Legal Eagle Eye Newsletter for the Nursing Profession(4)1 Oct 95


   Quick Summary: At this hospital vital signs were to be taken at least every ten minutes in the emergency room.  The gap between the last time vital signs were taken by the nurses and the patient getting some attention to his complaints did not conform to the hospital’s standard protocols. There was a violation of the EMTALA with respect to this patient. 

   The patient’s family’s suit against the hospital under the Emergency Medical Treatment and Active Labor Act was upheld by the U.S. District Court for the Western District of North Carolina.

   The patient had come to the emergency room with complaints of vomiting and abdominal pain, according to the court record. He was examined, diagnosed with gastroenteritis, and sent home with instructions to follow up with his family physician.

   He returned two days later, at 8:25 in the evening. He complained of right-sided abdominal pain with chills and nausea. His vital signs, including temperature, pulse, blood pressure and respiration, were taken and charted at 8:30 pm. However, over the next four hours and twenty minutes, no vital signs were taken by the emergency room nursing staff.

   At around 11:30 pm a physician decided that this patient needed to go to the ICU. Since there was no ICU bed available, an ambulance was summoned at 1:30 am to take the patient elsewhere. When he got to another facility shortly after 2:00 am, a ruptured appendix with sepsis was diagnosed. The patient suffered cardiac arrest during surgery two hours later, and died.

   The court ruled that the EMTALA requires a hospital emergency room to screen all patients the same, without regard to financial or insurance considerations. An "appropriate" screening is judged by reference to the hospital’s standard screening procedure.  Romo vs. Union Memorial Hospital, 878 F. Supp. 837 (W.D. N.C., 1995).

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