HospitalInspections.org

Based on policy and procedure reviews, medical record reviews, staff and physician interviews, the facility's Labor and Delivery (L&D) unit staff failed to ensure necessary stabilizing treatment for an emergency medical condition by failing to provide stabilizing treatment as required within the capabilities of the staff and facilities available at the hospital, for 2 of 3 obstetrical sampled medical records reviewed (Patient #8, Patient #9).


The findings include:


Review of the policy and procedure titled "EMTALA Policy" last revised 04/2021 revealed in part revealed in part,
"On-Call Physician Under EMTALA ...On call Physician shall respond to request for evaluation, when Qualified Medical Provider/Designated Screener Personnel determines an emergency medical condition exists and the on-call physician is required for Necessary and Stabilizing treatment ...Consistent with Federal law, all necessary stabilizing treatment ...must be rendered in the hospital for patients with emergency medical conditions ...Definitions ...Stabilize with respect to an Emergency Medical Condition, to provide whatever treatment of the condition is necessary to assure within reasonable medical probability, that no material deterioration is likely to result from (or occur during) transfer (including discharge home or to another location) of individual; and with respect to pregnant female experiencing contractions, that the baby and placenta have ben delivered."


1. Closed medical record of Patient #8 revealed 26-year-old pregnant female who presented to the hospital's L&D from her Obstetrician's office to rule out pre-eclampsia (high blood pressure) on 06/01/2021. Record review revealed Patient #8 presented at 1209. Her BP at 1240 was 136/78 pulse 100. Review revealed she was 29 weeks pregnant with twins. Record review revealed at 1309 OBMD (Obstetric Medical Doctor) #1 was notified by OBRN (Obstetric Registered Nurse) #2, OBMD ordered labs and a BPP (Biophysical Profile) and at 1500 OBMD #1 was notified of lab results. Patient #8 BP at 1545 130/72 pulse 78. Review revealed OBRN #2 notified OBMD #1 at 1625 "Called and informed "named MD" (OBMD #1) of BPP (Biophysical Profile) results. MD (OBMD #1) states that patient is able to be discharged and she should keep all upcoming appointments. Informed vaginal check had not been performed, he stated that is not necessary for this visit." Record review revealed Patient #8 was discharged at 1631, and was not stabilized prior to discharge. Review of the record revealed no MSE (Medical Screening Exam) was completed by a QMP (Qualified Medical Provider).

Interview on 06/16/2021 with OBRN#2 revealed she was the nurse caring for Patient #8. Interview revealed if OBMD #1 came in to see the patient she would have written a note stating he did, or he was in the room. Interview revealed OBMD #1 sends patients all the time to be worked up from his office without coming to the hospital to see them. Interview revealed he would come if there was an emergency and if we called asking him to do so.

Interview on 06/16/2021 at 1215 with OBMD #1 revealed he was told "If I triaged the patient over the phone I did not have to be physically there as long as I took full responsibility". Interview revealed he "thought he was following what he was told he could do," Interview revealed he wants to do the "right" thing. Interview confirmed he did not perform a MSE on Patient #8 on 06/01/2021.

Interview on 06/16/2021 at 1625 with Nurse Manager for Mother/ Baby. Interview revealed she performs the Labor and Delivery MSE chart audits for compliance. Interview revealed the only component for compliance she reviewed was physician progress note and signature. Interview confirmed she did not review any chart for documentation nor care content.

2. Closed medical record of Patient #9 revealed 25-year-old pregnant female (Estimated Delivery Date of 7/21/21) who presented to the hospital's L&D on 06/07/2021 at 1512. Review of record revealed "Patient presents to the floor via wheelchair at this time. Patient states that she has been having on and off contractions since yesterday, but she came to the hospital for decreased fetal movement and pelvic pressure." Review revealed Patient #9 placed on EFM (external fetal monitor HR 145). Review revealed at 1707 "Named MD" (OBMD #1) on the floor. MD notified of SVE (sterile vaginal exam) MD states patient can be discharged home but offer Brethine (medication to help slow contractions) to ease patient discomfort if patient wishes." Review at 1711 "Patient offered Brethine denies at this time.[sic] Discharge instructions given. MD updated on patient refusal of Brethine, MD verbalized understanding." Review revealed Patient #9 was discharged at 1724, and was not stabilized prior to discharge.

Interview on 06/16/2021 at 1215 with OBMD #1 revealed he was told "If I triaged the patient over the phone I did not have to be physically there as long as I took full responsibility". Interview revealed he "thought he was following what he was told he could do," Interview revealed he wants to do the "right" thing. Interview confirmed he did not perform a MSE on Patient #9. Interview confirmed he was on the unit but did not physically examine Patient #9 on 06/07/2021.

Interview on 06/16/2021 at 1625 with Nurse Manager for Mother/ Baby. Interview revealed she performs the Labor and Delivery MSE chart audits for compliance. Interview revealed the only component for compliance she reviewed was physician progress note and signature. Interview confirmed she did not review any chart for documentation nor care content.

The facility failed to ensure that Patient #8 and Patient #9 received stabilizing treatment as required. Both patients were never evaluated, nor managed by a qualified medical provider prior to discharge when Patient #8 and Patient #9 presented to the hospital's ED.