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Based on review of policies and procedures and medical records and interviews with hospital staff, the hospital failed to follow its policies concerning EMTALA (Emergency Treatment and Active Labor Act) responsibilities.

Findings:

The hospital's policy, MSE - Provision of Care, with a revision date of 05/2012, stipulates that:

1. Every individual who requests medical treatment at SAS (St. Anthony Shawnee Hospital) will receive an appropriate medical screening examination to determine whether he/she has an emergency medical condition. The hospital failed to follow its policy and provide Patient #1 with an appropriate medical screening examination.

2. SAS will provide care within the extent of its capabilities and capacity to patients suffering from an emergency medical condition. The hospital failed to follow its policy and provided stabilizing treatment to Patient #1.

Based on review of medical records and hospital documents and interviews with hospital staff, the hospital failed to provide a medical screening examination sufficient to determine whether or not an emergency medical condition existed. This occurred in one of twenty-five medical records reviewed.

Findings:

Patient #1 - On 11/19/2012 at 2247, the patient presented as a transfer from another acute care hospital with lower abdominal pain and a diagnosis of possible ectopic pregnancy. The patient had a history of tubal ligation and a menstrual period two weeks prior. The ER (emergency room) physician ordered a pelvic ultrasound and a quantitative pregnancy (BHCG) test. The ER physician evaluated the patient and consulted with the on-call obstetric/gynecology (OB/Gyn) specialist concerning the management of the patient. The results of the tests were discussed with the specialist. The OB/Gyn did not come to the ER and examine the patient to perform further clinical examination. It was known, due to the ultrasound results that an ectopic pregnancy could not be excluded as there was a complex mass in the left adnexa adjacent to the fundus of the uterus; as well as free fluid present within the right adnexa adjacent to the uterus.

1. The ER physician did not perform a pelvic examination.

2. The ER physician did not order a repeat complete blood count to ensure that the hemoglobin was not decreasing which could be a clinical indicator of internal hemorrhage of a ruptured fallopian tube.

3. No further examination was done to rule out ectopic pregnancy.

4. During the interview with the ER physician on the morning of 12/05/2012, she confirmed the above findings with the surveyor and that she relayed the findings first to the on-call OB/Gyn and then relayed what the OB/Gyn gave as options.

Based on review of medical records and hospital documents and interviews with staff, the hospital failed to provide stabilizing treatment within the hospital's capability for one of three patients who presented with lower abdominal pain and symptoms consistent with ectopic pregnancy.

Findings:

Patient #1 - On 11/19/2012 at 2247, the patient presented as a transfer from another acute care hospital with lower abdominal pain and a diagnosis of possible ectopic pregnancy. The patient had a history of tubal ligation and a menstrual period two weeks prior. The ER (emergency room) physician ordered a pelvic ultrasound and a quantitative pregnancy (BHCG) test. The ER physician evaluated the patient and consulted with the on-call obstetric/gynecology (OB/Gyn) specialist concerning the management of the patient. The record documented the results of the tests were discussed with the specialist. It was known, due to the ultrasound results that an ectopic pregnancy could not be excluded as there was a complex mass in the left adnexa adjacent to the fundus of the uterus; as well as free fluid present within the right adnexa adjacent to the uterus.

Ectopic pregnancy is a clinical condition that demands immediate attention to prevent further deterioration of the clinical picture and is a life-threatening condition. The developing cells must be removed to save the mother's life. The patient would need emergency medical help if the area of the ectopic pregnancy ruptures which could lead to shock. If medical management is done with methotrexate, close monitoring by a physician must occur.

1. The hospital offers OB/Gyn services to emergency patients and had OB/Gyn coverage on 11/19 and 20/2012. The hospital had on-call surgery and anesthesia staff on 11/19 and 20/2012. The hospital had capability and capacity to admit and and provide stablizing treatment to the patient.

2. The OB/Gyn specialist on-call did not come to the ER and examine the patient to perform further clinical examination. No further examination was done by the ED pysician to ruleout ectopic pregnancy.

3. The patient was not admitted and provided further stabilizing treatment. Patient #1 should had been admitted and kept for 24-hour observation to ensure no further deterioration of her condition would occur. The patient's obstetrical condition (probable ectopic pregnancy) was not resolved at the time of discharge.

Based on review of medical records and hospital documents and interviews with staff, the hospital failed to provide stabilizing treatment within the hospital's capability for one of three patients who presented with lower abdominal pain and symptoms consistent with ectopic pregnancy.

Findings:

Patient #1 - On 11/19/2012 at 2247, the patient presented as a transfer from another acute care hospital with lower abdominal pain and a diagnosis of possible ectopic pregnancy. The patient had a history of tubal ligation and a menstrual period two weeks prior. The ER (emergency room) physician ordered a pelvic ultrasound and a quantitative pregnancy (BHCG) test. The ER physician evaluated the patient and consulted with the on-call obstetric/gynecology (OB/Gyn) specialist concerning the management of the patient. The record documented the results of the tests were discussed with the specialist. It was known, due to the ultrasound results that an ectopic pregnancy could not be excluded as there was a complex mass in the left adnexa adjacent to the fundus of the uterus; as well as free fluid present within the right adnexa adjacent to the uterus.

Ectopic pregnancy is a clinical condition that demands immediate attention to prevent further deterioration of the clinical picture and is a life-threatening condition. The developing cells must be removed to save the mother's life. The patient would need emergency medical help if the area of the ectopic pregnancy ruptures which could lead to shock. If medical management is done with methotrexate, close monitoring by a physician must occur.

1. The hospital offers OB/Gyn services to emergency patients and had OB/Gyn coverage on 11/19 and 20/2012. The hospital had on-call surgery and anesthesia staff on 11/19 and 20/2012. The hospital had capability and capacity to admit and and provide stablizing treatment to the patient.

2. The OB/Gyn specialist on-call did not come to the ER and examine the patient to perform further clinical examination. No further examination was done by the ED pysician to ruleout ectopic pregnancy.

3. The patient was discharged home on 11/20/12 at 02:03 AM. The patient should have been monitored for at least 24-hours to ensure that no further deterioration of the ectopic pregnancy was going to occur (rupture of the fallopian tube).

4. The patient's obstetrical condition was not resolved at the time the patient was discharged home.

6. The patient presented to another hospital on 11:20/12 at 10:16 AM with complaints of severe abdominal and lower back pain.

7. The patient underwent surgical procedure for the "removal of left ectopic pregnancy and tube, and bilateral partial salpingectomy."