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Based on tours/observations, staff interviews and review of medical records, 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 2406 - Medical Screening Examination
Based on interviews and a review of records, the facility failed to provide a Medical Screening Exam (MSE) for a patient who requested care for the onset of labor as required by Emergency Medical Treatment and Active Labor Act (EMTALA) regulations.

Tag A 2408 - Delay in Examination and Treatment
Based on interviews and a review of records, the facility failed to ensure the patient had a Medical Screening Examination to determine if an Emergency Medical Condition was present. The patient left the off site emergency department, thus delaying examination and treatment and presented to the hospital where a MSE was performed as required by Emergency Medical Treatment and Active Labor Act (EMTALA) regulations.

Based on interviews and a review of records, the facility failed to provide a Medical Screening Exam (MSE) for a patient who requested care for the onset of labor as required by Emergency Medical Treatment and Active Labor Act (EMTALA) regulations.

The failure created the potential for patient/fetus harm related to an unattended delivery and/or complications from a potential unidentified emergency medical condition as no medical screening of the patient was performed.

FINDINGS:

1) The facility's off site Emergency Department did not provide a Medical Screening Exam for a patient who requested care related to the onset of labor, as required by EMTALA regulations.

a) A review of facility documents revealed that Patient #1 presented to the off site Emergency Department and requested medical care related to the onset of labor. Registered Nurse (RN) #1 advised the patient that the site did not deliver babies and that the patient would be transferred to a hospital by ambulance if she checked in at this site. The patient chose to leave and was transported via private vehicle to the main campus of the facility.

b) An interview with the facility's Vice President on 7/22/14 at 10:00 a.m. revealed facility staff identified that a potential violation of EMTALA had occurred relative to Patient #1 as a result of actions taken by RN #1. An investigation was conducted and the facility self reported the event to the State Agency.

c) A review of the medical record of Patient #1 revealed she was admitted to the obstetrical unit of the facility's main campus and delivered by cesarean section. Admission and transfer logs for the off site Emergency Department were reviewed. There was no documentation of the patient's visit to this site.

Based on interviews and a review of records, the facility failed to provide a Medical Screening Exam (MSE) and/or initial stabilizing medical treatment for a patient who requested care for the onset of labor as required by Emergency Medical Treatment and Active Labor Act (EMTALA) regulations.

The failure resulted in a delay in care, creating the potential for patient/fetus harm related to an unattended delivery and/or complications from an unidentified emergency medical condition.

FINDINGS:

1) The facility's off site Emergency Department did not provide an MSE and/or initial stabilizing treatment for a patient who requested care related to the onset of labor, as required by EMTALA regulations.

a) A review of facility documents revealed that Patient #1 presented to the off site Emergency Department and requested medical care related to the onset of labor on 6/29/14 at 12:30 a.m. Registered Nurse (RN) #1 advised the patient that the site did not deliver babies and that the patient would be transferred to a hospital by ambulance if she checked in at this site. The patient chose to leave and was transported via private vehicle to the main campus of the facility, where she was provided medical care on 6/29/14 at 1:07 a.m. and delivered by caesarian section on 6/29/14 at 9:19 p.m. There was a 37 minute delay from the time medical care was initially requested at the off site emergency department and the time it was received at the hospital.

b) An interview with the facility's Vice President on 7/22/14 at 10:00 a.m. revealed facility staff identified that a potential violation of EMTALA had occurred relative to Patient #1 as a result of actions taken by RN #1. An investigation was conducted and the facility self reported the event to the State Agency.