HospitalInspections.org

Based on interviews the facility failed to maintain a log of all individuals who presented to the emergency room requesting examination or treatment for a medical condition. The facility only logged patients admitted to the emergency room.

A review the facility's log revealed all individuals presenting to the emergency room requesting examination or treatment for medical condition were not logged.

A phone interview was conducted on 08/01/2012 at 2:15 PM with patient #1 confirms she was present in the Emergency Room (ER) and did not receive a medical screening. The interview revealed, "My husband took me to Facility A's emergency room. I was having contractions 5 minutes apart. When we got to the ER, I nearly went to my knees the contraction was so strong. I was registering in the ER when the Dr. and Nurse came out and told me they were not refusing to care for me but... they told me they didn't have Obstetrical (OB) services there and didn't have an OB Doctor. They said they didn't know how soon they could get an ambulance because they didn't know where they were stationed in the area. They told me and my husband the best thing for me was to go to Facility C because they had OB services. They didn't even help get me back to the truck. We broke down on the side of the road and had to call 911. The ambulance picked me up on the side of the road and took me to Facility B."

A review of Emergency Medical Systems (EMS) Patient Care Report revealed, "Patient picked up: US Highway 79E. Patient found: in vehicle. Pt. presented to EMS stating that she thought she was in labor. Pt. was having contractions lasting 30 sec - 1 min. they were happening about every 5 min. Pt. stated that she felt like she needed to have a bowel movement. Pt. was also having some bloody discharge. Pt. stated that the contractions had started yesterday evening. Pt. was assisted to the cot and into the truck. Pt. stated that she went to Facility A and they advised her that they couldn't do anything and she needed to just go to Facility C. Pt. stated that she had multiple contractions during the trip from Facility A to the point where EMS picked her up. Upon initial transport Facility C was contacted and the Labor and Delivery (L&D) transferred EMS to Pt's doctor. Pt's doctor told EMS to go to Facility B and she would advise the on call doctor that she was coming. Pt. continued to have multiple contractions in route and all thru transport. Pt. was transported directly to Facility B, L&D."

Review of the Operative Report dated 07/25/2012 for patient #1 from Facility B revealed, "CLINICAL DECISION-MAKING: This patient is a 28-year-old gravida 1 (first pregnancy) who arrived complaining of uterine contractions, by ambulance. The patient had received prenatal care in Facility C. She went to the emergency room in Facility A and was told to go by private vehicle to Facility C. Her car broke down on the way to Facility C and then got in an ambulance heading toward Facility C that then went to Facility B, per the husband. When she arrived she was 7 cm with a bulging bag of waters, baby was breech by ultrasound with stable fetal heart tones. Therefore she was taken back for a stat caesarean section."

A review of the document titled, "History and Physical" from Facility B, dated 07/25/2012 and timed 6:16 AM revealed, "HISTORY: Baby Boy is a 24-week, extremely premature infant delivered by a 28-year-old, primigravida (first pregnancy) mom. She was admitted this morning in advanced labor with abruption. The baby was delivered by caesarian section due to breech presentation. APGAR (assessment of a newborn immediately after birth) scores were 7 at one minute and 8 at five minutes. He was intubated (insertion of a breathing tube) in the delivery room and received dose of prophylactic Surfactant." The medical chart further revealed at approximately 4:27 PM on 07/31/2012 the baby was pronounced dead.

An interview with staff #4 from Facility A on 08/02/2012 at 10:30 AM in the Emergency Room (ER) confirmed the facility did not maintain a log for all individuals who presented to the emergency room requesting examination or treatment for a medical condition. Staff #4 revealed the facility only maintained the electronic log with the individuals who were admitted to the Emergency Room (ER).

An interview was held with staff #16 from Facility A, on 08/03/2012 at 09:10 AM in the office across from the Administrative Conference Room with staff #3 present as witness. Staff #16 confirmed the facility did not maintain a log for all individuals who presented to the emergency room requesting examination or treatment for a medical condition. Staff #16 confirmed the facility only maintained an electronic log of the individuals who were admitted to the Emergency Room (ER).

An interview was held with staff #1 from Facility A on 08/03/2012 at 10:10 AM in the Administrative Conference Room confirmed the facility did not maintain a log of all individuals who presented to the emergency room requesting examination or treatment for a medical condition. Staff #1 confirmed the facility only maintained an electronic log of the individuals who were admitted to the Emergency Room (ER).

Based on document reviews and interview, Facility A failed to provide a medical screening to 1 of 1 patients presenting in the emergency room that was twenty four weeks pregnant with a complaint of contractions for two days.

A phone interview was conducted on 08/01/2012 at 2:15 PM with patient #1 from Facility A confirms she was present in the Emergency Room (ER) and did not receive a medical screening. The interview revealed, "My husband took me to Facility A's ER. I was having contractions 5 minutes apart. When we got to the ER, I nearly went to my knees, the contraction was so strong. I was registering in the ER when the Dr. and Nurse came out and told me they were not refusing to care for me but... they told me they didn't have Obstetrical (OB) services there and didn't have an OB Doctor. They said they didn't know how soon they could get an ambulance because they did not know where they were stationed in the area. They told me and my husband the best thing for me was to go to Facility C because they had OB services. They didn't even help get me back to the truck. We broke down on the side of the road and had to call 911. The ambulance picked me up on the side of the road and took me to Facility B."

A review of Emergency Medical Systems (EMS) Patient Care Report revealed, "Patient picked up: US Highway 79E. Patient found: in vehicle. Pt. presented to EMS stating that she thought she was in labor. Pt. was having contractions lasting 30 sec-1 min. They were happening about every 5 min. Pt. stated that she felt like she needed to have a bowel movement. Pt. was also having some bloody discharge. Pt. stated that the contractions had started yesterday evening. Pt. was assisted to the cot and into the truck. Pt. stated that she went to Facility A and they advised her that they couldn't do anything and she needed to just go to Facility C. Pt. stated that she had multiple contractions during the trip from Facility A to the point where EMS picked her up. Upon initial transport Facility C was contacted and the Labor and Delivery (L&D) transferred EMS to Pt's doctor. Pt's doctor told EMS to go to Facility B and she would advise the on call doctor that she was coming. Pt. continued to have multiple contractions in route and all thru transport. Pt. was transported directly to Facility B's L&D."

Review of the Operative Report dated 07/25/2012 for patient #1 from Facility B revealed, "CLINICAL DECISION-MAKING: This patient is a 28-year-old gravida 1 (first pregnancy) who arrived complaining of uterine contractions, by ambulance. The patient had received prenatal care in Facility C. She went to the emergency room in Facility A and was told to go by private vehicle to Facility C. Her car broke down on the way to Facility C and then got in an ambulance heading toward Facility C that then went to Facility B, per the husband. When she arrived she was 7 cm with a bulging bag of waters, baby was breech by ultrasound with stable fetal heart tones. Therefore she was taken back for a stat caesarean section."

A review of the document titled, "History and Physical" form Facility B, dated 07/25/2012 and timed 6:16 AM revealed, "HISTORY: Baby Boy is a 24-week, extremely premature infant delivered by a 28-year-old, primigravida (first pregnancy) mom. She was admitted this morning in advanced labor with abruption. The baby was delivered by caesarian section due to breech presentation. APGAR (assessment of a newborn immediately after birth) scores were 7 at one minute and 8 at five minutes. He was intubated (insertion of a breathing tube) in the delivery room and received dose of prophylactic Surfactant." The medical chart further revealed at approximately 4:27 PM on 07/31/2012 the baby was pronounced dead.

An interview was held with staff #16 at Facility A on 08/03/2012 at 9:10 AM in the office across from the Administrative Conference Room with staff #3 present as a witness. Staff #16 was asked if she had knowledge of or had been made aware of a 24 week pregnant woman presenting to the ER on 07/25/2012 in active labor and asked ER staff for assistance. Staff #16 stated "no". Staff #16 recanted and said she was made aware of the incident this morning by ER staff. Staff #16 was asked if she had any knowledge of a similar type of OB incident happening in the past. Staff #16 stated "no".

At approximately 9:30 in the hallway, staff #3 reported that staff #16 had called to make a correction in her statement. The correction was that staff #16 had not been made aware of the incident this morning (08/03/2012) but had been made aware of the incident last night when a night nurse called and informed her (staff #16).

The review of an email dated 07/27/2012 and authored by staff #16 was sent to staff #14 and all ER staff confirmed that staff #16 had knowledge of patient #1 being present in the ER. The email revealed, "You cannot tell an OB we don't have OB services. The patient must be brought back and assessed and seen by the ER doctor. We do have OB services in that we have a physician and a nurse. If an OB patient is told we have no OB services and leaves to go somewhere else and delivers en route or is in a car wreck you and the hospital are legally and morally responsible for the Mother and the baby. I was told by a family member on Wednesday that we told a pregnant patient we do not have OB services and to go somewhere else. The patient headed to Facility C but her car broke down on the way. They called EMS. The baby was 3 months early and weighed barely over one pound. Whoever told her we don't have OB services could be in big trouble if the patient and her family pursue it ...even if all turns out well. That very scenario is why we have the EMTALA law and this was an EMTALA violation. Since this is at least the second time this has happened, you are going to force me to give a verbal warning the next time it happens and then I will write you up the second and then we shall see."

An interview was held with staff #8 from Facility A on 08/02/2012 at approximately 7:45 PM in the ER Supervisor's office confirmed patient #1 had presented to the ER on 07/25/2012 at approximately 3:45 AM requesting to be evaluated. Staff #8 revealed, the ER clerk called the nurses' station and reported a lady at the registration desk who states she is in labor. Staff #8 told staff #9 to notify MD #11. Staff #8 went to the registration desk to check the situation. Staff #8 revealed, he arrived at the desk and found a lady that stated she was about 24 weeks pregnant and had been having abdominal pain for two days and wanted to be checked out. The lady thought she was in labor. Staff #8 stated that staff #9 was present at the registration desk at this time and both staff members spoke with the lady and her husband. Staff #8 and staff #9 informed the lady that Facility A did not have OB services and did not have an OB physician on staff. They revealed to the lady they were not refusing to see her but she should go to a facility that provides OB services and where her OB Doctor was located. Staff #8 revealed the patient and her husband left the facility at 3:59 AM exactly, "I remember looking at my watch." Staff #8 was asked if the patient was offered a medical screening. Staff #8 stated "no". Staff #8 was asked if he had any knowledge of what happened to the patient once she left the facility. Staff #8 stated "yes". Staff #16 had called staff #8 into the office on 07/27/2012 and revealed the patient's car broke down leaving the patient stranded on the side of the road. The patient was picked up by EMS.

An interview was held with staff #9 from Facility A on 08/02/2012 at approximately 8:00 PM in the ER Supervisor's office. The interview confirmed, patient #1 had presented to the ER on 07/25/2012 at approximately 3:45 AM requesting to be evaluated. Staff #9 revealed the ER clerk called the nurses' station and reported a lady was at the registration desk and patient #1 thinks she is labor. Staff #9 was asked if the MD #11 was notified of the individual. Staff #9 reported "I can't remember if he was notified or not". Staff #9 revealed, "staff #8 and I went to the registration desk to evaluate the situation." Staff #9 confirmed on arrival to the desk a lady was present who stated she was about 24 weeks pregnant and had been having abdominal pain for two days and wanted to be checked out. Staff #9 confirmed, the lady (patient #1) was told that Facility A did not have OB services and did not have an OB physician on staff. Staff #9 confirmed the lady was told she (patient #1) was not being refused services but she (patient #1) should go to a facility that provides OB services and where your OB Doctor is located. Staff #9 revealed that patient #1 and her husband left the facility. Staff #9 was asked if the patient was offered a medical screening. Staff #9 stated "no".

A follow up interview was done in the office across from the Administrative Conference Room in Facility A on 08/03/2012 at approximately 7:00 AM with both staff #8 and staff #9 present. The question was posed to both staff members "Was MD #11 notified of the individual, patient #1, presenting at the registration desk and requesting to be checked because she thought she was in labor?" Staff #8 stated "yes". Staff #9 revealed, after speaking with staff #8 last night, it was brought to my attention I had notified the physician. Staff #9 was asked to give the details of the conversation. Staff #9 revealed, the details of the conversation could not be remembered.

An interview with MD #11 from Facility A on 08/02/2012 at approximately 8:00 PM in the ER Supervisor's office reported he did not recall being notified of patient #1 being present in the ER.