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Based on tours/observations, staff interviews and review of medical records, policies/procedures and other facility documents, the facility failed to comply with the Medicare provider agreement as defined in ?489.20 and ?489.24 related to EMTALA (Emergency Medical Treatment and Active Labor Act) requirements.

Findings:

1. The facility failed to meet the following requirement under the EMTALA regulations:

Tag A 2407 - Stabilizing Treatment
The facility failed to stabilize 1 of 12 obstetric patients prior to discharge.

Tag A 2409 - Appropriate Transfer
The facility failed to ensure 8 of 10 patients transferred from the facility's labor and delivery department were transferred with appropriate paperwork and documentation of EMTALA specific requirements.

Based on interviews, record review, and policy/procedure review, the facility failed to stabilize 1 of 12 obstetrical (OB) patients prior to discharge (Patient #3).

This failure created the potential for harm to the mother and unborn child.

Findings

POLICY

According to facility policy Emergency Medical Treatment and Active Labor Act (EMTALA) Treatment and Transfer of Individuals with Emergency Medical Conditions, In no event shall provision of emergency services and care be based upon or affected by an individual's insurance status, economic status, or ability to pay for medical services. "Emergency Medical Condition" means: "Labor means the process of childbirth beginning with the latent or early phase and continuing through the delivery of the placenta.

1. The facility discharged Patient #3 while the patient was in labor.

a) On 07/29/14 a review of Patient #3's medical record was conducted. On 07/09/14 at 9:15 p.m., the patient presented to the hospital with complaints of contractions. Registered Nurse (RN) #6 performed a medical screening exam, and it was determined that Patient #3 was having irregular contractions and there had been a spontaneous rupture of membranes via a positive nitrazine test. On 07/09/14 at 10:14 p.m., RN #6 discharged the patient. RN #6 wrote on the discharge instructions for the patient to go directly to contracted hospital.

b) On 07/29/14 at 9:09 a.m., an interview with the RN that cared for the patient was conducted. The RN stated that Patient #3 presented with ruptured membranes. At that time the RN placed the patient on a monitor and the contractions were irregular. The RN stated s/he called the on-call physician and gave him/her the patient's history and physical. The physician told the RN that if there were no changes, to discharge Patient #3 to the hospital where the patient had received care, for continuity of care. The RN also stated that when s/he went to discuss this with the patient, the patient had questions and asked about an ambulance. The RN called the physician back to relay the patient's concerns and the physician instructed the RN to still discharge the patient by private vehicle as delivery was not imminent. The RN stated this was not normal practice and s/he did not advise the patient to go home and would not advise a patient to go home in that situation.

c) On 07/29/14 at 11:36 a.m., during an interview with the physician on call during Patient #3's hospital visit the physician stated s/he was not in the hospital at the time of Patient #3's visit. The physician stated when the RN called him/her, s/he asked the RN who the patient "belonged" to and the RN told him/her what insurance the patient had. The physician stated the RN gave him/her the specifics about the patient and it did not sound like she was in active labor. The physician stated s/he told the RN the patient could walk around for an hour to see if her labor progressed or she could leave. The physician also stated that if it had been his/her patient s/he would have felt it was fine to send her home.

Based on interview, record review and facility policy/procedure review, the facility failed to ensure 10 of 12 Obstetric (OB) patients from the facility's obstetric department were transferred with appropriate documentation of EMTALA specific requirements (Patients #1, #2 #4, #5, #6, #7, #8, #9, #10, #11 and #12).

This failure created the potential for negative outcome.

Findings

POLICY

According to the facility's policy Emergency Medical Treatment and Active Labor Act (EMTALA), Treatment and Transfer of Individuals with Emergency Medical Conditions, the hospital shall send the receiving facility copies of all pertinent medical records available at the time of transfer, including, a copy of the completed applicable sections of the transfer form. The transfer shall be effected through appropriately trained professionals and transportation equipment, including the use of necessary and medically appropriate life support measures during transfer.

1. The facility utilized a two page EMTALA Transfer Form for OB patients and, in review of 12 medical records of patients transferred from the OB department to a higher level of care, 10 of the forms were not completed in entirety and inclusive of critical information.

a) Review of the medical record for Patients #1, #4, #5, #6, #9, #10 and #12 revealed the patients were OB patients transferred emergently to a hospital with a higher level of obstetric/neonatal care. The EMTALA transfer form contained no documentation in the following areas: name of individual who received report at the destination hospital (as well as date/time report called), and the entire portion of transportation section, including transport agency, who accompanied the patient and what life support measures were required.

b) Review of the medical record for Patients #2 and #11 revealed the patients were OB patients transferred emergently to a hospital with a higher level of obstetric/neonatal care. The EMTALA transfer form contained no documentation in the following areas: name of individual who received report at the destination hospital (as well as date/time report called).

c) Review of the medical record for Patient #8 revealed the patient was an OB patient that was transferred emergently to a hospital with a higher level of obstetric/neonatal care. The EMTALA transfer form was without documentation in the following areas: entire portion of transportation section, including transport agency, who accompanied the patient and what life support measures were required.

d) In an interview with the facility's Regulatory Affairs Manager, on 07/29/14 at 2:00 p.m., s/he confirmed the EMTALA transfer form for the 10 medical records reviewed were not complete.