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EMTALA counts remain in Puerto Rico hospital case
Triage protocols at issue
The U.S. District Court for the District of Puerto Rico, in a recent decision, has refused to dismiss a case brought by the survivors of Alfonso Domenech, who was discharged from a hospital in spite of complaints of chest pain and abnormal test results.
Hospital Ausillo Mutuo de Puerto Rico had moved to dismiss the EMTALA counts against the hospital on the grounds that it had provided an examination in the emergency department (ED) and had obtained a consult from an internist.
The court ruled that a genuine issue of fact existed as to whether the hospital followed its own policies and procedures in the medical screening exam. The court cited the triage protocol that would make a person with acute chest pain and unstable vital signs a "category 1" patient, but noted that Domenech was classified as a "category 3" patient instead.
The court also found that there was a genuine question about the qualifications of the hospital's triage screener.
Stephen Frew, JD, a web site publisher (www.medlaw.com) and risk management specialist, notes that it is common for the Centers for Medicare & Medicaid Services (CMS) to cite hospitals that deviate from their triage protocols to "triage down" patients who do not appear to be extremely ill — especially when the ED is busy.
The court also ruled that the plaintiff's allegation that the hospital failed to stabilize Domenech could go to trial upon a finding that although the hospital ran tests, there is no indication that the hospital treated the chest pain or the underlying heart condition.
The complaint alleges that the hospital was aware that Domenech had chest pain and a history of a transient ischemic attack two years earlier. Upon discharge, the court determined, there was evidence that the patient was urinating uncontrollably, disoriented, and could barely walk.