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Based on hospital policy review, medical record reviews, physician and staff interviews the hospital failed to comply with 42 CFR §489.20 and §489.24.

The findings include:

1. Based on medical record review, Medical Staff Bylaws and staff and physician interviews, the hospital failed to provide an appropriate medical screening exam within the capabilities for 1 of 3 sampled obstetrical patients that presented to the hospital's obstetrical unit for an identified Emergency Medical Condition (EMC) received an appropriate medical screening by a qualified medical person (Patient #3).

~cross refer to 489.24(a), Medical Screening Exam - Tag A2406.

2. The hospital's DED and Labor and Delivery (L&D) physician failed to ensure necessary stabilizing treatment for an emergency medical condition by failing to provide within the capabilities of the staff and facilities available at the hospital, for stabilizing treatment as required to stabilize the emergency medical condition for Patient #3.

~ Cross refer to §489.24(d)(1) Necessary Stabilizing Treatment for Emergency Medical Conditions, Tag A2407.

3. The hospital's Labor and Delivery (L&D) physician failed to provide an appropriate transfer by failing to conduct a medical screening examination to evaluate the medical risks and benefits associated with the transfer for 1 of 3 sampled obstetrical patients that were transferred with an EMC to other acute care hospital (Patient #3).

~ Cross refer to §489.24(e)(1)-(2) Appropriate Transfer, Tag A2409.

Based on medical record review, and staff and physician interviews, the hospital failed to provide an appropriate medical screening exam within the capabilities for 1 of 3 sampled obstetrical patients that presented to the hospital's obstetrical unit for an identified Emergency Medical Condition (EMC) received an appropriate medical screening by a qualified medical person (Patient #3).

The findings include:

1. Record review of Patient #3 revealed a 24-year-old female who presented to the facility's labor and delivery triage from her OB/GYN office on 07/25/2019 1530. Record review revealed "Pt to unit with orders from MD #2 office. States pt is 3-4 cm, twins, footing breech, pre term labor, Pt reports feeling an occasional ctx (contraction). Review revealed at 1537 "Transfer center called, will call back with physician and room assignment ..." Review at 1550 revealed "MD #2 called to unit. Orders received." Review of the record revealed, the patient was transferred to another facility on 07/25/2019 at 1655. Review of record revealed no examination was conducted by a QMP after arrival to the labor and delivery triage unit nor prior to transfer.

Review of the OB physician on call schedule revealed MD #2 was on call on July 25, 2019, when Patient #3 presented to the hospital's obstetrical unit.

Interview on 08/07/2019 at 0941 with RN #2 revealed she was Patient #3's nurse. Interview revealed MD #2 did not come to the hospital to examine the patient. Interview revealed the patient was examined in MD #2's office and sent to the hospital. Interview revealed she was not aware the patient needed to be reexamined when sent from a MD office.

Interview on 08/07/2019 at 1045 with MD #2 revealed he may not have examined the patient at the hospital. Interview revealed he was not aware of the rules and regulations and was trying to get the patient transferred as quickly as possible. Interview revealed he had not received any formal EMTALA training in 14 years.

In summary, the review revealed Patient #3 was in the labor and delivery department for 1 hour and 25 minutes, prior to transfer, without an examination by a qualified medical provider. The review revealed Patient #3 did not receive an appropriate medical screening as evidenced by patient #3 was never examined by a physician or QMP prior to being transferred to another hospital.



26622

Based on medical record review, policy review, and staff and physician interviews, the hospital's Dedicated Emergency Department (DED) and/or Labor and Delivery (L&D) unit, the Obstetrical physician failed to ensure necessary stabilizing treatment for an emergency medical condition by failing to provide stabilizing treatment within the capabilities of the staff and facilities available at the hospital, for 1 (#3) of 3 obstetrical patient in a total of 20 sampled medical records reviewed.

The finding include:

1. Record review of Patient #3 revealed a 24-year-old female who presented to the facility's labor and delivery triage from her OB/GYN office on 07/25/2019 1530. Record review revealed "Pt to unit with orders from MD #2 office. States pt is 3-4 cm, twins, footing breech, pre term labor, Pt reports feeling an occasional ctx (contraction). Review revealed at 1537 "Transfer center called, will call back with physician and room assignment ..." Review at 1550 revealed "MD #2 called to unit. Orders received." Review of the record revealed, the patient was transferred to another facility on 07/25/2019 at 1655. Review of record revealed no examination by a QMP after arrival to the labor and delivery triage unit nor prior to transfer.

Review of the OB physician on call schedule revealed MD #2 was on call on July 25, 2019.

Interview on 08/07/2019 at 0941 with RN #2 revealed she was Patient #3's nurse. Interview revealed MD #2 did not come to the hospital to examine the patient. Interview revealed the patient was examined in MD #2's office and sent to the hospital. Interview revealed she was not aware the patient needed to be reexamined when sent from a MD office.

Interview on 08/07/2019 at 1045 with MD #2 revealed he may not have examined the patient at the hospital. Interview revealed he was not aware of the rules and regulations and was trying to get the patient transferred as quickly as possible. Interview revealed he had not received any formal EMTALA training in 14 years.

Review of the facility's Policy titled "EMTALA- Emergency Medical Treatment and Labor ACT" Policy number 3760834, Origination: 02/2001; Last revised: 01/2012. The policy revealed in part, "Stabilization: if an Emergncy Medical Condition exists, medial treatment within the capabilities of the staff and facilities routinely available ("Capacity"), will be provided to Stabilize the individual prior to consideration of...transfer.


In summary, the review revealed Patient #3 was in the labor and delivery department for 1 hour and 25 minutes. Patient #3 was having preterm labor with a breech presentation, the patient was not stabilized prior to transfer.


26622

Based on medical record review, and staff and physician interviews, the hospital's Labor and Delivery (L&D) physician failed to provide an appropriate transfer by failing to conduct a medical screening examination to evaluate the medical risks and benefits associated with the transfer for 1 of 3 sampled obstetrical patients that was transferred with an EMC to another acute care hospital (Patient #3).

The findings include:

Record review of Patient #3 revealed a 24-year-old female who presented to the facility's labor and delivery triage from her OB/GYN office on 07/25/2019 1530. Record review revealed "Pt to unit with orders from MD #2 office. States pt is 3-4 cm, twins, footing breech, pre term labor, Pt reports feeling an occasional ctx (contraction). Review revealed at 1537 "Transfer center called, will call back with physician and room assignment ..." Review at 1550 revealed "MD #2 called to unit. Orders received." Review of the record revealed, the patient was transferred to another facility on 07/25/2019 at 1655. Review of record revealed no examination by a QMP after arrival to the labor and delivery triage unit nor prior to transfer.

Review of the OB physician on call schedule revealed MD #2 was on call on July 25, 2019.

Interview on 08/07/2019 at 0941 with RN #2 revealed she was Patient #3's nurse. Interview revealed the patient came from MD #2's office with orders to transfer. Interview revealed MD #2 did not come to the hospital to examine the patient. Interview revealed the patient was examined in MD #2's office and sent to the hospital. Interview revealed she was not aware the patient needed to be reexamined when sent from a MD office.

Interview on 08/07/2019 at 1045 with MD #2 revealed he may not have examined the patient at the hospital. Interview revealed he was not aware of the rules and regulations and was trying to get the patient transferred as quickly as possible. Interview revealed he had not received any formal EMTALA training in 14 years.

In summary, the review revealed Patient #3 was in the labor and delivery department for 1 hour and 25 minutes, prior to transfer, without an examination by a qualified medical provider, nor stabilized as required. The review revealed that Patient #3 was not appropriately transferred as the medical risks and benefits could not be weighed without an examination by a qualified medical provider.