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Based on review of documentation, it was determined that 1 of 23 patients (Patient #21) did not receive an appropriate Medical Screening Exam prior to discharge from the emergency department.

Findings were:

Facility policy entitled "EMTALA-Compliance with the Emergency Medical Treatment and Active Labor Act" (last revised 3/16, last approved 10/21) stated in part "Any individual who "comes to the hospital emergency department" requesting examination or treatment shall be provided with an appropriate Medical Screening Exam (MSE). This MSE will determine whether an individual has an actual Emergency Medical Condition (EMC). This exam should be done in a non-discriminatory way ...

Pampa Regional Medical Center will provide emergency services and care without regard to an individual's race, ethnicity, national origin, citizenship, age, sex, sexual orientation, preexisting medical condition, physical or mental handicap, insurance status, economic status or ability to pay for medical services, except to the extent that a circumstance such as age, sex, preexisting medical condition, or physical or mental handicap is medically significant to the provision or appropriate medical care to the patient."

On 12/13/23, Patient # 21 arrived at the emergency department requesting nebulizing treatment with complaints of cough, congestion, and shortness of breath (SOB). Patient #21's triage vital signs at 9:42 pm included high pulse (118), high blood pressure (BP 208/157), and decreased oxygen saturation at 92% on Room Air (RA). Patient #21 refused labs, but there was no documentation of discussion of risks of refusal. Patient #1's last set of vital signs at 10:35 pm continued to be abnormal: BP 206/157, pulse 101, oxygen saturation 92% RA. There was no documentation of determination of severity of asthma exacerbation and the patient's abnormal vital signs were not addressed. Patient #21 was not provided an appropriate MSE, as there was no continued assessment of systems.

On 12/15/23, Patient #21 presented to the ED with severe SOB. The ordered EKG (electrocardiogram) was not documented or scanned into the chart. Patient had elevated troponin level and MI (myocardial infarction/heart attack) was not ruled out prior to the transfer. Patient had elevated WBC and was not given antibiotics or IV fluids prior to transfer.

Based on review of documentation, it was determined for 1 of 23 ED patients reviewed (Patient #21), the facility failed to:
A. ensure Patient #21 was stable and appropriate for transfer; and
B. obtain a written request by the individual (or their represtantive) or ensure a physician signed a certification detailing benefits outweighed the risks of the transfer.

Findings were:

Facility policy entitled "EMTALA-Compliance with the Emergency Medical Treatment and Active Labor Act" (last revised 3/16, last approved 10/21) stated in part "Any individual who "comes to the hospital emergency department" requesting examination or treatment shall be provided with an appropriate Medical Screening Exam (MSE). This MSE will determine whether an individual has an actual Emergency Medical Condition (EMC). This exam should be done in a non-discriminatory way ...

Pampa Regional Medical Center will provide emergency services and care without regard to an individual's race, ethnicity, national origin, citizenship, age, sex, sexual orientation, preexisting medical condition, physical or mental handicap, insurance status, economic status or ability to pay for medical services, except to the extent that a circumstance such as age, sex, preexisting medical condition, or physical or mental handicap is medically significant to the provision or appropriate medical care to the patient."


On 12/15/23, Patient #21 presented with chest pain and respiratory distress via EMS (Emergency Services/Ambulance) to the ED after becoming unrresponsive at home. This was Patient #21's third time to visit the ER in 4 days; Patient #21 was diagnosed with influenza B on their first visit to the ED on 12/11/23. EMS attempted intubation; a king tube (airway management device) was placed instead.

In the ED, the physician orders for Patient #21 included: labs, urine, arterial blood gas, chest x-ray (CXR), and EKG; an endotrachial tube, gastric tube, and foley catheter were placed. Patient #21 had elevated troponin levels, d dimer, white blood cell count, and lactic acid level; Patient #21's CXR revealed right middle lobe pneumonia. Patient #21 was treated for possible angioedema (swelling under the skin) with medications (epinephrine, solu-medrol, famotidine, and benadryl) but was not treated for sepsis (no antibiotics or IV (intravenous) fluids) with no documentation why these were not given.

Although Patient #21's troponin level was elevated, which could indicate heart attack (MI), the ordered EKG was not documented nor scanned into the chart. Patient #21's elevated d dimer could indicate pulmonary embolism (PE), but Patient #21 did not receive a CT (computed tomography scan) to rule out PE.

Further, there was no documentation of a written request of transfer indicating the patient was aware of the risks and benefits of the transfer; nor did a physician sign a certification that contained a summary of the risks and benefits reasonably expected from the provision of appropriate medical treatment at another medical facility outweighing the increased risks to the individual from being transferred.