HospitalInspections.org

Based on review of medical records, policies and procedures, on-call physician schedules, interviews, and video surveillance, it was determined the facility failed to provide, within the capabilities of the staff and facilities available at the hospital, adequate medical examination and treatment for 1 of 20 sampled patients reviewed, Patient #1, who presented to the ED (Emergency Department) at Hospital A on 09/20/25 at 9:57 PM with chief complaint of severe vaginal bleeding. Hospital A discharged Patient #1 home on 09/21/25 at 3:10 AM, with discharge instructions to see a gynecologist emergently the next day.

At the time of discharge, Patient #1's blood pressure had decreased from 144/115 upon arrival to 95/57 at 2:00 AM despite intravenous fluids and an ultrasound at 12:04 AM that showed no free fluids but a CT scan at 1:59 AM (less than 2 hours later) showed 'fluid filled endometrial cavity.' Patient #1 was not offered further medical screening or transfer to another hospital offering gynecology services since they did not have gynecology services on call.

Patient #1 did not receive medical treatment and interventions of her conditions necessary to stabilize the identified emergency medical conditions, including care to assure there would not be material deterioration after discharge, such as excessive blood loss.

Cross Refer to additional findings at A2406.

Based on observation, review of census data for the hospital's locality, and interview, the provider failed to post the required signage in the languages understood by the population served by the Hospital.

The findings included:

During tours of the ED (Emergency Department) on 11/13/25 beginning at 3:59 PM and 11/18/25 beginning at 3:55 PM, signage by the ED walk-in entrance and ED ambulance entrance informing persons of their rights to examination and treatment for emergency medical conditions and women in labor was observed posted in English and Spanish, but not in Haitian-Creole. Further observation of the ED revealed signage for Patient's Bill of Rights and Notice of Privacy Rights & Practices were posted in English, Spanish and Creole in the lobby near the walk-in entrance.

Review of the 2023 5-year census data from Census Reporter reveals in Lauderdale Lakes (the city in which Florida Medical Center is located) 59.3% of the population speaks only English; 32.2% of the population speak French, Haitian or Cajun with 17.4% speaking French, Haitian or Cajun but English less than "very well;" and 5.4% of the population speak Spanish with 1.9% of the population speaking Spanish and English less than "very well."

During a telephone interview on 11/19/25 at 12:00 PM, the Chief Executive Officer stated the predominant languages of the area are first English, then Spanish, then Creole; and stated his belief that only English and Spanish signage is required.

Based on hospital policy, record review, observation, hospital video, and interview, the provider failed to ensure an adequate medical screening exam to determine whether an emergency medical condition existed before discharging 1 of 20 sampled patients (Patient #1).

The findings included:

Review of the Hospital A's Policy and Procedure titled Emergency Medical Treatment and Active Labor Act (EMTALA), Policy Number RI 23, last revised 10/04/22, documents under Policy, "Every patient, regardless of ability to pay, who (i) presents to the Hospital's Dedicated Emergency Department or presents on Hospital Property and (ii) requests an examination or treatment of a potential Emergency Medical Condition ("EMC") shall receive an appropriate Medical Screening Examination ("MSE") to determine whether the patient is experiencing an EMC. If it is determined that the patient is experiencing an EMC, the Hospital shall either stabilize the EMC within the capability of the Hospital or transfer the patient to another medical facility in accordance with the provisions of the Emergency Medical Treatment and Active Labor Act (EMTALA) and this Policy."

Observation on 11/13/25 at 3:59 PM of Hospital Emergency Services signage in the Emergency Department lobby near the walk-in entrance reveals it documents, "The following services are offered at FLORIDA MEDICAL CENTER" and lists the service name "Gynecology" with a check mark in the column for "Services Available 24 hours a day, 7 days a week," and "Any patient requesting emergency care will be screened, evaluated and stabilized based on EMTALA regulations." Review of the Hospital's license also reveals its Dedicated Emergency Department Services includes Gynecology.

Review of the record revealed Patient #1 walked into the emergency room on 09/20/25 at 9:57 PM. Patient #1's Emergency Room Sign-In Form documents her "Chief Complaint, Symptoms" as "vaginal bleeding & clots - severe."

Patient #1's ED (Emergency Department) Triage Assessment, created 09/20/25 at 9:58 PM, documents she came from home with complaint of heavy bleeding after intercourse at 5 PM that day, her pulse was high at 95 (reference range 60-90 beats per minute) per pulse ox machine, her BP (Blood Pressure) was high at 144/115 (reference range 90/60-140/90 mmHg) per automatic cuff, and she was assigned an ESI (Emergency Severity Index: a five level triage system in which level 1 is the most urgent) Level of 2 (indicating high-urgency, but not immediately life-threatening).

Patient #1's ED Document, dictated and signed by ED Physician #1, documents Patient #1 was seen by the provider (physician) on 09/20/25 at 10:02 PM and reported vaginal bleeding that started after intercourse six hours prior and that she had not had a menstrual cycle for several years; and on Physical Exam she was alert and oriented x 3 (to person, place and time) with soft, nontender abdomen and GYN (gynecological exam findings) were described as "Normal external genitalia, Other (There is no obvious sign of injury nurse present during examination there is some blood oozing but no active bleeding)."

Patient #1's ED Interventions / Assessments / Treatments include a Vaginal Bleeding Assessment, created 09/20/25 at 10:17 PM, that documents heavy bright red constant vaginal bleeding since 5 PM with 6 sanitary pad changes, associated symptoms "Dizziness," and that Patient #1 stated she has a copper IUD (Intrauterine Device) that was supposed to be removed four years ago.

On 09/20/25 at 10:42 PM, Patient #1's Hemoglobin was 12.4 (within normal range) and hematocrit 36.9 (low). At 11:27 PM Patient #1's blood pressure was 105/57.

Patient #1's ED nurse's notes document on 09/20/25 at 11:36 PM, Patient #1 was given Dilaudid for "nausea/vomiting," although this was not found in her medication orders or administration record, and the ED record documents under medications that Patient #1 received ondansetron (a medication used to prevent nausea and vomiting) on 09/21/25 at 11:37 PM.

The report from Patient #1's pelvic ultrasound performed 09/21/25 at 12:04 AM documents an indistinct endometrial stripe complex (nonspecific finding), pelvis otherwise normal, and no free fluid. Patient #1's CT (Computed Tomography) of the abdomen and pelvis with contrast, performed 09/21/25 at 1:59 AM, documents under Impression, in part, "Fluid filled endometrial cavity."

An ED Interventions / Assessments / Treatments entry 09/21/25 at 12:05 AM for Vaginal Bleeding documents Patient #1's last menstrual period was four years ago and a "medium" amount of bright red constant bleeding, duration 7 hours, and "replaced bed pad d/t (due to) bleeding." Patient #1's vital signs at 12:05 AM included a pulse of 76 and blood pressure of 125/62.

Patient #1's ED record documented on 09/21/25 she received metoclopramide (a medicine used to treat heartburn, nausea and vomiting) 10 mg (milligrams) intravenously at 1:09 AM and 1 liter of intravenous normal saline at 1:10 AM.

Patient #1's ED Interventions / Assessments / Treatments entry for 2:00 AM for Vaginal Bleeding documents a medium amount of bright red bleeding, one sanitary pad change, and "pt (patient) passing clots." Patient #1's vital signs at 2:00 AM included a blood pressure that was low at 95/57 and pulse of 78.

Despite the drop in blood pressure and reports of nausea, vomiting and dizziness in the context of continued bleeding and passing clots, 4 years post menses, and "fluid-filled endometrial cavity" on CT scan just 2 hours after a pelvic ultrasound showed no free fluid, Patient #1 was discharged home to self-care on 09/21/25 at 3:17 AM without evidence of a recheck since 2:00 AM of her blood pressure, bleeding status, or recheck of her hemoglobin and hematocrit. Patient #1's discharge paperwork in the record included referrals to an OB/GYN (obstetrician / gynecologist) and a local clinic that accepts uninsured patients without any date or timeline for how soon to be seen, although the physician's own note had indicated she needed to be seen "as soon as possible emergently" by a GYN.

Review of Patient #1's Fire Rescue record reveals emergency services were called on 09/21/25 at 8:44 AM, went to the home where Patient #1 was found sitting on toilet and reported vaginal bleeding since the night before and that she had been discharged from Hospital A that morning after being told it was normal menstrual bleeding, although she hadn't had a period in 4 years, that bleeding persisted after that discharge and she became lightheaded and was going through 2 pads every 20 minutes, her blood pressure was low at 86/56 mmHg (millimeters mercury), heart rate 59 (beats per minute), and respiratory rate 26 (breaths per minute). Patient #1 was given intravenous fluids and transferred to Hospital B at 9:12 AM. Review of Patient #1's medical record from Hospital B reveals her hemoglobin and hematocrit levels were critically low at 6.7 and 20.6 respectively and she received blood transfusions.

During a telephone interview on 11/12/25 at 1:20 PM, the ED Medical Director stated a fluid filled endometrium could be normal if a patient is menstruating; that an ultrasound is more sensitive than a CT scan for fluid, so the ultrasound should have picked up fluid if there was any; and that her case would have been something to look into more if she was experiencing nausea, vomiting, or dizziness. Upon being informed that Patient #1 had reported nausea, vomiting and dizziness while in the ED, the ED Medical Director then replied he did not see the patient and cannot really give a true opinion on that.

During an interview on 11/12/25 at 2:28 PM, ED Physician A confirmed he had seen Patient #1 in the ED on 09/20/25 and 09/21/25 and had a chance to review the record, reported ultrasounds and CT scans would both show fluid, and that Patient #1's fluid-filled endometrium "absolutely could be blood. She was menstruating." When reminded that Patient #1 reported no menstruation for four years, he stated postmenopausal bleeding can still happen but when it does you think of a mass, cancer, or ectopic pregnancy; reported on exam there was some blood but it was oozing and "not pouring out" and he saw no IUD strings; denied reassessing the patient for bleeding before her discharge but stated he always asks how patients are doing and if she was bleeding so much she should have said that to him; that although he does not remember the case specifically, he would have kept her if she had said she was bleeding more or that she didn't think she should leave, so she must not have said that and that there was no report to him that bleeding was increasing or continuing. ED Physician A sated that the hospital does not have a gynecologist on call although one is on staff to see inpatients; and clarified that when he wrote she needed to be seen by GYN emergently in his note, he meant that she needed to be seen the next day and not wait a week, and denied offering a transfer to another facility where she could be seen by gynecology.

During interview on 11/17/25 at 2:28 PM, the ED Director stated they have old signage up in the ED lobby since before they lost half of their services and that on call specialty coverage is voluntary unless specifically contracted.

Review of the ED video footage for 09/21/25 at 3:14 AM (within 5 minutes of Patient #1's discharge time) shows a person leaving the Emergency Department in a gown, appearing to be holding something in place under her gown as she walks with one hand on her lower abdomen and another on her backside as carrying a clear bag that appears to be clothing.

Further review of the record does not reveal the patient was asked why she could not wear her own clothes but walked out in a hospital gown holding something between her legs.

The MSE was inappropriate in that it was not sufficient to determine whether an EMC was present. Specifically, the potential EMC of developing anemia and hemorrhagic shock secondary to vaginal bleeding (from a variety of possible causes) was not adequately ruled out.