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Based on staff interviews with staff, review of video footage, Policy and Procedure reviews, and Educational training revew, it was determined the facility failed to ensure that when an individual "Comes to the emergency department", the hospital must provide an appropriate medical screening examination within the capability of the hospital's emergency department (ED), including ancillary services routinely available to the ED, to determine whether or not an emergency medical condition existed for 1 (#1) of 21 sampled patients who was informed by a hospital staff that she could not be evaluated because she had a minor child with her. As this resulted in patient #1 not receiving an MSE (medical screening examination) on her initial visit to the hospital's ED.

Findings:

Patient #1's medical record noted the patient came into the Obstetrics Emergency Department (OB/ED) around 7:30 AM on 8/08/2022 with a chief complaint of "high blood pressure". The patient had a minor child with her at the time.

On 8/29/2022 at 1:30 PM, the security guard, who was on duty on 8/08/2022, said he explained to patient #1 that she couldn't take the child into the triage area with her and needed to call someone to come get the child. The security guard stated he never told patient she couldn't be seen. However, when she was told she couldn't take the minor child back to the triage area with her, she turned around and left the hospital.

Patient #1's medical record noted that she returned to the OB/ED the next day, 8/09/2022 around 9 PM with a chief complaint of decreased fetal movement. While being examined, she told nursing staff she was at the OB/ED on the previous day, 8/08/2022 and said the security guard told her she could not be evaluated because she had a minor child with her, so she left the hospital.

On 8/31/2022 at 9:10 AM, the System Director of Risk Management stated that Hospital Risk Management initiated an investigation and then self-reported the EMTALA because the security guard did not follow protocol with patient #1, who left the OB/ED area on 8/08/2022 and returned the next day, 8/09/2022. The System Director of Risk Management stated EMTALA was confirmed because the patient presented on 8/08/2022 and was not provided an appropriate medical screening examination with in the hospital's emergency department capability.

The hospital failed to provide patient #1 a medical screening examination on 8/08/2022.

Based upon CMS's review, EMTALA is being cited at:
42 CFR 489.24 EMTALA Requirements
42 CFR 489.24(a) and 489.24(c) Medical Screening Exam
Refer to findings at TAG 2406 - 489.24(c) Medical Screening Exam

Based on interviews with staff, review of video, medical record reviews, and Policy and Procedure reviews, it was determined the facility failed to maintain an accurate central log on each individual who comes to the emergency department seeking assistance for 1 of 20 sampled patients (#1).

Findings:

Policy and Procedure Review

The Facility's Policy titled "Outpatient Evaluation and Discharge" Effective 3/01/2007 and last revised 10/01/21, Policy # CP 16.01.37 PRO (DS) was reviewed. The Policy and Procedure revealed in part, " All pregnant patients presenting to labor and delivery will be logged in log book."


Medical Record Review

Patient #1's medical record noted the patient arrived at the Obstetrics Emergency Department (OB/ED) around 7:30 AM on 8/08/2022 with a chief complaint of "high blood pressure". The patient had a minor child with her at the time.

Patient #1 medical record noted she returned to the OB/ED the next day, 8/09/2022 around 9 PM with a chief complaint of decreased fetal movement. While being examined, patient #1 told nursing staff she presented to the OB/ED on the previous day, 8/08/2022 and said the security guard told her she could not be evaluated because she had a minor child with her, so she left.


Interviews

On 08/29/2022 at 1:30 PM, the security guard on duty at that time, said he informed patient #1 that she couldn't' take the child into the triage area with her and needed to call someone to come get the child. The security guard said never told patient she couldn't be seen. However, when she was told she couldn't take the minor child back with her, she turned around and left the hospital.

08/31/2022 at 9:10 AM, the System Director of Risk Management stated that OB/ED staff reported the incident to the Risk Manager on call on 08/09/2022; the hospital initiated an investigation, and then self-reported the EMTALA because the security guard did not follow protocol with a patient who left the OB/ED area without being seen and came back the next day. The System Director of Risk Management stated that upon doing an ultrasound and monitoring for fetal heart tones when the patient returned to the hospital the next day, 08/09/2022, staff noted the baby had no cardiac activity. Patient #1 was admitted and delivery by induction occurred on 08/12/2022 for a non-viable baby.


Video Review

Review of video footage (no audio) on 8/31/2022 at 11:25 AM of the 8/08/2022 incident on 8/31/2022 verified patient #1 presenting to the desk where the security guard was seated. A conversation between the security guard and patient #1 ensued and showed patient #1 leaving without the security guard attempting to deter patient from leaving.


Hospital Central Log

On 8/29/2022 at 1:15 PM, review of the hospital's central log did not have an entry of patient #1's name when the patient presented to the OB/ED for treatment 8/08/2022. The facility failed to ensure that their policy and procedure was followed as evidenced by failing to enter patient #1 on the ED log when she presented to the ED 8/08/2022 seeking medical assistance.

Based on interviews with staff, review of video footage, Policy and Procedure reviews and Educational training review, it was determined the facility failed to ensure that when an individual "Comes to the emergency department", the hospital must provide an appropriate medical screening examination within the capability of the hospital's emergency department (ED) including ancillary services routinely available to the ED, to determine whether or not an emergency medical condition existed for 1 (#1) of 21 sampled patients who was informed by a hospital staff that she could not be evaluated because she had a minor child with her. This resulted in patient #1 not receiving a medical screening examination (MSE) on her initial visit to the hospital's ED.

Findings:

Policy and Procedure Reviews

The facility's policy and procedure titled, "Emergency Department Patient Care Policy" Effective 9/01/2006, last revised 6/8/2022. Policy # 20.2, POL (DS) was reviewed. The policy revealed in part, "Provisions . . . C. Every patient that presents to the Emergency Department must have a medical screening examination performed by an ED physician/licensed independent provider (LIP)."

The facility's policy and procedure titled, "Outpatient Evaluation and Discharge" Emergency Department Patient Care Policy" effective 3/01/2007, last revised 10/01/2021, Policy # CP 16 16.01.37 PRO (DS) was reviewed. The policy specified in part, "DEFINITIONS:
EMTALA: Emergency Medical Treatment and Active Labor ACT. It is a component of Consolidated Board Reconciliation Act (COBRA). Its purpose is to ensure that patients receive emergency or active labor care when they seek it.
MSE: Medical Screening Examination is the process required to reach within reasonable clinical confidence a determination whether an obstetrical medical emergency does or does not exist.
EMC: An Emergency Medical Condition manifesting itself by acute symptoms of sufficient severity (including) severe pain such that the absence of immediate medical attention can reasonably be expected to result in placing health of the patient (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.

Medical Record Review

Patient #1's medical record noted the patient came into the Obstetrics Emergency Department (OB/ED) around 7:30 AM on 8/08/2022 with a chief complaint of "high blood pressure". The patient had a minor child with her at the time.

Patient #1's medical record noted that she returned to the OB/ED the next day, 8/09/2022 around 9 PM with a chief complaint of decreased fetal movement. While being examined, she told nursing staff she was at the OB/ED on the previous day, 8/08/2022 and said the security guard told her she could not be evaluated because she had a minor child with her, so she left.


Video

On 8/31/2022 at 11:25 AM, review of video footage (no audio) was conducted for the 8/08/2022 incident. It verified that patient #1 presented to the desk where the security guard was and a conversation between the two commenced. Patient #1 then left the area without the security guard attempting to deter the patient from leaving.


Interviews

On 8/29/2022 at 1:30 PM, the security guard on duty on 8/08/2022, said he explained to the patient #1 that she couldn't take the child into the triage area with her and needed to call someone to come get the child. The security guard stated he never told patient she couldn't be seen. However, when she was told she couldn't take the minor child back to the triage area with her, she turned around and left the hospital. A review of the hospital's 8/11/2022 "Patient Care and Scope of Work Orientation" education sheet, read that "Security Officers are to: NEVER refuse, deny, or delay patient care in any way . . . Security Officers are never to refuse entry to patients accompanied by minor children . . ."

On 8/31/2022 at 9:10 AM, the System Director of Risk Management stated that OB/ED staff reported the incident to the Risk Manager on-call on 8/09/2022. Hospital Risk Management initiated an investigation and then self-reported the EMTALA because the security guard did not follow protocol with patient #1, who left the OB/ED area and returned the next day. The System Director of Risk Management stated that upon doing an ultrasound and monitoring for fetal heart tones when patient came back to hospital next day, 8/09/2022, staff noted the baby did not have any no cardiac activity; the patient was admitted and delivery by induction occurred on 8/12/2022 for a non-viable baby. The System Director of Risk Management stated EMTALA was confirmed because the patient presented on 8/08/2022 and was not provided an appropriate medical screening examination within the hospital's emergency department capability.

The facility failed to ensure that their policy and procedure was followed as evidenced by failing to ensure that Patient #1 received an appropriate medical screening examination on her initial visit to the ED on 8/8/2022. As this failure placed patient #1, a pregnant women's health and her unborn child in serious jeopardy.