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Based on clinical record review, policy review and interview, it was determined the facility failed to:
1. Ensure 1 (#7) of 20 (#1-#20) patient received an appropriate and timely medical screening exam (MSE).
2. Ensure one of one (#7) patient transferred to another hospital was informed of the risks and benefits of the transfer.
3. Notify the recipient hospital and provide medical records to the recipient hospital for one of one (#7) patient.
4. Ensure the transfer was effected through qualified personnel and transportation equipment for one of one (#7) patient.
Failure to provide an appropriate and timely MSE did not ensure the facility was aware of whether Patient #7 had an emergency medical condition, which had the likelihood in delaying medical treatment.
The failed practice did not ensure the patient/patient's representative was informed of the risks and benefits of the transfer, failed to ensure the accepting facility had the capacity and capability to treat the patient and failed to ensure the patient could be treated for an emergency during the transfer.
The failed practice affected Patient #7 and had the likelihood to affect all patients presenting to the Emergency Department (ED). See A2406 and A2409 for details.

Based on clinical record review, policy review and interview, it was determined the facility failed to ensure 1 (#7) of 20 (#1-#20) patient received an appropriate and timely medical screening exam (MSE). Failure to provide an appropriate and timely MSE did not ensure the facility was aware of whether Patient #7 had an emergency medical condition, which had the likelihood in delaying medical treatment. The failed practice affected Patient #7 and had the likelihood to affect all patients presenting to the Emergency Department (ED). Findings follow:

A. Review of the facility's policy titled, "OB (Obstetric) Patient in ED/Deliveries in ED," with a reviewed date of 05/09/2025, showed, "If situation requires, staff will be prepared to care for an OB patient in ED. When an OB patient arrives to ER desk, the clerk should immediately notify the ER nurse, who then should approach the desk to make contact with the patient and obtain history, estimated date of delivery, and assessment of patient's complaint. OB patients will be placed in ER Exam 7 and given a gown. Fetal Heart Tones will be obtained by ED nurse, documented and reported to ED physician. If after examination by ED physician the OB patient is determined to in impending labor, attempts to transfer to an appropriate facility with LDRP capability will be made. If labor is so far advanced that there is not time to reach another facility, the patient will be delivered in the ED. ED physician will facilitate delivery of the OB patient and initial care of the newborn. After delivery, newborn will be registered as an ED patient and appropriate ID band applied. After mother and baby are determined to be stable, transfer to appropriate post¿partum facility will be initiated."

B. Review of Patient #7's clinical record dated 05/10/2025 showed the following:
1) 8:40 AM: Chief Complaint: Possible contractions. Onset 0700 (7:00 AM).
2) 8:40 AM: Blood pressure 120/61; Heart Rate 88; Respiratory Rate 16; Oxygen saturation 99%; Temperature 98.1 degrees Fahrenheit; Pain level 6 of 10.
3) 8:40 AM: Registered Nurse Physical Assessment: states she has been having contractions since about 0700 (7:00 AM), states they are about 5 minutes apart. Appears in no acute distress. Abdomen soft and nontender. Gravid uterus.
4) Physician Assessment: Time seen: 8:39 AM. History of Present Illness: Chief Complaint: Uterine Contractions. States 5 mins (minutes) apar (apart) approx. (approximately). This started today and is still present. The patient complains of irregular contractions, with a frequency of about one every 5 minutes and duration of a few seconds. Patient has not had mild vaginal bleeding. The patient complains of a leakage of fluid (None). Gestational age is near term. Review of symptoms: All other systems reviewed and are negative. Past history: G (gravida) 3; P (para) 2; Ab (abortion) 0. Prior vaginal delivery. Progress and procedures: Course of Care: discussed with patient that we do not have any way of checking her contractions. We have no OB coverage. No amniotic fluid leak. Patient is going to drive herself to El Dorado to get checked.
Offered patient transportation in ambulance, however patient and her friend elected to drive themselves as it is faster. Vital signs stable. Disposition: Discharged in good condition. A medical screening exam: At the time of evaluation the presenting medical condition was determined to be of an emergent nature. Clinical impression: Braxton Hicks contractions at 37 weeks or greater. Possible third trimester preterm labor. Follow-up: Follow up with your doctor if not better.
5) 8:50 AM: Disposition/Discharge: Departure time: 08:50 AM, 05/10/2025. Glasgow Coma Scale: 15- eyes open- spontaneous (4); best verbal response- oriented (5); best motor response- obeys commands (6). Condition at departure: stable. The patient left prior to discharge education being provided. The patient was discharged by the physician. She was discharged home and accompanied by family. She left ambulatory and via private vehicle. Family member driving.

C. There was no evidence Patient #7 had a cervical exam to assess for dilation. There was no evidence the fetal status was evaluated for fetal heart tones, or palpation for fetal position. There was no evidence the patient's contractions were assessed for duration and intensity.

D. In an interview with the ED Director on 05/22/2025 at 10:30 AM, she stated, the facility does not have the capability for continuous fetal monitoring since they do not deliver babies there. If there is an emergent situation and the fetal heart rate needs to be assessed the facility does have a doppler in the ED. She stated the ED physicians assess the patients. If required, the ED physicians are credentialed to do a vaginal exam. She said if the patient's amniotic fluid membranes are intact, the ED physician will contact the nearest hospitals that deliver babies in (Named Cities) to determine a plan. The patient and the ED physician then determine whether the patient will go by personal car or ambulance to that hospital. She stated if the patient was in distress or preterm labor then of course they would be transferred via ambulance

E. Review of Patient #7's (Recipient Hospital) clinical record showed the following:
1) 9:51 AM: "Triage Summary: 22 y/o patient of Dr. (Named) presents to L&D (Labor and Delivery) via wheelchair from ER (Emergency Room) with complaints of contractions since 0700 (7:00 AM) this am. She says that they are 5 mins apart. She denies LOF (leaking of fluids) or vaginal bleeding. Her last baby was 11 months ago. She has had some prenatal care at (named facility) in Shreveport and then moved here after being in jail. She has seen Dr. (Named) for one visit so far. She presented to Magnolia's ER this morning for contractions and was told there was nothing they could do for her since they don't have OB and to just drive to El Dorado because it would take 30 minutes for an ambulance to get there to take her. She was not evaluated or assessed by the physician while she was there and was given no paperwork. Gown, abd (abdominal) binder and specimen cup provided."
2) Discharge Summary: Assessments/Problem List: Presented to Labor delivery and progressed to complete dilation. She delivered a 7 lb (pound) 7 oz (ounces) female at 10:35 PM on 05/10/2025. There were no laceration no episiotomy. She has done well post partly (partum) and draped (?) be discharged."

Based on clinical record review, it was determined the facility failed to:
1. Ensure one of one (#7) patient transferred to another hospital was informed of the risks and benefits of the transfer.
2. Notify the recipient hospital and provide medical records to the recipient hospital for one of one (#7) patient.
3. Ensure the transfer was effected through qualified personnel and transportation equipment for one of one (#7) patient.
The failed practice did not ensure the patient/patient's representative was informed of the risks and benefits of the transfer, failed to ensure the accepting facility had the capacity and capability to treat the patient and failed to ensure the patient could be treated for an emergency during the transfer. The failed practice had to likelihood to affect all patients transferred out of the facility. The findings follow:

A. Review of Patient #7's clinical record dated 05/10/2025 showed the following:
1) 8:40 AM: Chief Complaint: Possible contractions. Onset 0700 (7:00 AM).
2) 8:40 AM: Blood pressure 120/61; Heart Rate 88; Respiratory Rate 16; Oxygen saturation 99%; Temperature 98.1 degrees Fahrenheit; Pain level 6 of 10.
3) 8:40 AM: Registered Nurse Physical Assessment: states she has been having contractions since about 0700 (7:00 AM), states they are about 5 minutes apart. Appears in no acute distress. Abdomen soft and nontender. Gravid uterus.
4) Physician Assessment: Time seen: 8:39 AM. History of Present Illness: Chief Complaint: Uterine Contractions. States 5 mins (minutes) apar (apart) approx. (approximately). This started today and is still present. The patient complains of irregular contractions, with a frequency of about one every 5 minutes and duration of a few seconds. Patient has not had mild vaginal bleeding. The patient complains of a leakage of fluid (None). Gestational age is near term. Review of symptoms: All other systems reviewed and are negative. Past history: G (gravida) 3; P (para) 2; Ab (abortion) 0. Prior vaginal delivery. Progress and procedures: Course of Care: discussed with patient that we do not have any way of checking her contractions. We have no OB coverage. No amniotic fluid leak. Patient is going to drive herself to El Dorado to get checked.
Offered patient transportation in ambulance, however patient and her friend elected to drive themselves as it is faster. Vital signs stable. Disposition: Discharged in good condition. A medical screening exam: At the time of evaluation the presenting medical condition was determined to be of an emergent nature. Clinical impression: Braxton Hicks contractions at 37 weeks or greater. Possible third trimester preterm labor. Follow-up: Follow up with your doctor if not better.
5) 8:50 AM: Disposition/Discharge: Departure time: 08:50 AM, 05/10/2025. Glasgow Coma Scale: 15- eyes open- spontaneous (4); best verbal response- oriented (5); best motor response- obeys commands (6). Condition at departure: stable. The patient left prior to discharge education being provided. The patient was discharged by the physician. She was discharged home and accompanied by family. She left ambulatory and via private vehicle. Family member driving.

B. Review of Patient #7's (Recipient Hospital) clinical record showed the following:
1) 9:51 AM: "Triage Summary: 22 y/o patient of Dr. (Named) presents to L&D (Labor and Delivery) via wheelchair from ER (Emergency Room) with complaints of contractions since 0700 (7:00 AM) this am. She says that they are 5 mins apart. She denies LOF (leaking of fluids) or vaginal bleeding. Her last baby was 11 months ago. She has had some prenatal care at (named facility) in Shreveport and then moved here after being in jail. She has seen Dr. (Named) for one visit so far. She presented to Magnolia's ER this morning for contractions and was told there was nothing they could do for her since they don't have OB and to just drive to El Dorado because it would take 30 minutes for an ambulance to get there to take her. She was not evaluated or assessed by the physician while she was there and was given no paperwork. Gown, abd (abdominal) binder and specimen cup provided."

C. There was no evidence the facility informed Patient #7 of the risks and benefits of the transfer, notified the recipient hospital and provide medical records to the recipient hospital, and ensured the transfer was effected through qualified personnel and transportation equipment.