The patient has a history of hypertension (HTN), coronary artery disease (CAD), previous myocardial infarction in 2018, alcohol, cocaine and tobacco abuse, who presented with chest pain. Pain was 10/10 in severity and increased with deep inspiration. The patient had used cocaine the day before admission. Toxicology screen was positive for alcohol and cocaine. The blood pressure (BP) was 130/92 mm Hg and pulse 85 beats per minute (bpm). Troponin was negative at 0.01. An electrocardiogram (EKG) showed anterior T wave inversion.

The health plan's determination is upheld. The patient presented with chest pain, but was hemodynamically stable. His initial EKG, although abnormal, was not diagnostic of an acute myocardial infarction (MI). His initial cardiac biomarkers were negative. The patient was stable during the hospitalization. He was admitted over a weekend, and this may have accounted for the delay in service. A lower level of care would have been more appropriate.