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Based on clinical record review and interview, it was determined the Facility failed to fully disclose the risks and benefits of transfer specific to the condition of transferred patients for two of two (#9 and #10) unstable Patients. Failure to fully disclose the risks and benefits did not allow the transferred Patients to make an informed decision regarding the need for the transfer along with associated risks and benefits particular to the Patient's medical condition. The failed practice was likely to affect Patients #9 and #10 and any unstable patient transferred to another Facility. The findings follow:

A. Review of Patient #9's clinical record on 05/03/17 revealed the following:
1) ED (Emergency Department) Provider Note dated 03/07/17 at 2100 revealed, "Given Terbutaline, Mag (Magnesium) Sulphate in attempt to stop labor. Contractions continued. Contacted (Named Facilities). Dr. at (Named Facility) advised deliver first twin, then send mother and undelivered breech second twin to (Named Facility), and (Named Facility) would come and get first baby. Membranes were ruptured with a needle, and within one minute delivery occurred. Gentle back pressure applied to vertex to control rate of expulsion, no other maneuvers necessary. Baby initially purple, cord clamped and cut. Baby dried and placed in incubator, given bag mask assistance due to retractions. Mother transported to (Named Facility)."
2) There was no evidence of a certification signed by the Physician stating the risks and benefits of the transfer were discussed with the Patient.

B. Review of Patient #10's clinical record on 05/03/17 revealed the following:
1) ED Provider Note dated 03/07/17 at 2233 revealed, "Premature newborn. First of twins. Purple at birth, became red with suction and bag-mask ventilation. Cries at times. Diaphragmatic and intercostal retractions with every breath. Mother arrived at 8:56, time of birth 9:39 PM, 3-7-17. Occiput presentation, vag (vaginal) delivery. Premature vaginal delivery. Spontaneous cry, urinated at 10 minutes. 3 # (pounds) 5 oz (ounces), 15.5 inches. Initially cyanotic, became red, then pink with assisted ventilation. Transported by (Named Transport) to (Named Facility)."
2) Medically Indicated Transfer Consent dated 03/07/17 revealed the patient was identified as "Unstable." Transfer Risks listed were "Change in condition/vital signs, cardiac arrest, death, vehicle accident." There was no evidence of the risks specific to the condition for which the patient was being transferred.

C. The findings of A and B were confirmed in an interview with the Emergency Room Manager on 05/03/17 at 1400.