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Based on facility provided information, staff interviews and record review the facility (OPMC), failed to enforce their policy and procedure appropriate transfers, in accordance with 42 CFR 498.24 for one of 30 sampled patients. Patient #18, who was 37 weeks pregnant presented to OPMC, having " stroke like symptoms " (numbness to hands and right arm, side of face, tongue, had blurred vision and slurred speech), . The patient was taken to the obstetrics unit, was seen by a staff nurse, who consulted an obstetrical physician by phone, and was instructed by the physician to tell the patient to go to another acute care facility, without any further screening examination for the " stroke like " symptoms, as OPMC did not have a neurologist available. Although the facility has a dedicated emergency department, the patient was not sent to the emergency department to be screened by an emergency department physician prior to discharge. Patient #18 was not seen by a physician during the emergency room visit. The facility (OPMC) did not communicate with the other acute care facility regarding acceptance of the patient. There was no attempt to have an accepting physician, and no medical information was sent with the patient.
The findings include:
1. A. Review of OPMC Policy & Procedure (PC 0163) Obstetrical Emergency and Triage and Medical Screening - " To guide personnel in the appropriate and timely assessment and screening of pregnant patients presenting for Obstetrical and/or Medical emergency conditions. Patients greater than 20 weeks gestation for a medical condition that could not be related to an OB condition. The patient should be stabilized in the ED from a hemodynamic, respiratory and neurological standpoint with no significant chance of becoming unstable.
b. Review of OPMC policy & Procedure (ED 018) Florida EMTALA Medical Screening and Evaluation- " To establish guidelines for providing appropriate medical screening examinations and if the individual is determined to have an emergency medical condition any necessary stabilizing treatment or an appropriate transfer for the individual as required by the Emergency Medical Treatment & Active Labor Act. When an individual comes to the emergency department an appropriate medical screening examination within the capabilities of the hospital shall be performed to determine if an emergency medical condition (EMC) exists. If an EMC is determined the individual will be provided necessary stabilizing treatment or an appropriate transfer.
c. Review of OPMC (ED022) EMTALA transfer - to establish guidelines for providing an appropriate transfer and acceptance of an individual with an EMC. A transfer due to medical necessary because OPMC lacks the service. A physician must sign a written certification which is specific to the condition, indicates the reason for the transfer, and must summarize the benefits and risks. The individual must sign the consent. OPMC must call the receiving hospital to verify the hospital has the available space, and must agree to accept the individual in transfer. OPMC must document its communication with the receiving hospital including the request date, and time and name of person accepting the transfer. OPMC must send to the receiving hospital copies of all medical records related to the EMC.
d. Review of OPMC Rules and Regulations Rules and Regulations 5/25/09 revealed an appropriate medical screening examination shall be provided to any individual who comes on the property , be performed by a qualified medical personnel physician or allied health professional supervised by a physician.
2. Medical record review revealed Patient #18, and was 37 weeks pregnant, presented to OPMC emergency department on 1/20/10 at 7:20pm complaining of stroke like symptoms, (numbness to hands and right arm, side of face, tongue, had blurred vision and slurred speech). Patient #18 was triaged and sent to the obstetrical unit and was assessed by a staff nurse. The nurse consulted by phone with the on-call obstetrician who instructed the nurse to discharge the patient with instructions for the patient to go to another acute care hospital for further evaluation, as there was no neurologist available at OPMC. There was no screening examination done by a physician, to determine if the patient needed further care, and if so, there was no oral or written communication between the two hospitals, nor were any transfer consents completed or signed, and there was no certification signed by a physician.
3. Interview with the Risk Manager on 2/9/10 at 9am revealed Patient #18 did not have a screening examination done, nor was an appropriate transfer completed. This was also confirmed by the Director of Nurses and the Unit Manager of the Obstetrical Unit.

Based on medical record review, facility provided information and staff interviews the facility failed to ensure that one of thirty sampled patients, (#18) who presented to the emergency department received an appropriate medical screening examination. Patient #18 who was 37 weeks pregnant presented to OPMC emergency department on 1/20/10 with stroke like symptoms, (numbness to hands and right arm, side of face, tongue, had blurred vision and slurred speech) and did not receive a medical screening examination to determine if an emergency medical condition existed.
The findings include:
1. Medical record review revealed Patient #18, who was 37 weeks pregnant arrived at OPMC on 1/20/10 at 7:20pm complaining of stroke like symptoms including numbness of the face, hands and slurred speech. Patient #18 was triaged and sent to the obstetrical unit where a staff nurse assessed her. The staff nurse consulted with the on-call obstetrician by telephone and was instructed to discharge the patient with instructions for the patient to go to SVMC for further evaluation as OPMC did not have a neurologist. Although OPMC has a dedicated emergency department, the staff nurse did not send the patient there to have a medical screening examination by a physician prior to discharge, or to be transferred if necessary. Patient #18 was discharged without having had a medical screening examination for her stroke like symptoms.
2. Interview with the administrative personnel (Risk Manager, Director of Nursing, and Obstetrical Nurse Manager) at OPMC on 2/12/10 all confirmed that Patient #18 did not receive a medical screening examination before being told to go to another acute care facility for further evaluation.
3. Review of OPMC Policy & Procedure for Medical Screening revealed all individuals presenting to OPMC requesting care will receive a medical screening examination to determine if an emergency medical condition exists.

Based on medical record review, staff interviews and facility provided information the facility failed to ensure that one of 6 sampled patients (#18) was transferred to another acute care hospital appropriately. Patient #18 who was 37 weeks pregnant presented to OPMC on 1/20/10 at 7:20pm complaining of stroke like symptoms including numbness of the face and hands and had experienced slurred speech. Patient #18 was taken to the obstetrical unit, assessed by a staff nurse who called the on-call obstetrician, who instructed the nurse to send the patient to another acute care facility for further evaluation. The staff nurse did not send the patient back to the dedicated emergency department to be seen by the emergency room physician in order to determine if the patient needed to be transferred.
The Findings include:
1. Medical record review revealed Patient #18 was 37 weeks pregnant when she presented to OPMC on 1/20/10 at 7:20pm complaining of stroke like symptoms including numbness of the hands, face and slurred speech. Patient #18 was triaged to the obstetrical unit and assessed obstetrically by a staff nurse who after the assessment consulted by telephone with the on-call obstetrician. The obstetrician instructed the staff nurse to discharge Patient #18 and instruct her to go to another acute care facility for further evaluation. There was no oral communication or written communication between OPMC and the other acute care facility regarding the patient presenting to another acute care facility for further evaluation, by the staff nurse on the obstetrical unit. The staff nurse also did not take the patient to the dedicated emergency department to be examined by a physician to determine the need for further evaluation at another acute care facility. The patient was discharged from the obstetrical unit without having an appropriate medical screening examination, and no medical information was sent with the patient after being assessed on the obstetrical unit.
2. Interview with the administrative personnel of OPMC on 1/20/10 including the Risk Manager, Director of Nurses and the Obstetrical Nurse Manager revealed there was no communication done between the two hospitals including obtaining an accepting physician, no consent for transfer and/or other paperwork.
3. Review of OPMC POLICY and Procedures revealed all persons presenting to the hospital and requesting care will receive a medical screening examination. When necessary, patients will be transferred after consent is obtained from the patient, risks and benefits of the transfer are explained to the patient, a certification of the transfer is signed by the attending physician and there is an accepting facility and physician.