOSPITAL PERSONNEL, PHYSICIANS AND PROVIDERS: ... I. MEDICAL SCREENING EXAM (MSE): a. When an individual comes to the Hospital concerned that they may have an emergency medical condition and requests medical care, the Hospital must provide for an appropriate and timely MSE performed by a physician or QMP within the capability of the Emergency Department, including ancillary services routinely available to the Emergency Department, to determine with reasonable clinical confidence whether an Emergency Medical Condition exists ... b. The MSE should be tailored to the individual's presenting symptoms and complaints. ... II. STABILIZATION AND TRANSFER: a. If it is determined that an Emergency Medical Condition exists, the Hospital must provide stabilizing treatment within its capability and capacity. If the individual is provided with treatment and is stabilized, the individual may be admitted to the Hospital, transferred or discharged, as may be clinically appropriate ..."

On May 1, 2023, review of MR1 revealed that the patient presented to the hospital's Emergency Department (ED) via ambulance on October 28, 2022, at 3:18 AM with chief complaints of abdominal pain, nausea, and vomiting. Patient was triaged with orders placed for lab tests, EKG, medications, and intravenous therapy (IV). Patient was treated with pain and nausea medications. Per the ED provider note on October 28, 2022, at 4:19 AM, patient was tachycardic (fast heart rate), with epigastric (upper middle area of the abdomen) tenderness and vomiting. Provider documented concern as patient's presentation of symptoms greater than 12 hours and lack of diarrhea, were "not typical for foodborne illness". At 5:17 AM patient complained of shortness of breath (SOB) and the physician was notified. Patient was placed on oxygen and another set of Troponins were drawn along with a stat lactic acid test. At 5:30 AM pulse oxygen level improved while still on 2 liters of oxygen. Patient took pain medication at 6:50 AM and at 7:00 AM reported a pain level of 9 out of 10.

At 7:40 AM, the patient was signed out to a new provider at shift change and the new provider documented the patient had received two doses of Dilaudid IV and MS Contin pain medication and patient denied relief from pain. In addition, the provider documented, "She feels thirsty, is getting some water, sips of water [sic] constant pain to radiate from the epigastric area to her back as well." The provider further indicated that the patient was stable for discharge.

At 8:13 AM the nurse documented the patient's pain score as 10 out of 10 (10 is the worst pain ever felt) and patient was given a dose of Dilaudid IV pain medication. The provider was called to bedside. No further assessment of the pain, tachycardia, or the effectiveness of the treatment was recorded in the MR prior to discharge. Patient continued to be tachycardic, with a heart rate of 106 at 6:30 AM, 113 at 7:00 AM, and 109 at 7:30 AM. Order for discharge was written at 9:15 AM and patient was discharged to home at 9:30 AM.

Further review of MR1 revealed that less than 24 hours later, on October 29, 2022, at 4:33 AM, patient returned to the ED via ambulance for vomiting coffee ground emesis, and then had a bradycardic (slow heart rate) episode and went into cardiac arrest when pulling into the ED. CPR (Cardiopulmonary resuscitation) was initiated at 4:32 AM and successful. Upon further examination, patient was found to have a strangulated hernia/gastric volvulus (an abnormal rotation of the stomach which creates an obstruction) and gastric ischemia (lack of blood flow to the gastrointestinal tract). Patient expired at 12:24 AM on October 30, 2022.

Interview on May 1, 2023, at 10:30 AM with the ER Medical Director (EMP1) confirmed they had reviewed the patient's medical record and indicated that there was concern that tachycardia was present upon discharge.