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Based on interview and lack of patient records it was determined the Facility failed to provide a medical screening exam, for one (Patient #28) of one patient that was 36 weeks pregnant and presented to the Emergency Department requesting to see a Physician on 07-22-16. Failure to provide and document a medical screening exam did not ensure Patient #28 was stable and did not have an emergency medical condition. Findings follow:

A. Review of the Emergency Room (ER) Log did not reveal Patient #28's name. Review of the written statement authored by Registered Nurse (RN) #4 at 1436 on 07/25/16 revealed the following: "This patient came up to the window stating 36 weeks pregnant, 1 cm (centimeter) dilated and having contractions. I went out to speak with patient and explained that we do not have the capabilities for OB (obstetrics). Patient replied "she wanted to get checked to see if she needs to go to Fayetteville".

B. Review of the written statement authored by Patient Access Clerk #2 at 1111 on 07/26/16 revealed the following: "A woman who was 36 weeks pregnant came to the (ER) window with her mother. The Mother stated "My daughter is 36 weeks pregnant and we think she is having contractions. We would like the Doctor to see her." I said, "Are you aware that we do not have OB here?" The Mother replied, "Yes, we just want to know if she is having contractions or not so we can take her to a bigger hospital." I checked her in and then the Mother added, "We went to her doctor yesterday and she is 1 cm dilated." RN #4 approached me and asked "What is she here for?" I said, "She is 36 weeks pregnant and think(s) she is having contractions. She also went to the doctor yesterday and they told her she was 1 cm dilated." RN #4 replied, "I am going to send her to her OB." I went back to the window to put the identification band on the patient. RN #4 went outside to where they were and asked the patient, "Where is your OB?" The patient replied, "In Fayetteville but we just want to know if having contractions." RN #4 said, "You need to go to Fayetteville to your OB. You are delaying your care. We do not have OB here, you need to go to your OB." The patient and the Mother got up and left. RN #4 came back and asked me if I could take her off the board. I said, "If I take her off I would delete the encounter." She (RN #4) replied, "She wasn't seen."
Patient #28 left the Facility without receiving a medical screening exam.

Review of Section 13 of the Operating Manual of the Medical Staff Bylaws, received from the CNO at 0935 on 08/02/16 revealed the following: 13.1 Screening: 13.1.1 Any individual who presents to the Emergency Department of this Hospital for care shall be provided with a medical screening examination to determine whether that individual is experiencing an emergency medical condition. Generally an "emergency medical condition" is defined as active labor or as a condition manifesting such symptoms that the absence of immediate medical attention is likely to cause serious dysfunction or impairment to bodily organs or function or serious jeopardy to the health of the individual or fetus...

Based on clinical record review and interview, it was determined the Facility failed to fully disclose the risks and benefits of transfer specific to the condition of transferred patients. Failure to fully disclose the risks and benefits did not allow five (Patients #7,
#9, #11, #12 and #16) of five (Patients #7, #9, #11, #12 and #16) transferred patients to make an informed decision regarding the need for the transfer along with associated risks and benefits particular to the patient's medical condition. The failed practice was likely to affect Patients #7, #9, #11, #12 and #16. Findings follow:

A. Review of the clinical records of Patients #7, #9, #11, #12 and #16 revealed no documentation of the risks and benefits specific to the condition for which the patient was being transferred for.

B. The above findings were verified by the Emergency Room Nurse Manager at 1220 on 08/02/16.