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Based on document review and staff interview, it was determined for 1 of 1 (Pt #1) patient requiring screening for a medical emergency, the Hospital failed to ensure compliance with 42 CFR 489.20 and 42 CFR 489.24.

Findings include:

1. The Hospital failed to provide the patient with an appropriate medical screening. See deficiency cited at C2406.

Based on document review and staff interview, it was determined for 1 of 1 (Pt #1) patient in route to the hospital emergency department for evaluation of an emergency medical condition, The Hospital instructed EMS (emergency medical services) to reroute patient to another facility and failed to provide an appropriate medical screening. This failure has the potential to affect all patients in transit to the emergency department.

Findings include:

1. A review of the Edwards County EMS patient care report for Pt #1 was conducted on 7/21/16 at approximately 10:00 AM. The care report indicates the EMS received a call on 7/12/16 at 22:30 to transport Pt #1, who was " having a miscarriage". Patient's mother stated, "We were at (Hospital B) earlier this evening and was told she was having a miscarriage and to go back home cause this is normal. After 2 hours of this I called (Hospital A) and they said this not normal and to get her to the hospital." Documentation indicates "Patient's mother wanted her daughter to be taken to (Hospital A) due to (Hospital B) earlier this evening. While en route to (Hospital A) Edwards county dispatched advised emergency medical technician (EMT/E #7) to call (Hospital A) and then gave out the phone number. E#7 called (Hospital A) and ER doctor advised E #7 that they were refusing care of this patient due to not having an OB (obstetric services) in the hospital and that if we showed up they wouldn't allow us to unload the patient and then make us go on to Mount Vernon or go to (Hospital B)." Pt #1 was taken to (Hospital B) for evaluation.

2. An interview was conducted with Registered Nurse/ Emergency Department (E#4) on 7/21/16 at 10:50 AM. During the interview E#4 was asked if she recalled the incident regarding Pt #1. E#4 stated, " Yes, I think I know what you are talking about. The house charge nurse (E#6) received a call from the patient or family stating Pt #1 was pregnant and bleeding heavily. E#6 told them to go to a hospital as soon as possible. Family of Pt #1 stated to E#6 they had been to (Hospital B) and would not go back. " E#4 reported when EMS called, E#4 took the call and transferred to the ED physician (E#5) per his request. E#4 was aware E#5 told EMS to take Pt #1 to the nearest facility with OB. E#4 confirmed Pt #1 did not present to their ED per the physician's instructions to take patient to another hospital.

3. A telephone interview was conducted on 7/21/16 at 1:45 PM with the ED physician (E#5) making the decision to reroute the EMS transporting Pt #1. E#5 stated " I believe the patient had been to another hospital and was evaluated. EMS said they were between 2 hospitals so I asked if the patient (Pt #1) was stable. EMS said she was and gave me her vital signs and report. I wanted to do what was best for the patient, save time in transferring and in bleeding, avoid a transfusion. I told the nurse they should take her to where she had treatment before, for continuity of care and they had OB services. Sounded like she needed a D&C (dilation and curettage) which we don ' t do here (Hospital A). If she came here our next closest hospital would be (Hospital C) 30 minutes away." E#5 denied any conversation regarding the EMS not being allowed to unload Pt #1 if they arrived at the ED.

4. A telephone interview was conducted with emergency medical technician (EMT/E#7) on 7/25/16 at 12:10 PM. E#7 recalled the transport of Pt #1 on 7/12/16 and confirmed the information in the patient care notes from Edwards County EMS. E#7 reiterated the ED physician told E#7 to take Pt #1 to another hospital with OB services and if Pt #1 was brought to their hospital he would not allow the EMS to unload Pt #1. E#7 confirmed Pt #1 was taken to (Hospital B) where care was transferred to their staff.

5. An interview was conducted with the hospital administrator (E#1) and the chief nursing officer (E#2). After a telephone conversation with the EMS, both staff agreed the EMS was instructed to transport Pt #1 to another hospital with OB (obstetric) services after knowledge the EMS was in route to their hospital.