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Based on interview and record review, the facility failed to provide stabilizing treatment within its capability and capacity to a patient in active labor. Specifically, an obstetrician was present on the Labor and Delivery (L&D) unit and the L&D unit was staffed at the time the patient was transferred.
Findings:
Medical record review determined that on 11/20/12 at 6:38 am, a 16 year old pregnant patient presented to the Bon Secours Community Hospital (BSCH) Emergency Department (ED) with complaints of back and stomach pains coming approximately five minutes apart. The patient denied rupture of membranes. The patient was evaluated for labor by the L&D RN at 6:50 am. The on-call obstetrician examined the patient at 7:20 am. The obstetrician determined that the patient was in active labor. The 8:00 am physician progress note documented that this was the patient's first pregnancy; she was 39 4/7 weeks pregnant with uterine contractions every 5 minutes. Documentation noted the plan to provide IV hydration, ampicillin (group B strep positive); and transfer the patient to another hospital for delivery. A physician at the other hospital was contacted and informed of the transfer. At 8:20 the obstetrician re-evaluated the patient and documented that the patient's vital signs were stable, pelvic exam was unchanged, she was comfortable and ambulance personnel (Emergency Medical Technicians) were ready for the transfer. Nursing documented the patient was off the floor at 8:32 am and report was provided by the BSCH L&D RN to the L&D RN at the other hospital at 8:55 am.
During interview of the obstetrician on 11/26/12 at 2:00 pm, she stated that her practice was to transfer any pregnant patient in active labor, and not at risk for imminent delivery, to another facility.

Based on interview and record review, the facility transferred a patient in active labor without certifying the medical necessity or the patient's informed consent for the transfer. Specifically, the obstetrician failed to document the medical necessity for the patient's transfer and failed to obtain the patient's informed consent for the transfer.
Findings:
Review of the patient's medical record revealed that there was no documentation of the obstetrician's evaluation of the medical necessity, risks, benefits and alternatives to transferring the patient to another facility. There was also no documentation of the obstetrician's communication of this information to the patient, or that the patient provided informed consent for the transfer.
The obstetrician who provided care to the patient was interviewed on 11/26/12 at 2:00 pm. The physician stated that she informed the patient and her father that all patients in labor were being transferred to another hospital. The obstetrician did not discuss with the patient, or document, the medical necessity, risks, benefits and alternatives to transferring the patient to another facility. The obstetrician confirmed that she did not obtain the patient's consent for transfer.