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Based on review of procedures, review of a medical record, review of information provided and interviews with key staff on December 4 and December 18, 2014, it was determined that the individual legally responsible for implementing all procedures failed to ensure that all obstetrical patients, who requested and had support persons with them during delivery, received quality health care in a safe environment.

Findings include:

1. Mount Desert Island Hospital revised a procedure in March 1995, approved by the Medical Director, titled 'Consent For Support Person/Team During Labor & Delivery'. This form outlined conditions that allowed support persons to accompany the labor patient in the Labor and Delivery Room. One of the conditions was that a consent form was signed by the patient and the support persons prior to admission to the Delivery Room.

2. A review of Patient A's medical record revealed that on November 26, 2014, Patient A arrived from home, to the hospital with two (2) lay midwives and a significant other. Patient A was in the second stage of labor and had been pushing at home. The decision to transfer Patient A to the hospital was based on the fact that meconium staining was noted and decelerations. Patient A arrived on the Obstetrical Unit and was then transferred to the Delivery Room. The lay midwives and the significant other accompanied Patient A to the Delivery Room. The Certified Nurse Midwife, a credentialed employee of the hospital, arrived and started the delivery process. While the Certified Nurse Midwife was delivering the newborn with shoulder dystocia, one of the lay midwives intervened in the delivery process, grabbed the newborn's arm, to help with delivery and the result was the newborn suffered a broken humerus.

3. On December 4, 2014, the Certified Nurse Midwife, present for Patient A's delivery in November 2014, stated that the consent form had not been signed by the support persons present in the delivery room during the delivery. She stated that she had the delivery under control and did not know why the lay midwife intervened.

4. This finding was confirmed by the Vice President Quality and Safety on December 4, 2014, at approximately 3:30 p.m.

Based on review of a procedure and a form, review of information provided and interviews with key staff on December 4 and December 18, 2014, it was determined that the facility failed to ensure that all procedures were followed at all times.

Findings include:

1. The Mount Desert Island Hospital Procedure titled, 'Consent For Support Person/Team During Labor & Delivery' stated, "Support Person/ Team may accompany the Labor Patient in the Labor & Delivery Room under the following Conditions: .....2. Appropriate consent has been signed by a patient, healthcare provider and all members of the support team."

2. A review of Patient A's medical record on December 4, 2014, revealed that there was no signed consent form present.

3. During an interview with the Certified Nurse Midwife on December 4, 2014, at approximately 3 p.m., when questioned if anyone signed the consent for support persons form, she stated, "Nope. No time!"

4. The lack of a signed consent form was verified by the Vice President Quality and Safety on December 4, 2014, at approximately 3:30 p.m.