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Based on record review, interview and review of facility policies, the facility failed to obtain physician signed certification of risk and benefits for transfer to another facility, contact the receiving facility for transfer and acceptance of patient and failed to send medical records to the receiving facility for one of 33 sampled patients (P 100).

These failures did not ensure risks and benefits were explained to Patient 100 upon transfer to another facility and the receiving facility was not provided with the records indicating the patient status (MSE ...).

Findings:

The facility policy and procedure titled, "Emergency Medical Treatment & Active Labor Act (EMTALA) dated 9/18, in part (111) (C) (1) indicates, "When it is determined that the individual has an Emergency Medical Condition, the Hospital must provide either: a. within the capability of the staff and facilities available at the hospital, for further medical examination and treatment as required to stabilized the medical condition: or b. provide for the appropriate transfer of the individual to another medical facility in accordance with these procedures. 3. If an individual had an Emergency Medical Condition ... The individual may be transferred: a. Upon request ... b. With certification: The individual may be transferred if a physician had documented, in the "Certification by Physician (for Transfer of Patient with Emergency) Medical Condition", that the transfer will not create a Medical Hazard for the individual." In part 4. a. indicates "The Hospital shall, within its capability, provide medical treatment which minimizes the risks to the individual's health and, in the case of a woman who is having contractions, the health of the unborn child. b. "A representative of the receiving facility must have confirmed that: (1) the receiving facility has available space and qualified personnel for the treatment of the individual; and (2) the receiving facility and physician have agreed to accept transfer of the individual and to provide appropriate medical treatment. c. The hospital shall send the receiving facility copies of all pertinent medical records available at time of transfer ... d. The physician or qualified medical person shall ensure that a completed "Transfer Summary", signed by the physician ... accompanies the individual."

A review of the emergency medical services (EMS) report, dated 2/12/21 at 6:18 a.m., indicated a call was received on 2/12/21 at 6:18 a.m., EMS team arrived at scene [ Hospital A] at 6:30 a.m., where they found a "31 year female sitting in the car in parking lot of [Hospital A] in moderate distress. Per husband he tried to check patient into [Hospital A] and was told by hospital staff that they couldn't help them and to drive her (P 100) to [Hospital C]. Los Angeles County fire department captain contacted [Hospital A] staff who came out to evaluate patient and acknowledged that patient was emergent. Patient complaint of pregnancy labor that started approximately one hour ago, unsure if water broke but had lost mucous plug. According to patient, she was having contractions approximately 1 minute apart and lasting 45 seconds. No crowning (baby's head visible) visualized. P 100 was transported to [Hospital B]."

A review of P 100's emergency department (ED) record was conducted on 5/12/21. A medical screening evaluation (MSE), dated 2/15/21 indicated P 100 was 36 weeks intrauterine pregnancy (IUP), presented in possible labor. An exam was performed on patient by the emergency department physician (EDP). Then, patient was transferred to another hospital with perinatal services. EMS was in the parking lot, where P 100 was examined. P 100 was then transferred to [Hospital B] for perinatal services. The entire record consisted of a face sheet with incorrect patient information and the EDP note. The record did not contain a physician signed transfer certification where a summary of the risks and benefits of transferring were provided to P 100.

During an interview with the Emergency Department Director (EDD) on 5/12/21 at 12:20 p.m., according to the EDD on 2/12/21 when she arrived at work. The charge nurse (CN) reported the incident to her that around 5:30 a.m., to 6:30 a.m., a man presented to the ED window to ask if they had obstetrics (OB- childbirth and the care of women giving birth) services. The registration clerk reply "We do not have OB services." Minutes later, the CN received a call from [Hospital B] base station to notify the CN there was a pregnant patient in the parking lot. The CN and ED physician (EDP) went to the parking lot to see the pregnant woman. Emergency medical system (EMS) personnel were already in the parking lot. EDP performed a MSE on patient. Then, patient was transfered to [Hospital B].

During an interview with registration clerk (RC) on 5/12/21 at 1:28 p.m., according to RC on the morning of 2/12/21, a gentleman came into the ED, picked up the ED window phone (phone outside the ED window is use to communicate to the registration clerk the reason the person is in the ED) and said "My girlfriend (or wife, not sure which one the man said) is having a baby. She is in the parking lot." The man said that and left the ED. The man did not come back into the ED. The pregnant woman did not come into the ED, either. According to the RC, the patient was not registered into the ED on the morning of 2/12/21 because the RC did not have or obtain any information about the patient.

During an interview with the Admissions Director (AD) on 5/12/21 at 11:49 a.m., according to the AD, P 100 was seen by the charge nurse and the EDP in the parking lot on the morning of 2/12/21. The RC did not register the patient in the ED at the time the patient was seen in the parking lot by the EDP. After the EDD was looking into the incident of the pregnant woman being seen in the parking lot by the EDP. AD was asked to create an account for P 100. The AD registered P 100 in the ED, created an account, and an ED medical record (chart) around 1:53 p.m., on 2/12/21.

During an interview with EDP on 5/12/21 at 3:35 p.m., according to the EDP on 2/12/21 around 6:20 a.m., the CN notify the EDP a woman is having a baby in the parking lot. The CN and the EDP went outside to the parking lot to see the woman who supposedly was having a baby. When the EDP went outside to the parking lot. The fire department personnel met the EDP and asked, "When did you close your labor and delivery services?" The EMT said "we will do this, (take the patient to another hospital) this time. But next time you cannot refused her." EDP performed a pelvic exam while the patient was sitting inside the car in the driver's seat. EDP indicated there was no man or husband at the scene, at the time. The patient was by herself in the car. According to EDP, P 100 was in "active labor, she was in horrible pain and screaming with pain." According to EDP, after performing P 100's pelvic exam, EDP told P 100 "It looks like you need to be seen by a hospital that has OB services. The paramedics are here to take you to [Hospital B] where they have the services you need." EDP acknowledged and confirmed not contacting the receiving hospital [Hospital B] to notify them the patient was being transfer to that hospital and to ensure the patient had been accepted for further treatment. Furthermore, EDP confirmed not sending any transfer medical records to the receiving hospital at the time of transfer because there were not records to send. According to EDP, the ED registration did not create a medical record (chart) P 100 on the morning of 2/12/21, when P 100 was in the ED parking lot. P 100 was registered into the ED, later that date (2/12/21). EDP documented the medical screening examination (MSE) days later.