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Based on record review and interview, the facility was not in compliance with 42 CFR §489.20(1), §489.24, and §489.24 (e) (1) and (2). The facility failed to provide a medical screening exam, and failed to provide appropriate transfers.

Based on record review and interview, the facility failed to provide a medical screening exam (MSE) for 3 (#s 1, 2, and 3) of 16 records reviewed.
Findings include:

1. On 4/24/15, patient #1 presented to the emergency room. The EHR (electronic health record) did not reflect a reason for the visit. The patient waited one hour before leaving the emergency room waiting room with her mother. The patient was not seen by a QMP (qualified medical provider) for a MSE.

In an interview on 5/13/15 at 9:45 a.m., staff member A, DON, stated there was no other information for patient #1 in the EHR.

2. On 4/21/15, patient #2 presented to the emergency room for onset of labor. A MSE was not completed and the patient was sent to another hospital by the nurse.

In an interview on 5/13/15 at 8:30 a.m., staff member A stated the patient was in active labor and the provider did not show up to the ED to complete a MSE. The provider called the ED nurse and told her to send the patient to another hospital.

3. On 4/15/15, patient #3 presented to the emergency room complaining of not being able to keep anything down. The QMP requested a urine specimen before a MSE would be started for this patient. The patient refused to provide a urine specimen and left the emergency room without a MSE. An AMA form was not obtained from the patient.

In an interview on 5/13/15 at 9:15 a.m., staff member A stated the provider refused to do a MSE until a urine specimen was collected. A MSE should have been completed for this patient. Staff member A stated all patients who present to the ED are to have a MSE by a QMP. Staff member A stated the QMPs were educated on this process May 1st, 2015 by the CEO.

Review of the email dated 5/7/15 from the CEO was addressed only to six out of the nine QMPs. Not all QMPs received the training on MSE.

Based on record review and interview, facility staff failed to appropriately transfer 2 (#s 2 and 4) of 16 patients reviewed who were in active labor. The facility staff failed to complete and provide the required Transfer with a Physician Certification form for the receiving hospital. The facility staff did not provide a copy of the medical record to the receiving hospital.
Findings include:

1. On 4/21/15, patient #2 presented to the ED complaining of the onset of labor. The patient was 38 weeks pregnant. The EHR reflected her contractions were every 3-4 minutes. A QMP or provider did not present to the ED to complete a MSE. A phone call was received by a provider directing the nurse to send the patient to another hospital. The EHR did not reflect if the patient was stable to be transferred. The rationale as to why the patient was sent to another hospital was not reflected in the EHR. The patient did not request a transfer to another hospital. The EHR reflected a Physician Certification form was not completed. A copy of the medical record was not provided to the receiving hospital.

2. On 4/18/15, patient #4 presented to the ED complaining of being in active labor. The EHR reflected the patient was 39 weeks pregnant. The patient was dilated to 6 cm with 100 % effacement. Contractions were every 5-6 minutes. The QMP documented the patient was having active contractions and transferred the patient to another hospital. The EHR did not reflect the reason as to why the patient was transferred in an unstable condition. The patient did not request a transfer to another hospital. The EHR reflected a Physician Certification form was not completed. A copy of the medical record was not provided to the receiving hospital.

In an interview on 5/13/15 at 9:30 a.m., staff member A, DON, stated both patients should not have been transferred to another hospital. The condition of both patients were not stable enough to be transferred. Staff member A stated transfer paper work was not completed or provided to the receiving hospital for both patients.