North Carolina Hospital Settles Case Involving Patient Dumping Allegations

On April 2, 2018, Southeastern Regional Medical Center (SRMC), Lumberton, North Carolina, entered into a $200,000 settlement agreement with OIG. The settlement resolves allegations that, based on OIG's investigation, SRMC violated the Emergency Medical Treatment and Labor Act (EMTALA) when it failed to provide an appropriate medical screening exam, stabilizing treatment, and/or an appropriate transfer for four individuals. Specifically, in the following two instances, SRMC failed to provide an appropriate medical screening examination and/or stabilizing treatment. The first patient, a 71-year-old male who had been living independently, presented to SRMC's Emergency Department (ED) on January 21, 2016, complaining of leg pain, weakness, inability to walk, and a drastic change in behavior and functioning. His daughter reported that he was occasionally disoriented, but that he had just made a trip to visit her and was in good health. The ED physician ordered labs and IV fluids. After about ten hours, the patient was discharged with a diagnosis of dehydration and weakness. Less than six hours later, the patient returned to the ED with similar symptoms and complaints. This time, another ED physician diagnosed the patient with a traumatic subdural hemorrhage and transferred the patient for brain surgery. At the receiving hospital, the patient remained in critical condition for two weeks with diagnoses of acute respiratory failure, possible stroke, and seizures. The patient passed away the following week. The second patient, a 49-year-old male, presented to SRMC's ED on August 27, 2015, with lethargy and overdose of multiple medications. The patient said he was depressed and expressed suicidal ideations. The ED physician ordered blood and urine tests, an EKG, and a head CT, and noted the patient had a history of depression and chronic back pain. The patient was placed on suicide precaution watch, but no psychiatric evaluation was ordered. The patient was discharged about 4.5 hours later with diagnoses of polypharmacy and asthenia with discharge instructions for near-syncope and weakness. Four days later, the patient died due to a self-inflicted gunshot wound to the head. In two additional instances, SRMC failed to meet its EMTALA obligations when it failed to re-evaluate the patient at the time of transfer to determine whether: (1) the benefits to each patient continued to outweigh the risks, (2) the previous arrangements for appropriate personnel and transportation equipment were appropriate given the patient's deterioration, and (3) additional medical treatment was needed to minimize the risks to the individual's health, and in the case of a woman in labor, the health of the unborn child. The third patient, a 44-year-old female, presented to SRMC's ED on February 28, 2014 at 3:38 p.m. for evaluation of an altered mental status when she was found unresponsive with an empty bottle of butalbital beside her. A CT scan revealed an extensive acute subarachnoid hemorrhage with possible artery aneurysm bleed. At 9:30 p.m., the ED physician certified that the medical benefits of neurosurgery at a hospital over 122 miles away outweighed the risks of transfer. However, the patient was not transferred until 2:16 a.m. the following day, when her condition had significantly deteriorated. The fourth patient, a 26-year-old who was 28 weeks pregnant, presented to the ED on March 13, 2014 with a complaint of ruptured membranes and lower back discomfort. The ED physician examined the patient at 11:15 a.m. and determined that her unborn child required tertiary services not available at SRMC and certified that the medical benefits of delivery at a hospital over 80 miles away outweighed the risks of transfer. However, the patient was not transferred until 1:00 p.m. Between the time of the ED physician's certification and the patient's transfer, the patient continued to have contractions. Senior Counsel Sandra Sands and Associate Counsel Matthew J. Westbrook represented OIG.

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