While mandated reporting by hospitals is the most common source of EMTALA investigations and citations, local news reports periodically come to CMS attention and trigger EMTALA investigations. You can be assured that you are going to get a CMS visit in the near future when local headlines say something like “Man dies hours after being turned away from hospital.”
In the real-life example case, a 46-year-old business owner presented at a local ED last December complaining of chest pain. The patient had undergone stent placement six months earlier. A sonogram revealed “serious” cardiac issues, and the doctor ordered the patient admitted, according to news reports. So far, so good, but that is when the train reportedly left the EMTALA track.
The 56-bed community hospital affiliate of a large system had no beds immediately available, according to the published reports. Instead of admitting the patient or transferring the patient to another hospital, the hospital directed the patient to go home to wait for a bed to become available, the media reported. It is not clear from published reports whether the physician was made aware of the decision to discharge the patient to home without stabilizing care.
At this point, as is so often the case, “Murphy’s Law” came into play. A few hours later, no call had come to return to the hospital, so the patient decided to drive to a nearby gas station to get a soda. As he was driving home, his car crossed the center line of the road, crashed into a utility pole, and came to rest in a ditch, according to news reports.
When police arrived, the patient was trapped in the car and told police that he was having chest pains. By the time the patient was freed from the wreckage and transferred to the ambulance, he lost consciousness and EMS crews were unsuccessful with life support attempts. The Coroner ruled the death was due to coronary artery disease.
If CMS missed the local newspaper articles, they definitely became aware of the incident when reporters followed up with them for comment, which they appear to have declined. The hospital was prudent enough to not comment and add a potential HIPAA violation to the mix, and the family has hired a law firm to investigate the case.
We will post follow-up details on the case if they become available.
Good article.
My last EMTALA case was three years ago when a private care large hospital told a man with severe back pain and weakness in both legs that if he could not pay for potential surgery (revealerd on x-ray a possible trumor on spine) that he could not stay there, he probably had cancer, and had to apply for Medical and go to a county hospital.
He had cauda equina syndrome, was transfered by ambulance to county hospital. Underwent emergency surgery, which revealed a large spinal abcess which was drained. He ended up a paraplergic. BIG lawsuit.