HospitalInspections.org

Based on document review, record review, policy review and interview the Hospital failed to ensure the emergency medical treatment and labor act (EMTALA) requirements were met by failing to provide stabilizing treatment for an emergency medical condition. Failure to provided stabilizing treatment places patients at risk for deterioration of an emergency medical condition resulting harm and injury up to an including death.

Findings Include:

Review of hospital policy titled "EMTALA-Inter-hospital Transfer-Emergency Response" revised July 2018 showed, "Policy Statement; It is the policy of Lawrence Memorial Hospital (LMH) to comply with all applicable laws and regulations relating to the provision of emergency services and transfer of patients, including requirements as defined in EMTALA regulations. ... Campus means the physical area immediately adjacent to the hospital's main buildings, other areas and structures that are not strictly contiguous to the main buildings but are located within 250 yards of the main buildings ... ..."Comes to the Emergency Department" with respect to an individual requesting examination and treatment for what may be an emergency medical condition, means that the individual is on the hospital property or premises including off-campus facilities ... ...If an individual arrives at the hospital and is not technically in the emergency department but is on hospital property or premises and requests emergency care, he or she is entitled to a medical screening examination ... ...3. A hospital must provide screening and stabilizing treatment within the scope of its abilities, as needed, to the individuals with emergency medical conditions who come to the hospital for examination and treatment ...

Review of hospital document titled "Medical Staff Bylaws Credentialing Procedures Manual Fair Hearing Plan And Rules and Regulations (The Governing Documents) of Lawrence Memorial Hospital" updated December 2023 showed " ...In the event an emergency medical condition is determined to exist, then the Hospital will provide such further medical examination and treatment as is available at the Hospital to stabilize the medical condition or will appropriately transfer the patient to another facility after consideration of the risks and benefits of transfer ... Render any care in a life-threatening emergency.

Review of hospital policy titled "Medical Evaluation Team (MET) Adult Adolescent Protocol" approved 11/2023 showed "PURPOSE: To outline actions of the MET team for rapid and proactive patient evaluation ...The function of the MET team is to rapidly assemble a group of specialized healthcare professionals in response to acute clinical deterioration before cardiopulmonary arrest occurs. The MET team is called to perform a rapid assessment and obtain standard objective clinical data for the attending physician. Anyone (e.g. patient, employee, volunteer, family, law enforcement officers) may summon the MET for assistance in assessment, evaluation and stabilization of the patient ...PATIENT CARE MANAGEMENT: The MET Team will A. ASSESSMENT: ...2. Implement further assessment based on patient's status to evaluate need for interventions ...The MET team will proceed with the following interventions as indicated by the evaluation process until physician is present, or individual has been transported to the ED for medical evaluation ..."


The hospital failed to provide stabilizing treatment of an emergency medical condition (EMC) for 1 of 20 patients (Patient 1). (Refer to tag A2407)

Based on record review, policy review, document review and interview the Hospital failed to provided stabilizing treatment of an emergency medical condition (EMC) for 1 of 20 patients (Patient 1) reviewed. The hospital's failure to provide stabilizing treatment has the potential to place patients at risk for deterioration of the emergency medical condition resulting harm and injury up to an including death.

Findings Include:

Patient 1

Review of Patient 1's medical record showed, a 24-year-old female, presented to the above named hospital cardiology department on 09/01/22 for 12:27 PM for an outpatient echocardiogram (Echocardiogram is a test to diagnosis with ultrasound by creating pictures of your heart valves and chambers).

Review of Patient 1's "Transthoracic Echocardiogram Report" dated 09/01/22 showed, " ...summary: ... 7. Severe aortic root and severe ascending aorta dilation (Otherwise known as an aortic root aneurysm, a dilated aortic root is when the first section of the aorta, where the aortic valve resides, becomes enlarged. When this enlargement reaches a critical size, there is a risk of it rupturing or tearing, leading to a life-threatening situation). The aortic arch is incompletely visualized but appears to be normal diameter 8. Aortic valve is not well visualized but appears to have a moderate degree of insufficiency without stenosis. 9. The aortic valve pressure half-time is approximate 436 msec (A pressure half-time of greater than 500 milliseconds (ms) is consistent with mild aortic regurgitation, from 500 to 200 ms with moderate, and of less than 200 ms with severe) .... Aortic Root (Mmode) 5.7 (2.4-3.7 (Ascending aortic aneurysm greater than 5.5 centimeters requires surgery for all patients) ..."

During an interview on 06/10/24 at 2:48 PM, Patient 1, stated, "I had appointment with [Staff I, MD (Doctor of Medicine)] because I couldn't even make it from my bed to my couch without passing out and being out of breath, so he scheduled an echo (Echocardiogram) on 09/01/22. During the echo, I could tell that something was up since the echo tech demeanor changed. She didn't tell me anything, but she told [Staff I, MD] the cardiologist. I was put into the waiting room while [Staff I, MD] was texting a doctor at [Hospital B] to schedule an appointment. [Staff I, MD] had me give him my personal number so that he could text me and check on me and get updates. While driving home, I had to pull over, because I could feel the aneurysm shredding, I thought I was going to die so I called 911. [Hospital C] got me stabilized best they could and transferred to [Hospital D]. I had my open-heart surgery at [Hospital D] where I received a mechanical heart valve for the repair for aortic dissection. [Hospital D] was the only hospital in the whole state of Kansas that could actually work on me that night."

During an interview on 06/11/24 at 4:11 PM, Staff H, Cardiac Sonographer (operate ultrasound equipment that provides moving images of the heart and chambers), stated "[Patient 1], the echo, showed ascending aorta was like giant dilated to something like 6.5 cm (centimeters) or something crazy and 3.5 cm normal. [Patient 1] was really young that's not normal. Notified the cardiologist [Staff I, MD], he came over and talked to her about what was going on and trying to figure out what the next steps for her care.. But I was very adamant that she shouldn't be leaving, and she should be going straight to the ER [emergency room]. It did not look like she was dissecting at that moment the aorta was very enlarged. She was complaining was getting dizzy and was having chest pain. I sent over my images to [Staff I], I think he looked at them on his own. He was talking about sending her to [Hospital B]. She was getting ready to leave too and told her if you're gonna leave you need to be aware of symptoms, if you start like tasting blood, feeling really bad or like a ripping sensation in your chest call 911 like immediately because those are all signs of a dissection."

During an interview on 06/12/24 on 06/12/24 at 8:42 AM, Staff I, MD, stated, "Enlarged aorta we will ask for conformation of CT [cat scan] chest we would correlate with CT. I f the aorta reaches 5.3 cm we get very concerned for women and send them for surgical consultation, only would be emergent if had symptoms otherwise it would be in office consultation. [Patient 1] was young and had shortness of breath. The echo tech came and got me because aorta was 5.6, I did not look at the echo. I explained to [Patient 1] that she had a very large aneurysm, critical in size, but she denied symptoms. I called [Hospital B] doctor, was told if not symptomatic then no reason to send here and that they would see her in the office. I told her drive over to the [Hospital B] emergency room to be seen, since I felt uneasy about letting her go. [Patient 1] stated she had something to do first and, I explained the critical size of the aneurysm. That day she started to have chest pain and went to ER with pericardial effusion (buildup of extra fluid in the space around the heart, putting pressure on the heart and prevent it from pumping normally) with a dissection (medical emergency in which the inner layer of the large blood vessel branching off the heart (aorta) tears). I did not document any of the conversation with [Patient 1] or [Hospital B]."

During an interview on 06/12/24 at 9:33 AM, Staff D, MD, Chief Medical Officer (CMO) stated " ... All doctors would need to document any contact with patient and doctor if it was in a clinic. If there was an emergency in the clinic or on the premises, they would call the MET [Medical Evaluation Team] team for response. It is the physician's responsibility to respond or whoever it was the nearest physician to respond to the emergency. [Patient 1's] ECHO was significant study; the cardiologist is to notify the physician of any study if there is abnormal finding there is a policy to this. It should be related immediately, and I did not see that in her chart. I also did not see a follow up note from [Staff I, MD] he should have documented the conversation with the doctor at [Hospital B] and with the patient. The echo is moderate to severe especially with the size of and the dilation of the vessels, the aorta was dilated, was leaking and had backflow."

Review of a document titled "[County 1] County EMS [Emergency Medical Services] Prehospital Care Report" dated 09/01/22 at 4:12 PM showed, "Narrative: ...patient stated that she was driving home from [Above Named Hospital] where she got EKG done, when she felt a sharp pain in her chest." ...Complaint pain going through my back and chest "

Review of Patient 1 medical record from Hospital C dated 09/01/22 at 5:07 PM showed Patient 1 arrival to ER via EMS and transferred to Hospital D via EMS on 09/01/24 at 10:22 PM with diagnosis of Type 1 dissection of ascending aorta and Ascending aortic aneurysm.

Review of Patient 1's medical record from Hospital C dated 09/01/22 at 5:07 PM showed " ...The CTS [cardiothoracic] surgeon. He is aware of the patient and feels that emergent surgery is indicated ... He recommends ED to ED transfer and then go directly to the operating room ...CTA [cat scan] Chest, Abdomen and Pelvis With IV Contrast ...Impression: Fusiform Aneurysm (rare sausage like expansion of the entire blood vessel on all sides)of the ascending thoracic aorta measuring 6.3 X 6.0 with a subtle dissection (tear) flap (Stanford type A)(occurs in the first part of the aorta closer to the heart and can be immediately life threatening) ...