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Based on review of facility documents, review of facility policy, and staff interviews (EMP), it was determined that the facility failed to maintain a central log on each individual who comes to the emergency department, as defined in ?489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged for one of one patients (PT1).

Findings include:

Review of facility policy "Emergency Medical Treatment & Active Labor Act (EMTALA) Date: June 15, 2009" revealed "Purpose: To ensure compliance with the Emergency Medical Treatment and Active Labor Act ('EMTALA') Policy: Any individual who comes to the Hospital Property or Premises requesting examination or treatment and appears to be suffering from an Emergency Medical Condition or expresses a complaint which could reasonably be construed as an Emergency Medical Condition, or who comes to the Dedicated Emergency Department requesting examination or treatment of a medical condition is entitles to and shall be provided an appropriate Medical Screening Examination to determine whether or not an Emergency Medical Condition exists, stabilization to the extent the facility is able to do so, and an Appropriate Transfer if necessary. Procedure: I. Definitions ... Central Log is a log that a Hospital is required to maintain on each individual who comes to its emergency room or any location on the Hospital Property or Premises seeking emergency assistance and the disposition of each individual, whether he or she refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged. The purpose of the central log is to track the care provided to each individual who comes to the Hospital Property or Premises seeking care for an Emergency Medical Condition. The Hospital has the discretion to maintain the central log in a form that best meets the needs of its patients ... Hospital Property or Premises means (i) the Hospital; (ii) the physical area immediately adjacent to the Hospital including the parking lot, sidewalk, and driveway;"

Review of "Emergency Department Log-Control Register ... Revised: 2/10" revealed "Purpose: To document registration information of those seeking care in the Emergency Services Department. I. The control register includes the following information for every individual seeking care: a. Name b. Age c. Sex d. Date/time of registration e. Nature of complaint f. Disposition ..."

1) Interview with EMP1 on November 29, 2010, at approximately 9:20 AM revealed "We self reported [a suspected EMTALA violation] ... A pregnant patient [PT1] presented to the parking area ... Our employee stated we no longer do OB [obstetric services] ... 911 was called and the patient was transferred to another hospital."

2) Review of a City of Pittsburgh "EMS" form revealed "11/19/2010 15:15:00 ... Chief Complaint: Pregnancy problems ... City of Pittsburgh EMS, Medic 4 was dispatched at 15:15 on Nov 19, 2010 to the Central Northside neighborhood of the City of Pittsburgh, PA and arrived at scene (a hospital) at 15:23 in response to a medical. ... Patient ... with a chief complaint of Pregnancy problems. ... Pt was standing at the non emergency entrance to AGH [Allegheny General Hospital]. ... Pt stated she has been having contractions for 4 days. Pt stated she talked to her Dr today and [they] said for her to go to the hospital and be evaluated. ... Pt stated that she was confused and did not realize she needed to go to [other hospital] for OB care. Pt requested transport to [other hospital]."

3) Interview with EMP4 on November 29, 2010, at approximately 1:25 PM revealed that PT1 presented to a parking/valet area, on the hospital property, on November 19, 2010. Further interview with EMP4 revealed "The patient came in and asked for labor and delivery ... I said 'wrong hospital' ... The patient said 'I am in labor' ... I said 'Do you want me to take you to the ED' and she said 'no' ... I called 911." During further interview with EMP4, they were asked if they reported this occurrence to anyone in the hospital and they stated "I really did not have time." During additional interview with EMP4, they were asked if they knew what "EMTALA" was and EMP4 stated "Just today."

4) Review of the Emergency Department Log-Control Register for November 19, 2010, revealed no documented evidence that PT1 came to the emergency department, as defined in ?489.24(b), seeking assistance and whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged.

Confirmation via telephone, with EMP2, on November 30, 2010, at approximately 5:58 PM confirmed the above findings and revealed "That patient's name does not appear on our ED log as the ED was not aware of the patient and was told that the patient was already gone from the hospital."

Based on review of facility documents, facility policies, and staff interviews (EMP), it was determined that the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition existed for one of one patients (PT1).

Findings include:

Review of facility policy "Emergency Medical Treatment & Active Labor Act (EMTALA) Date: June 15, 2009" revealed "Purpose: To ensure compliance with the Emergency Medical Treatment and Active Labor Act ('EMTALA') Policy: Any individual who comes to the Hospital Property or Premises requesting examination or treatment and appears to be suffering from an Emergency Medical Condition or expresses a complaint which could reasonably be construed as an Emergency Medical Condition, or who comes to the Dedicated Emergency Department requesting examination or treatment of a medical condition is entitles to and shall be provided an appropriate Medical Screening Examination to determine whether or not an Emergency Medical Condition exists, stabilization to the extent the facility is able to do so, and an Appropriate Transfer if necessary. Procedure: I. Definitions ... Hospital Property or Premises means (i) the Hospital; (ii) the physical area immediately adjacent to the Hospital including the parking lot, sidewalk, and driveway; ... Medical Screening Examination (MSE) is the process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an Emergency Medical Condition exist or a woman is in labor. Such screening must be done within the facility's Capacity and Capability, including on-call physicians. ... II. Medical Screening Examination A. General Requirements. In general, when an individual comes by him or herself or with another person to the Hospital Property or Premises, and appears to be suffering from an Emergency Medical Condition or expresses a complaint which could reasonably be construed as an Emergency Medical Condition, or who comes to the Dedicated Emergency Department requesting examination or treatment of a medical condition, the Hospital or a department thereof must provide for an appropriate Medical Screening Examination with the Capacity and Capability of the Hospital's emergency department or department to which the individual has presented to determine whether or not an Emergency Medical Condition exists, or with respect to a pregnant woman having contractions, whether the woman is in Labor. ... B. When a Medical Screening Examination is Required. 1. If an individual arrives on the Hospital Property or Premises or and off-campus dedicated emergency department and is not technically in the Hospital emergency department, and request emergency care, he or she must receive a Medical Screening Examination within the Capacity and Capabilities of the Hospital. ... 3. Individual Seeking Emergency Services Who in Not at a Dedicated Emergency Department If an individual requests service for what may be an emergency condition at a hospital site on campus and away from a dedicated ED, the hospital must provide a screening and any needed stabilizing treatment."

1) Interview with EMP1 on November 29, 2010, at approximately 9:20 AM revealed "We self reported [a suspected EMTALA violation] ... A pregnant patient [PT1] presented to the parking area ... Our employee stated we no longer do OB [obstetric services] ... 911 was called and the patient was transferred to another hospital."

2) Review of a City of Pittsburgh "EMS" form revealed "11/19/2010 15:15:00 ... Chief Complaint: Pregnancy problems ... City of Pittsburgh EMS, Medic 4 was dispatched at 15:15 on Nov 19, 2010 to the Central Northside neighborhood of the City of Pittsburgh, PA and arrived at scene (a hospital) at 15:23 in response to a medical. ... Patient ... with a chief complaint of Pregnancy problems. ... Pt was standing at the non emergency entrance to AGH [Allegheny General Hospital]. ... Pt stated she has been having contractions for 4 days. Pt stated she talked to her Dr today and [they] said for her to go to the hospital and be evaluated. ... Pt stated that she was confused and did not realize she needed to go to [other hospital] for OB care. Pt requested transport to [other hospital]."

3) Interview with EMP4 on November 29, 2010, at approximately 1:25 PM revealed that PT1 presented to a parking/valet area, on the hospital property, on November 19, 2010. Further interview with EMP4 revealed "The patient came in and asked for labor and delivery ... I said 'wrong hospital' ... The patient said 'I am in labor' ... I said 'Do you want me to take you to the ED' and she said 'no' ... I called 911." During further interview with EMP4, they were asked if they reported this occurrence to anyone in the hospital and they stated "I really did not have time." During additional interview with EMP4, they were asked if they knew what "EMTALA" was and EMP4 stated "Just today."