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Based on record review, the hospital failed to ensure a medical screening examination was provided to each patient presenting to the ED to determine whether or not an emergency medical condition existed. This deficient practice was evidenced by the physician failing to evaluate for presence of a PE (pulmonary embolism) for 1 (#1) of 1 patients (#1) who presented to the emergency department with chest pain with persistent tachycardia [increase heartrate] and mild hypoxia [decrease oxygen to tissue] . (See findings at A-2406).

Based on record review, the hospital failed to ensure a medical screening examination (MSE) was provided to each patient presenting to the Emergency Department (ED) to determine whether or not an emergency medical condition existed. This deficient practice was evidenced by the physician failing to evaluate for presence of a pulmonary embolism (PE) for 1 (#1) of 1 patients (#1) who presented to the emergency department with chest pain with persistent tachycardia [increase heart rate] and mild hypoxia [decrease oxygen to tissue].

Findings:

Review of the medical record for Patient #1 revealed an 80-year-old female with history of hypertension [elevated blood pressure], hyperlipidemia [high cholesterol], gastroesophageal reflux (GERD), and tobacco abuse presented to the Emergency Department on 10/08/24 at 1:03 p.m. for evaluation of sternal chest pain and epigastric[upper center of abdomen] pain which the patient rated as severe at 9/10 that had been ongoing for 4 hours.

Review of the MSE revealed there was no evaluation for pulmonary embolism [blood clot in the lung] .
Patient #1 demonstrated tachycardia on multiple evaluations (including a heart rate of 105 at discharge) and borderline hypoxia (92%). There was no d-dimer [blood test used to help diagnosis blood clots] or computed tomography (CT) angiography performed.

In summary, the MSE was inappropriate as PE [blood clot in the lung] was not evaluated for in the setting of chest pain with persistent tachycardia and mild hypoxia.

Review of the policy, "Emergency Medical Treatment and Active Labor Act," created 01/2023 and revised/ reviewed 03/2023 and 06/202424, revealed in part:

"IV. DEFINITIONS:
A. EMTALA [Emergency Medical Treatment and Active Labor Act] requires that a hospital provide a MSE [medical screening examination] within the capability and capacity of its emergency department including ancillary services routinely available to the emergency department.
Capabilities of a hospital refers to the physical space, equipment, supplies, and specialized services of the hospital (e.g., surgery, psychiatry, obstetrics, intensive care, pediatrics, trauma care).
Capabilities of the staff refers to the level of care that the personnel of the hospital can provide within the training and scope of their professional licenses. This includes coverage available through the hospital's on-call roster.
Capacity to render care is not reflected simply by the number of persons occupying a specialized unit, the number of staff on duty, or the amount of equipment on the hospital's premises. Capacity includes whatever a hospital customarily does to accommodate patients in excess of its occupancy limits. If a hospital has customarily accommodated patients in excess of its occupancy limits by whatever means (e.g., moving patients to other units, calling in additional staff, borrowing equipment from other facilities) it has, in fact, demonstrated the ability to provide services to patients in excess of its occupancy limits."
and
"E. Emergency Medical Condition (EMC) is defined as:
1. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in:
a. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy;
b. Serious impairment to bodily functions; or
c. Serious dysfunction of any bodily organ or part;"
and
"K. Medical Screening Examination (MSE) is the process required to reach, with reasonable clinical confidence, the point at which it can be determined whether the individual has an emergency medical condition (EMC) or not. A MSE is not an isolated event. It is an ongoing process that begins, but typically does not end, with triage. "
and
"V. PROCESS OR PROCEDURES:
A. If an individual "comes to the emergency department" as defined in Paragraph C under Definitions, the Hospital must:
1. Provide an appropriate MSE [medical screening examination] within the capability of the Hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether an EMC [emergency medical condition] exists. The examination must be conducted by a physician or a QMP [qualified medical professional]."