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Based on record review and interview, the hospital failed to ensure compliance with 489.24 (a) Medical Screening Exam, in that 1 of 1 patient (Patient #1) came to the emergency department on 1/15/2017 and was not provided a medical screening examination and was not documented on the central log.

Cross refer to A2405 and A2406

Based on record review and interview, the facility failed to include on the emergency room log the information of Patient #1 who was pregnant and came to the emergency department seeking treatment.

Findings included:

On 1/15/2017 at approximately 11:00 PM, Patient #1's husband came into the emergency department and stated that his wife's water had broken and she was in labor. He inquired about their status as a hospital and if they had a labor and delivery department. The hospital staff failed to provide triage or medical screening examination for this patient. The patient was not listed on the emergency room log.

On 1/31/2017 at approximately 2:30 PM, Personnel #1 was asked if Patient #1 was listed on the emergency room log. Personnel #1 answered, "No."

Based on record review, tour and interview, the facility failed to perform a medical screening exam on 1 of 1 patient (Patient #1), in that, Patient #1's husband entered the emergency department and stated his wife was in labor and her water had broken. He stated they needed a hospital and a labor and delivery department. Personnel #4 advised the husband that they were not a hospital and that they did not have a labor and delivery department.

Findings include:

There was not a medical record for Patient #1 who came to the emergency department as she was in labor and her water had broken. No medical record was documented.

A telephone interview was conducted with Personnel #4 on the afternoon of 1/31/2017. Personnel #4 stated that the husband came into the emergency department and stated that his wife was in labor and her water had broken. Personnel #4 stated they were not a hospital and did not have a Labor and Delivery. Personnel #4 stated that she told the husband they could have their baby in the emergency department ..."but it would not be the best experience." The husband hurried from the emergency department back to his car that was parked at the front entrance to the emergency department and drove to Hospital B.

Hospital B was 8.2 miles away from the free standing emergency center. When Patient #1 arrived at Hospital B, the husband ran in and told the staff that his wife was in labor. A doctor and licensed nurse went out to the car in the parking lot to attend to Patient #1. Patient #1 was in the back seat of the vehicle and was in the process of delivery of the baby. The staff assisted with the delivery in the vehicle and quickly brought Patient #1 and infant into the hospital where they were evaluated, treated and admitted. Both Patient #1 and infant had a normal post-natal course and were discharged in stable condition.

Policy: Medical Screening Examinations and Patient Transfers Effective Date: 08/23/2016 states: " ...Any person who comes to Hospital Emergency Department (ED) and request an examination or treatment for a medical condition shall receive an appropriate Medical Screening Examination by a physician or other Qualified Medical Person as defined in Section 5.0 within the Capability of the ED, including ancillary services routinely available to the ED to determine whether or not the person has an Emergency Medical Condition.

Any woman who comes to the Labor and Delivery Department and requests an examination or treatment for her pregnancy shall receive an appropriate Medical Screening Examination by a physician on the medical staff or other Qualified Medical Personnel, including ancillary services.

Persons present on the hospital campus (but outside the ED or Labor and Delivery) If any person who arrives on the hospital campus (as defined in Section 5.0 below), and the person, or someone on his behalf, asks for an exam or treatment for what may be or appears to be an Emergency Medical Condition (as defined in Section 5.0). Hospital's medical emergency response team will be called. The medical emergency response team will stabilize the person within its Capability and transport the person to the ED for an appropriate Medical Screening Examination in accordance with this policy."

The free standing ED had not delivered any babies at their facility, however while on tour of the facility, we were shown the OB/GYN room that had an OB tray and an isolette for the baby. When questioned about having a birth at the center, Personnel #2 stated that in any other patient with an emergency medical condition, they would stabilize and transfer the patient and if it was a delivery that was impending, they would deliver the baby and as soon as stabilized they would transfer to the appropriate facility.