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Based on observations and tours of the ED and Obstetrical unit, and on staff interviews, the facility failed to post signs that specify the rights of patients to an examination and treatment of emergency conditions and for women in labor in accordance with Section 1867.

Findings include:

A tour of the ED walk-in entrance, ambulance area, registration area, waiting rooms and treatment areas at approximately 10:35 AM on February 1, 2011, revealed there were no signs displayed which notify participants of their rights to examination and treatment of emergency medical conditions and which also apply to women in labor. In addition, there were no signs posted in admitting area.

These findings were confirmed by Staff # 2 and Staff # 14 at that time.

During the survey, interviews were conducted with Staff #2. It was revealed maternity patients are sent directly to the labor and delivery unit on the 6th floor. There were no signs displayed on the 6th floor which notify participants of their rights to examination and treatment of emergency medical conditions and which also apply to women in labor.

Based on review of the emergency department central log (ED log), obstetrical unit log and staff interviews, it was determined that the facility did not ensure that it had a central log complete with all the required components as required by this regulation.

Findings include:

During a review of the hospital's ED daily Log and the log maintained on the obstetrical unit for 2/2/11, it was revealed that some maternity patients were not documented in the ED central log.

Based on staff interviews conducted on February 2, 2011 at 12:10 PM, Staff #s 8, 9, and 10 confirmed that patients that are in labor and some maternity patients are sent directly to the labor and delivery unit on the 6th floor by their private physicians. These patients bypass the ED and are logged into the OB log in the obstetric unit. These patients are treated, admitted or released from this unit. They also confirmed that there was no central log that contained the necessary data components that are required of a central log.

Based on a review of medical records and staff interview, it was determined that the facility failed to ensure that transfer requirements were met. 5 of 6 patients that were transferred from the ED were missing informed written consent. These deficiencies were identified in Five of 6 applicable medical records for patients who were transferred from the ED to other facilities. Refer to MR #s 1, 2, 3, 5 and 6.

Findings include:

A review of 6 medical records for patients transferred to other facilities for medical care determined these records were missing transfer consents signed by the patient or designee.

MR #2: On February 2, 2011, a review of the medical record revealed this patient presented to the ED on December 20, 2010. The patient was unresponsive after she had collapsed at the bus stop that day. The patient was intubated and attached to a ventilator. The patient was diagnosed with STEMI and CVA and was listed in critical condition. The patient was transferred to another facility for further care. The record lacked a written consent for the transfer even though the patient's daughter was available to agree to the transfer.

Similar findings were noted in MR #s 1, 3, 5 and 6.

These findings were verified by Staff #12 at that time.