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Based on medical record review, document review, and interview, in 4 (four) of 4 (four) medical records reviewed, it was determined that the facility failed to ensure: (a) that obstetric patients received an appropriate medical screening examination by a Qualified Medical Practitioner (QMP), and (b) EMTALA (Emergency Medical Treatment and Labor Act) training is provided for all staff. (Patient #3, #16, #17 & #18).


This failure may have placed patients at risk for potential harm.


Findings include:

See TAG A-1104.

Based on medical record review, document review and interview, in 4 (four) of 4 (four) medical records reviewed, it was determined that (a) obstetric patients did not receive an appropriate medical screening examination by a Qualified Medical Practitioner (QMP), and (b) that EMTALA (Emergency Medical Treatment and Labor Act) training is provided for all staff. (Patient #3, #16, #17 & #18).


Findings include:


(a) A review of the medical record for Patient #3 revealed the following: Patient #3 presented to the facility on August 7, 2016 at 10:54 AM with a complaint of "not feeling the baby move." She had not received prenatal care and had just relocated to New York. She assessed by the nurse and an ultrasound was done which showed a single live intrauterine gestation of 19 weeks. The nurse reported the results of her assessment and the ultrasound via a telephone call to a physician who instructed her to discharge the patient home. The medical record did not contain a telephone order to discharge the patient home.
The patient was discharged home without an appropriate medical screening examination by a QMP.

A review of the medical record for Patient #16 revealed: the patient presented to the facility on August 2, 2016 at 9:15 PM complaining of abdominal tightening since 5:00 PM that day and pressure on urination. The patient's expected date of delivery was 11/15/16. The nursing assessment and evaluation determined the FHR (fetal heart rate) was normal and by 9:30 PM, the patient reported feeling less cramping. The urine results were negative and the ultrasound to evaluate the cervical length was normal. The physician instructed the nurse to discharge the patient home one (1) hour after her contractions had stopped. She was discharged at 10:30 PM that night. The patient was discharged home without an appropriate medical screening examination by a QMP.


Review of the medical record for Patient #17 revealed: the patient presented to the facility on August 2, 2016 at 10:00 PM complaining of urinary symptoms and she reported that she had been bleeding on the tissue after voiding. The patient was 22 weeks pregnant and had been treated 2 weeks prior for a Urinary Tract Infection but the symptoms had not gone away. According to the nurse's notes the maternal review of systems was normal and the urine analysis was within normal limits. The nurse gave " a telephone report" to the physician who requested a urine culture and that a vaginal examination should be done. These procedures were done and they were found to be normal. The nurse discussed her findings with the physician over the phone and he instructed her to discharge the patient home with instructions for follow-up care with the physician. The patient was discharged home without an appropriate medical screening examination by a QMP.


Similar findings were identified for Patient #18. The patient was 39 weeks and 2 days of gestational age and presented to the facility on August 8, 2016 at 3:32 AM with a complaint of abdominal cramping along with a possible leakage of clear fluid since 8:00 AM on August 7, 2016. The patient was examined by a nurse, the nurse discussed the results with the physician, and discharged the patient home as advised by the physician. The patient was discharged home without an appropriate medical screening examination by a QMP.

During an interview on August 12, 2016 at 10:15 AM with Staff A, the Vice President of Quality, she confirmed this process of the nurses in the obstetrical unit performing the function of a QMP. She stated that the facility had not designated these nurses to serve as QMP's.

(b) A random sample of 12 personnel files consisting of the Director of Obstetric Department, an obstetrician, and Registered Nurses who worked on the L&D Unit were reviewed. This review revealed none of the 12 employees had received training on Emergency Medical Treatment and Labor Act requirements.
This finding was acknowledged by Staff A, the Vice President of Quality on 08/17/16 at 3:00 PM.