Question

Margaret was forty-eight, obese, a cigarette smoker, and had a family history of coronary artery disease and diabetes. On February 10, 2009, Margaret arrived at the Brandywine Hospital emergency department. During Brandywine Hospital’s initial screening during triage, Margaret reported pain in the middle of her chest that radiated down both arms and her back, right side neck pain, and right-arm numbness. Margaret was seen first by Dr. Dan, who ordered the following: a complete blood count, a blood serum chemistry panel, chest x-rays, a computerized tomography scan (“CT”) of her chest, cardiac marker tests, and an electrocardiogram (“EKG”). The results were normal with no indication that Margaret was having a cardiac event. Margaret’s pain was somewhat alleviated by two doses of nitroglycerin spray. Dr. Dan concluded that Margaret was suffering from “atypical chest pain” and ordered a second enzyme to check for abnormal cardiac markers. Brandywine Hospital has a standard screening procedure for chest-pain patients which was applicable to patients with the same or similar symptoms as Margaret. The guidelines provided for serial cardiac enzyme measurements, serial EKG testing, and cardiology consultation. Margaret did not receive serial enzyme measurements, serial EKGs, a cardiology consultation, or a cardiac perfusion scan; because Dr. Dan did not consider them necessary in her case. Dr. Dan ordered Demerol for Margaret to treat her continuing pain, which lessened it. After the second set of cardiac markers were normal, Dr. Dan determined that Margaret could be discharged from the emergency department. The next day, Margaret died from hemopericardium with cardiac tamponade (fluid accumulated in the sac in which the heart is enclosed), which was due to the rupture of acute myocardial infarction due to ischemic heart disease. Margaret’s heirs probably have a strong EMTALA claim against:

• A. Brandywine Hospital
• B. Dr. Dan
• C. The triage screener
• D. All of the above
• E. None of the above: these facts do not clearly demonstrate a violation of either the screening or stabilization requirement
  

Answer 1

This is clearly a case of violation of EMTALA since the guidelines provided for serial cardiac enzyme measurements, serial EKG testing, and cardiology consultation was not performed in Margaret case. Everyone is responsible for this loss of life. Starting with Dr Dan who neglected the importance of that screening procedure. Secondly, the triage screener is also responsible for not following his regular and authorized work which he/she is supposed to undergo in any circumstances. Thirdly, Brandywine Hospital management is equally responsible for not looking into the matter and let the patient to get discharge without screening.

Action must be taken against Brandywine Hospital, Dr. Dan and the triage screener under state medical malpractice/ negligence laws.

Additionally, Brandywine Hospital should also be sued under EMTALA for not evaluating and stabilizing Margaret's medical condition.