1. In the setting of multiple cardiac risk factors, the standard of care almost always mandates admission to the hospital for observation and/or risk stratification testing. A single EKG, and even one set of enzymes, are not adequate to rule out the presence of an acute coronary syndrome. Discharge may be done on a case-by-case basis when there is a clear alternate explanation for the pain, or when an appropriate risk stratification test has been performed within an 18-month period and has been noted to be negative for inducible ischemia.
  2. The use of a GI cocktail as a decision-making tool is not adequate for the level of diagnostic prudence required for the evaluation of chest and abdominal pain. Also, the presence of isolated abdominal pain is not adequate to rule out the presence of an acute coronary syndrome in the following populations: diabetes; elderly females; and in the presence of multiple cardiac risk factors.
G. Application of the Standard of Care: the Respondent failed to meet the standard of care.
  1. The Respondent failed to meet the standard of care by failing to perform an EKG in a high-risk patient with abdominal and chest pain.
  2. The Respondent failed to meet the standard of care by failing to obtain a set of cardiac enzymes in a high-risk patient with abdominal and chest pain.
  3. The Respondent failed to meet the standard of care by failing to admit the patient in the setting of chest and abdominal pain of uncertain etiology.