The US District Court for the District of Puerto Rico has refused to dismiss a case brought by the survivors of Alfonso Domenech who was discharged from a hospital inspite of complaints of chest pain and abnormal test results.

The hospital (Hospital Ausillo Mutuo de Puerto Rico) moved to dismiss the EMTALA counts against the hospital on the grounds that the hospital had provided an examination in the Emergency Department and also obtained a consult from an internist.

CMS frequently cites hospitals where patients are "triaged down" from protocols because the patient "doesn't seem that serious."

The court ruled that a genuine issue of fact existed whether the hospital followed its own policies and procedures in the medical screening exam. The court cited the triage protocol that would make a patient with acute chest pain and unstable vital signs as a "category 1" patient, but 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.

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 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 that the evidence included that the patient was urinating uncontrollably, disoriented, and could hardly walk.