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Based on review of twenty emergency department records, patient #1's obstetrical record from another hospital (RMH), a review of the hospital's bylaws, and review of the policies and procedures for patients who present to the emergency department, it was determined that in one (patient #1) of twenty-one patients who presented to the hospital requesting emergency services, the hospital failed to ensure compliance with 489.24. Patient #1 presented to the hospital in labor and was refused treatment and was not provided a medical screening examination on 11/21/11. This resulted in an immediate jeopardy to the patient's health and safety. The immediate jeopardy has the potential to affect all patients who are pregnant and present to the hospital in labor. The immediate jeopardy is cited at 42 CFR 489.24, C2406

Based on documentation and interviews, the hospital failed to ensure that each patient who presented to the emergency department received a medical screening examination, to determine whether or not an emergency medical condition existed, in one of twenty-one patients reviewed (Patient #1). Findings include:

Documentation and interviews revealed that patient #1 went into labor during the night of 11/21/11 and her labor progressed more rapidly than patient #1 expected. Person (F) drove patient #1 to the local hospital (SCBH) for care, although it was originally planned that she would deliver at another hospital (RMH) which was several miles from (SCBH). Person (F) went to the front door of the emergency department and informed nurse (C) that patient #1 was in the car and in labor. In response to person (F's ) request for care, nurse (C) told person (F) that SCBH did not provide obstetrical services and that he should continue to drive to their original destination, RMH. Patient #1's labor became more severe on the way to RMH, so person (F) stopped the car, called 911 and delivered the baby in the car. The ambulance arrived and transported patient #1 and the baby to RMH.

Review of patient #1's 11/21/11 ambulance record confirmed that on 11/21/11, at 3:44 a.m., a 911 call was received and an ambulance was dispatched to an identified location on a highway between Benson, MN and Willmar, MN. The request for an ambulance was related to child birth and upon arrival the paramedics observed patient #1 in the passenger seat of the vehicle with her baby lying on her chest. The paramedics examined patient #1 and the baby and determined that they were both stable. Patient #1 and the baby were transported by ambulance to RMH for ongoing care.

Review of patient #1's 11/21/11 hospital record confirmed that patient #1 was admitted to RMH at 4:17 a.m. and that person (F) and patient #1 had requested care at SCBH prior to the delivery of the baby in the car.

Person (F) was interviewed by phone on 12/12/11, and he confirmed that when he and patient #1 went to the ED at SCBH seeking care for patient #1 during the night of 11/21/11. He stated he pushed the ED button and nurse (C) came out to the car and told him SCBH did not provide obstetrical services. When person (F) requested that nurse (C) call an ambulance for patient #1, nurse (C) refused and told person (F) to continue driving to his intended destination, RMH.

Nurse (C) was interviewed in person on 12/15/11, and she confirmed that patient #1 was not provided a medical screening examination and further assistance when she arrived at the ED in labor on 11/21/11. She stated she told person (F) that SCBH did not provide obstetrical services and told him to continue driving to his intended destination, RMH. She stated she did not attempt to call an ambulance for patient #1 and did not inform RMH that patient #1 was on her way.

Nurse (D) was interviewed in person on 12/15/11, and she stated she was working the 11/21/11 night shift on a unit adjacent to the ED. She stated she heard the ED buzzer ring and followed nurse (C) out the ED door because she was concerned about her safety. Nurse (D) stated she was holding the ED door open and clearly overheard the entire conversation between nurse (C) and person (F) that occurred by person (F's) car. She stated nurse (C) told person (F) that SCBH did not provide obstetrical services and told person (F) to continue driving to RMH. Nurse (C) did not offer patient #1 a medical screening examination and when person (F) asked if an ambulance should be called, nurse (C) replied "no." Patient #1 was sitting in the passenger seat of the car and looked very uncomfortable.

The hospital's EMTALA policy, dated March 2010 and revised on 1/5/11, states "All patients presenting to the ER (Emergency Room) will be given a medical screening exam. Any patient with an EMC (Emergency Medical Condition) or in labor will be stabilized. Appropriate transfer will be provided when patient requests or SCBH does not have capability or capacity to provide the necessary treatment."