HospitalInspections.org

Based on hospital policy review, medical record review, physician and staff interviews the hospital failed to comply with 42 CFR §489.20 and §489.24.

The findings included:

The hospital failed to provide a thorough medical screening examination, including ancillary services routinely available, to determine whether an emergency medical condition existed for one of one postpartum patients who arrived to OB Triage area seeking care (Patient #3).

~ Cross refer to §489.24(a) and §489.24(c) Medical Screening Examination - Tag A2406.

Based on policy review, Emergency Medical Treatment and Labor Act (EMTALA) log reviews, medical record review, documented electronic medical record events and staff and physician interviews, the hospital failed to have an accurate and complete EMTALA log for one of one postpartum patients who arrived to the obstetrical triage area seeking care (Patient #3).

The findings included:

Review of the "Obstetrical Medical Screening, Examination, and Admissions/Disposition from L&D.... LDR and Emergency Department" policy, dated 12/28/2023, revealed "...RN or designee enters patient information into the triage log. ..."

Review of the OB EMTALA log revealed Patient #3, a 21-year-old, arrived on 07/30/2024 at 1825.

Medical record review revealed Patient #3 arrived to the "Waiting Room" at 1813 and was moved into Labor and Delivery (L&D) triage at 1825, noting that the patient was sent from the office for pre-eclampsia labs. Review revealed Patient #3 was admitted and delivered on 08/01/2024 at 0454. A Progress Note on 08/03/2024 at 1012 documented "...blood pressures are a bit elevated but not in the severe range....Principal Problem: Preeclampsia, third trimester....Overall doing well. Home today....Continue....labetalol along with routine postpartum meds. ..." The last noted vital signs at 1050 revealed a blood pressure of 148/88. Patient #3 was discharged home on labetalol 400 mg twice a day.

Review of the EMTALA logs did not reveal Patient #3 listed on either the ED or OB EMTALA logs on 08/14/2024.

Review of entries on Patient #3's list of encounters revealed an entry, dated 08/14/2024 which stated "Admission (Canceled)... "

Review of "Event Management....Admission Details (Canceled)..." revealed an encounter was created for Patient #3 on 08/14/2024 at 1447, which documented the patient arrived to the Labor and Delivery Waiting Room at 1447 and was listed as "Pending Admission", then also at 1447, and entry that stated "Confirmed Admission." At 1510, an entry was documented that indicated "Canceled Admission [space] Entered in Error."

Requests on 04/10/2025 to interview the two staff members who entered the 08/14/2024 events on Patient #3 revealed neither staff member worked at the hospital now and thus were not available for interviews.

Interview with MD #6, on 04/10/2025 at 1325, revealed the MD understood Patient #3 may have come to L&D for triage at some point after discharge. Interview revealed if a postpartum (after delivery) patient arrived to L&D the patient should be registered. Registration staff were not allowed to send a patient off the floor, they were to get a nurse, more often than not the Charge Nurse, who would speak to the patient and then call the physician. Interview revealed MD #6 was not aware of being contacted about Patient #3 as a postpartum arrival.

Interview on 04/10/2025 at 1430 with Supervisor #8, Patient Access Manager, revealed that when information was pulled on Patient #3's 08/14/2024 event no account notes were written but should have been. Interview revealed there was a consent form signed but nothing to indicate if a nurse was called or what happened with Patient #3 during the encounter. Supervisor #8 stated she attempted to pull footage, but none was available, video footage was only kept for 60 days. Interview further revealed staff should have documented all information they had on what occurred during the visit. If an encounter was canceled, notes should have indicated why it was canceled. Supervisor #8 stated the two staff members involved no longer worked at the hospital so there was no way to determine if there was a deviation in their practice and what it was.

Interview on 4/10/2025 at 1550 with an OB Charge Nurse, RN #10, revealed if a patient needed to be sent to the ED from the OB triage area, the Charge Nurse designated someone to take the patient down. Interview revealed RN #10 would not generally write a note about the encounter and stated that patients taken down to the ED prior to triage would not appear on the OB log. Interview revealed patients were not placed on the log until they moved into triage.

In summary, there was evidence Patient #3 returned to the obstetrical triage area on 08/14/2024 since a event for the patient was entered into the computer system. Patient #3's name did not appear on the EMTALA log on 08/14/2024. An OB Charge Nurse stated arriving patients would not appear on the log until the patient was placed into triage. Pt #3 was documented on the entry as in the waiting room "Pending Admission" and the event was then canceled.

Based on policy review, Obstetrics (OB) Emergency Medical Treatment and Labor Act (EMTALA) log review, event review, medical record review and staff and physician interviews, the hospital failed to provide a medical screening examination on one of one postpartum patients reviewed who arrived to the OB triage area (Patient #3).

The findings included:

Review of the "Obstetrical Medical Screening, Examination, and Admissions/Disposition from L&D.... LDR and Emergency Department" policy, dated 12/28/2023, revealed "...In compliance with the Emergency Medical Treatment and Active Labor Act (EMTALA) law, [Hospital Name] ....L&D provides a medical screening examination to individuals requesting care and if it is determined an emergency medical condition exists, provides treatment to stabilize the condition... ." Although the policy mentioned maternal hypertension, review of the policy did not reveal how postpartum patients would be managed if they arrived to OB triage seeking care.

Medical record review for Patient #3 revealed the patient was admitted on 07/30/2024, delivered, and was discharged 08/03/2024.

Review of the EMTALA logs for 08/14/2024 did not reveal Pt #3's name appeared on either the ED or the OB log, however, there were entries noted in the electronic medical record on Patient #3's list of encounters. An entry, dated 08/14/2024 noted "Admission (Canceled)... " Review of "Event Management....Admission Details (Canceled)..." revealed an encounter was created for Patient #3 on 08/14/2024 at 1447, which documented the patient arrived to the Labor and Delivery Waiting Room at 1447 and was listed as "Pending Admission", then also at 1447, a note indicated "Confirmed Admission." At 1510, an entry was made that documented "Canceled Admission [space] Entered in Error."

Interview with MD #6, an Obstetrician, on 04/10/2025 at 1325, revealed the physician was on call for the group on 08/14/2024. Interview revealed MD #6 remembered Pt #3. Interview revealed MD #6 understood Patient #3 may have come in to L&D for triage postpartum (after delivery) on 08/14/2024 and possibly went to the ED. Interview revealed if a postpartum patient arrived to L&D the patient should be registered. Registration staff were not to send patients off the floor, they were to get a nurse who would speak to the patient and then call the physician. Interview revealed MD #6 was not aware of being contacted about Patient #3 on 08/14/2024.

Interview on 04/10/2025 at 1430 with Supervisor #8, Patient Access Manager, revealed that when information was pulled on Patient #3's 08/14/2024 event no account notes were written but there should have been an explanation of what occurred. Interview revealed a consent form was signed by the patient but nothing to indicate if a nurse was called or what happened during the encounter. Interview revealed staff should have documented all information they received to explain the event note. If an encounter was canceled, interview revealed, notes should have indicated why it was canceled.

Interview on 4/10/2025 at 1550 with an OB Charge Nurse, RN #10, revealed patients were not placed on the OB log until they moved into OB triage. Interview revealed RN #10 generally did not write a note about an encounter when a patient arrived to the OB triage and was sent to ED for care.

Interview with MD #12 on 04/10/2025 at 1730 revealed MD #6 was a solo practice and was on call for the practice every day.

In summary, there was evidence that Patient #3 returned to the obstetrical triage area on 08/14/2024. An event was entered into the system to indicate a possible admission. The patient was not on an EMTALA log on 08/14/2024. An OB Charge Nurse stated OB patients would not appear on the OB log until they went brought into triage. Pt #3 was noted to be in the waiting room not in triage. The event was canceled without explanation of the reason for the "Entered in Error" note. There is documentation that Patient #3 arrived to the hospital OB triage waiting area seeking care but there was no evidence Patient #3 was offered or received a medical screening examination.