After being cited for emergency-care violations, Iowa hospital faces lawsuit

The family of a Webster County woman is suing Trinity Regional Medical Center in Fort Dodge for an alleged chain of errors that resulted in her death.

The lawsuit claims the hospital violated federal regulations related to the discharge of emergency-room patients before they are stabilized. Government inspectors cited the hospital for two such violations earlier this year.

The estate of Shelly Nelson is suing Trinity Regional Medical Center in Fort Dodge and its operators, Iowa Health System and UnityPoint Health.

According to the lawsuit, Nelson came to the emergency room at Trinity Regional shortly before 6 a.m. on Aug. 29, 2020, complaining of intermittent, sharp shooting pain in her abdomen, along with nausea. Within an hour she was given medication for nausea and pain, and a CT scan of her abdomen was performed due to clinical history of bowel obstructions.

Doctors allegedly concluded Nelson was constipated and approved her for discharge from the hospital, although she was unable to stand up and get into her car without assistance.

At 2:40 p.m. that day, she returned to the emergency room by ambulance, complaining of increased abdominal pain. At that time, her blood pressure was recorded as 130/80, but it soon dropped to 80/42. A nurse practitioner examined Nelson’s abdomen and found it to be notably protruding, distended and firm, the lawsuit states.

By 4:15 p.m., laboratory results indicated she was at high risk for sepsis or septic shock and her blood pressure had dropped to 41/27. An antibiotic was ordered and was administered about 50 minutes later, according to the lawsuit.

By 7 p.m., Nelson was minimally responsive and by 7:30 p.m., she was unresponsive, and her heart rate had slowed. She died soon after, the lawsuit states.

EMTALA violations cited by inspectors 

The lawsuit alleges Trinity Regional violated the Emergency Medical Treatment and Labor Act, better known as EMTALA, by discharging Nelson before she was stabilized.

The lawsuit also alleges the medical staff was negligent in failing to diagnose mesenteric ischemia — a blockage in an artery that cuts off blood flow to a portion of the intestine – and in failing to adequately treat Nelson before discharging her from the emergency room.

The hospital has yet to file a response to the lawsuit. UnityPoint Health declined to comment on the case.

Earlier this year, Trinity Regional was cited by the state for two separate EMTALA violations unrelated to Nelson’s care.

In the first case, which dates back to January 2022, the hospital allegedly discharged a nursing home resident who was then transported, by her daughter, to another hospital approximately 25 miles away for treatment of a life-threatening infection.

In the second case, which also dates back to January, a pregnant woman arrived in the emergency room with a cough, a fever, leg cramps and an elevated heart rate. Within 90 minutes, the woman was discharged. Almost three hours later, the results of a test she had been given at the hospital showed she was positive for COVID-19.

Inspectors later concluded the emergency room staff had transferred the woman to obstetrics without first completing a general medical screening, believing that was obstetrics’ responsibility. The emergency staff “did not want the obstetrical staff to transfer a pregnant patient back to the emergency department for management of non-obstetrical emergency medical conditions, especially if the emergency department was busy at the time,” inspectors reported.

As a result, even though a particular obstetrician felt unqualified to treat non-obstetrical emergency conditions, he had to do so anyway, the inspectors reported.