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Based on review of Delaware County Memorial Hospital policy, Mercy Fitzgerald Emergency Department record (MR24), Delaware County Memorial Hospital medical record (MR) and interviews with staff (EMP), it was determined that the provider failed to ensure that the Emergency Medical Treatment and Labor Act (EMTALA) policies that the facility adopted were followed by staff.

Findings include:

A review on December 10, 2014, of the Delaware County Memorial Hospital policy entitled "COBRA/EMTALA Policy Statement," last revised June 2013, revealed, " ... II. Definitions: ... Medical Screening Exams (MSEs) are performed by physicians and/or qualified medical personnel in conjunction with the attending physician as defined by the Board of Directors. Labor and Delivery patients must have a Medical Screening Exam performed by a physician or a nurse certified by AWONN in conjunction with the attending physician. ... III. POLICY: The hospital will provide a medical screening examination to any person presenting for treatment to determine whether an emergency medical condition exists. A medical screening exam is provided to any individual who presents-regardless of diagnosis, financial status, race, color, national origin, or handicap. ... IV. POLICY A. Medical Screening Examinations and treatment for emergency medical conditions may be provided in departments outside the Emergency Department, e.g. Labor and Delivery. 1. Hospital - Inpatient Facility ... An allied health care provider shall include a physician assistant, nurse midwife, nurse practitioner, or AWHON certified labor and delivery nurse. ..."

1) A review of MR24 on December 11, 2014, revealed, " ... HPI Abdominal Pain ... History of Present Illness: 24F with no PMH, G1 at 42 weeks presents for lower abd cramping since last night, and intermittent headache, visual changes, dizziness, and SOB since this morning. ... Patient attempted to be seen at DelCo prior to coming here to ED but says she could not be seen and was instructed to call Dr. (name redacted) office to establish prenatal care. ... "

An interview conducted on December 10, 2014, at 10:30AM with EMP9 confirmed that MR24 was not entered in the Delaware County Memorial Hospital Emergency Department Central Log. Therefore, there was no medical record created for the patient.

An interview conducted on December 10, 2014, at 11:30AM with EMP3 confirmed MR24 was not entered in the Delaware County Memorial Hospital Labor and Delivery Log. Therefore, there was no medical record created for the patient. EMP3 also confirmed the labor and delivery (L&D) staff did not receive EMTALA training.

2) A review on December 10, 2014, of MR3 revealed the following: On October 7, 2014, the patient presented to the emergency department and was registered at 7:36PM with complaints of bleeding and cramping on and off for approximately two weeks. The patient was five and one half months pregnant. MR3 further revealed the patient was referred to L&D at 7:50PM and taken to L&D at 8:05PM. MR3 failed to reveal any documentation that the patient presented at the labor and delivery department. MR3 failed to reveal a medical screening examination (MSE) was performed.

An interview conducted on December 11, 2014, at 11:38AM, with EMP2 confirmed MR3 was unable to provide documentation of an OB medical record and an OB MSE.

Based on review of Delaware County Memorial Hospital policy, Delaware County Memorial Hospital documents, Mercy Fitzgerald Emergency Department (ED) record (MR24) and staff interviews (EMP), it was determined the facility failed to ensure a patient who presented to the Emergency Department (ED) seeking emergency care was entered into the central log.

Findings include:

A review on December 10, 2014, of Delaware County Memorial Hospital policy entitled "COBRA/EMTALA Policy Statement" last revised June 2013 revealed, "I. Policy Statement ... IV. Policy ... E. Central Log: The Emergency Department, Crisis and Labor and Delivery shall maintain a central log to track each individual who comes to the hospital seeking care of an emergency medical condition. ..."

A review of the Delaware County Memorial Hospital Emergency Department Central Log titled "Picis Chart Archive" and the Delaware County Memorial Hospital Labor and Delivery Log, revealed no documented evidence MR24 was entered into either log.

A review of MR24 on December 11, 2014, revealed, " ... Patient attempted to be seen at DelCo prior to coming here to ED but says she could not be seen and was instructed to call Dr. (name redacted) office to establish prenatal care. ... "

An interview conducted on December 10, 2014, at 10:15AM with EMP1 and EMP2 revealed they received notification that the patient had received care at Mercy Fitzgerald Hospital after presentation at Delaware County Memorial Hospital Emergency Department.

An interview conducted on December 10, 2014, at 10:30AM with EMP9 confirmed that MR24 was not entered on December 2, 2014 in the Delaware County Memorial Hospital Emergency Department Central Log.

An interview conducted on December 10, 2014, at 11:30AM with EMP3 confirmed MR24 was not entered on December 2, 2014 in the Delaware County Memorial Hospital Labor and Delivery Log.

Based on a review of Delaware County Memorial Hospital policy, Mercy Fitzgerald Emergency Department (ED) record, Delaware County Memorial Hospital medical record and interviews with staff (EMP), it was determined that Delaware County Memorial Hospital's Emergency Department failed to provide an appropriate medical screening examination for two of 14 obstetrical (OB) patients. (MR24 (Mercy Fitzgerald medical record) and MR3).

Findings include:

A review on December 10, 2014, of the Delaware County Memorial Hospital policy entitled "COBRA/EMTALA Policy Statement," last revised June 2013, revealed, " ... II. Definitions: ... Medical Screening Exams (MSEs) are performed by physicians and/or qualified medical personnel in conjunction with the attending physician as defined by the Board of Directors. Labor and Delivery patients must have a Medical Screening Exam performed by a physician or a nurse certified by AWONN in conjunction with the attending physician. ... III. POLICY: The hospital will provide a medical screening examination to any person presenting for treatment to determine whether an emergency medical condition exists. A medical screening exam is provided to any individual who presents-regardless of diagnosis, financial status, race, color, national origin, or handicap. ... IV. POLICY A. Medical Screening Examinations and treatment for emergency medical conditions may be provided in departments outside the Emergency Department, e.g. Labor and Delivery. 1. Hospital - Inpatient Facility ... An allied health care provider shall include a physician assistant, nurse midwife, nurse practitioner, or AWHON certified labor and delivery nurse. ..."

1) A review of MR24 on December 11, 2014, revealed, " ... HPI Abdominal Pain ... History of Present Illness: 24F with no PMH, G1 at 42 weeks presents for lower abd cramping since last night, and intermittent headache, visual changes, dizziness, and SOB since this morning. ... Patient attempted to be seen at DelCo prior to coming here to ED but says she could not be seen and was instructed to call Dr. (name redacted) office to establish prenatal care. ... "

An interview conducted on December 10, 2014, at 10:30AM with EMP9 confirmed that MR24 was not entered on December 2, 2014 in the Delaware County Memorial Hospital Emergency Department Central Log. Therefore, there was no medical record created for the patient.

An interview conducted on December 10, 2014, at 11:30AM with EMP3 confirmed MR24 was not entered on December 2, 2014 in the Delaware County Memorial Hospital Labor and Delivery Log. Therefore, there was no medical record created for the patient.

2) A review on December 10, 2014, of MR3 revealed the following: On October 7, 2014, the patient presented to the emergency department and was registered at 7:36PM with complaints of bleeding and cramping on and off for approximately two weeks. The patient was five and one half months pregnant. MR3 further revealed the patient was referred to labor and delivery (L&D) at 7:50PM and taken to L&D at 8:05PM. MR3 failed to reveal any documentation that the patient presented at the labor and delivery department. MR3 failed to reveal a medical screening examination (MSE) was performed.

An interview conducted on December 11, 2014, at 11:38AM, with EMP2 confirmed MR3 did not contain documentation of an OB medical record and an OB MSE.