HospitalInspections.org

Based on interview and record review, the hospital failed to meet the regulatory requirements under Emergency Medical Treatment and Labor Act (EMTALA) as evidenced by:

1. The hospital failed to ensure all obstetric patients presenting to the dedicated emergency department (DED) or the DED Labor and Delivery (L&D) Department, also known as the Childbirth Center (CBC), seeking a medical screening examination (MSE) for a potential emergency medical condition (EMC) were maintained or referenced on the ED central log for the timeframe of October 2023 through October 2024. (Cross reference to A-2405)

Based on document review, policy review, and interview, the facility failed to ensure all obstetric patient presenting to the dedicated emergency department (DED) or the DED Labor and Delivery (L&D) Department, also know as the Childbirth Center (CBC), seeking a medical screening exam (MSE) for a potential emergency medical condition (EMC) were maintained or referenced on the ED central log for the timeframe of October 2023 through October 2024.

Findings include:

Review of the document entitled "OB Outpatient Log," paper logs for the timeframe of October 2023 through October 2024 showed all OB (obstetrics) patients, including scheduled OB appointment for patients coming from physician offices, but failed to show which OB patients were presenting to the ED or L&D/CBC Department seeking a MSE for a potential EMC.

Review of the ED EMTALA electronic central logs for the timeframe of October 2023 through October 2024 failed to document all OB patients presenting to the ED or L&D/CBC Department for a MSE for a potential EMC.

On 10/08/24 at 9:45 AM, while on tour of the ED, the Director of Childbirth Center (DCBC), also known as the L&D Department, stated, "ED OB patients are not documented on the ED EMTALA central log once they go to OB."

During an interview on 10/08/24 at 11:04 AM, the DCBC confirmed the OB Outpatient Log did not indicate which OB patients presented to the DED L&D/CBC Department or the DED ED seeking a MSE for a potential EMC.

During an interview on 10/08/24 at 1:57 PM, the Childbirth Center Manager (CBCM) confirmed the L&D/CBC Department is a DED ED. The CBCM also confirmed that OB patients that circumvent the ED are not documented as OB ED patients seeking an MSE for a potential EMC on the OB Outpatient Log. The DCBC stated, "We are not keeping a log of OB ED patients."

Review of the policy titled, "EMTALA - Screening, Stabilization And Transfer Of Individuals With Emergency Medical Conditions, " revised 02/07/2022 showed, "Section I: Policy & Purpose ...C. This Policy and Procedures apply to 1. Any individual who presents at any Dedicated Emergency Department ("DED") of the Hospital, as defined in section II and requests and examination or treatment of a medical condition ...Section II. Definitions ...D. "Central Log" refers to the log maintained by the Hospital that documents each patient that comes to a Dedicated Emergency Department seeking assistance and documents such patient's disposition. E. "Dedicated Emergency Department" ("DED") means any department or facility of the Hospital, regardless of whether it is located on or off the main Hospital campus that meets at least one of the following requirements: ... 4. Presently, the Hospital's DEDs are the main emergency department and the labor and delivery department ...G. "Emergency Medical Conditions" ("EMC") means: 1. A medical condition manifesting itself by acute symptoms of sufficient severity ...such that the absence of immediate medical attention could reasonably be expected to result in: a. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy; or b. Serious impairment to bodily functions; or c. Serious dysfunction of any bodily organ or part; or
2. With respect to a pregnant woman who is having contractions: a. That there is inadequate time to effect a safe transfer to another hospital before delivery; or b. That transfer may pose a threat to the health or safety of the woman or her unborn child. 2. With respect to a pregnant woman who is having contractions: ...Medical Screening Examination" ("MSE") means the screening process performed by a physician or another QMP [Qualified Medical Provider] required to determine with reasonable clinical confidence whether an EMC does or does not exist. Section III. Procedures ...H. Recordkeeping. The Hospital, whether transferring or receiving patients must maintain the following: ...b. Logs that are maintained in other departments that perform Medical Screening Examinations shall be incorporated into the Central Log by reference. i. Such ancillary patient logs shall be maintained in accordance with the requirement for Central Log and are considered a part of the Central Log."