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Based on reviews of medical records, policies and procedures, Motherhood Center Outpatient registration log and complaint letter, and interviews, the facility failed to ensure that an appropriate medical screening examination was provided to an obstetrical patient who was 32 weeks pregnant and complaining of shortness of shortness of breath, which was within the capabilities of the hospital ' s emergency department to include ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition exists for 1 of 24 sampled patients (SP#1). Refer to findings in Tag A-2406.
Based on reviews of medical records and policies and procedures, the failed facility to ensure that stabilizing treatment was provided for an individual that was within the capabilities of the staff and facilities at the hospital for further medical examination and treatment as required to stabilize the medical condition for 1 of 24 sampled patients (SP #1) who was 32 weeks pregnant. Refer to findings in Tag A-2407.

Based on reviews of medical records, policies and procedures, Motherhood Center Outpatient registration log and complaint letter, and interviews, the facility failed to ensure that an appropriate medical screening examination was provided to an obstetrical patient who was 32 weeks pregnant and complaining of shortness of shortness of breath, which was within the capabilities of the hospital ' s emergency department to include ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition exists for 1 of 24 sampled patients (SP#1).

The findings:

Review of sampled patient (SP) #1 face sheet showed that the admit date/time to the facility was on 09/09/2015 at 01:43 AM. Her demographic information was completed, but there was no discharge date, chief complaint or diagnosis documented on the sheet.
There is no documented information recorded of the patient being triaged by the Emergency Department (ED) Nurse or that a medical screening evaluation for SP # 1 on 9/9/2015 when she presented to the ED and the hospital ' s obstetrical unit. There was no documentation that vital signs (Blood pressure, pulse, respirations, temperature, and pulse oximetry) were completed or that the patient was assessed by the ED triage Nurse or by a Nurse in the obstetrical unit.

Review of the "Motherhood Center Outpatient Registration Log," dated 09/09/2015 noted the patient (SP#1) arrived at 01:50 AM through the ER (Emergency Room). The chief complaint/reason for visit was listed as " IUP (intrauterine) pregnancy 32 week ' s shortness of breath. The disposition condition was "sent to ER for evaluation."
Review of a copy of a letter sent via the hospital ' s internet dated 09/18/2015 showed a complaint was made due to a refusal at the Labor and Delivery department. The letter documented, I was rushed at night due to shortness of breath. I'm 32 weeks pregnant. Since I wasn't in labor and they didn't have a doctor at the time to see me. I was never checked or seen by any nurse to make sure that my unborn baby was okay or that I was okay. They had me from L&D (Labor & Delivery) to the ER (Emergency Room) and back and forth. When I got to the front desk, the two ladies in the front were very gentle and professional and immediately called labor and delivery due to the fact that I'm 32 weeks pregnant. One of the ladies asked me if I was cramping, which I said only a little bit. She immediately told me that once I was taken to labor and delivery to say that I was cramping a little strong, if not the labor and delivery wouldn't see me since I was not in labor. I was taken upstairs by a nurse in a wheelchair, he also told me to say I was cramping, if not they weren't going to see me. Once I got to labor and delivery, the nurse asked me what was wrong, my boyfriend told him that I was cramping and that I couldn't breathe. Once he said, I couldn't breathe one of the nurses jumped immediately to call the guy who had taken me upstairs to come back because they couldn't see me, since I wasn't in labor and they didn't have a doctor to check me at that moment. The other two nurses told him to take me to the ER and once the ER was done doing an x-ray to make sure that I didn't have a blood clot then they were going to take me upstairs again to monitor me. I told them that I was 32 weeks pregnant and they said that it didn't matter that I still had to go to ER. The whole time I was there, they never checked my pulse, my temperature or check to make sure that my baby was okay. I didn't want to be in that back and forth from ER to Labor and Delivery, so I took my wristband off to walk out to go to another hospital. In Labor and Delivery, one nurse told me, to not walk out, to sit in the wheelchair, while another one told her, to let me go since I wanted to go home. Once the nurse took me to ER, we walked out because they were going to send me again to labor and delivery. I was never checked or seen by any doctor or nurse.

During interview on 09/29/2015 at 9:40 AM, the Director of Admitting stated, when the patients come to the emergency room they come to the window and fill out the information sheet, we put their demographic information into the computer, and then they go to the triage nurse who medically assesses them.

During interview on 09/29/2015 at 9:46 AM, the Director of Emergency Services stated, patients less than 20 (twenty) weeks stay here in the emergency department and those patients that are greater than 20 weeks with a medical complaint, the labor personnel will come down and assess them if it is a non-labor complaint. They are either cleared and stay here and eventually go home, or they will go upstairs to labor/delivery. He also stated, when a patient comes into the Emergency Room they are registered and screened by the Triage Nurse. When asked if SP# 1 was screened, he stated he did not know because he could not find the paper work.


During interview on 09/29/2015 at 10:40 AM, the Labor and Delivery Nurse Manger stated, the non-laboring patients go to triage and through the ED (Emergency Department). If they are not in labor, we get a FHR (fetal heart rate), if we can ' t handle the patient, we get an order from the OB (Obstetrician) and then transfer the patient to the emergency department. Sometimes they get triaged in OB (Obstetrics/Labor and delivery) and we monitor them. She stated, SP#1 was not assessed because she complained of shortness of breath and was sent back to the emergency room.

During interview on 09/29/2015 at 2:34 pm, the Director of the ED stated, SP #1 pre-registered and was assigned a medical record number and was given a band. She was seen in triage. There was a conversation and a quick account creation. She should have gone upstairs.

The Director of Labor and Delivery stated, on 09/29/2015at 3:45 PM, SP #1 was placed on our Labor and Delivery log. The log states, she was (SOB) short of breath and that she was sent to the emergency department and they would see her.



During interview (Staff N) an emergency department nurse stated on 10/02/2015 at 12:30 PM, I work in the triage area 3-4 shifts a week. As for pregnant patients greater than 20 weeks with a medical complaint, they remain in the ED and we call the Labor and Delivery department staff, one of the ED techs would escort the patient upstairs. Today, we had a staff meeting and moving forward, pregnant patients greater than 20 weeks with an OB complaint will be evaluated in the ED, and we will speak to the patient and get their chief complaint, and assess as needed. If non-related to the pregnancy and greater than 20 weeks, they will remain in the ED, and will go through the same process as the medical. This part has not changed.

During interview (Staff O) a registered nurse who works in Labor and Delivery (triage) and Postpartum department stated on 10/02/2015 at 1:25 PM, when we get a patient from the ED we place them on the monitor, obtain an admission number, obtain orders, call the doctor, and put the patient into the system. We then obtain FHT (Fetal Heart Tones), initial vitals, and initial complaint. Even if they come from the ED we have to see what is going on first. If the patient complains of SOB we put in a consult or call the doctor. Normally we don't send them downstairs unless they are cleared. The Director of Labor and Delivery then stated, if there is labored breathing, we call a "rapid response," then we would not move the patient.

The Director of Patient Access and Admissions stated on 10/02/2015 at 2:05 PM, the registration form is what the patient fills out so we can initiate the admission number, we scan it into the WEB (computer) system for that particular account. Once we do the other forms, we have them sign and then we scan them, and it (the form) is sent to medical records to be a part of the record.


Review of the facility ' s policy, "Obstetrical Patient Care in the Emergency Department, (review date 07/2015) documented, it is the policy of the hospital that patients who present to the Emergency Department for obstetrical care, or are in need of a obstetrical evaluation, regardless of physician assignment (staff, non-staff or none) will follow the guidelines within this policy. (The emergency department is available to the labor and delivery staff in the event of an emergency). The procedure: #5- Patient with an EGA (Estimated Gestational Age) of 20 weeks gestation or more with a non-pregnancy related complication will be evaluated and treated in the emergency department with the assistance of the labor and delivery staff, which will be notified to float to the ED to care for the patient/fetus. #6. An Emergency Department record must be completed on all patients who are evaluated or treated in the emergency department, either by the Emergency Department physician or the patient's private attending physician.

Review of the facility ' s policy, "Medical Screening" (review date 07/15) documented, the procedure: #2- Triage Nurse will interview all registered patients and verify: (a) include the reason for coming to the Emergency Room, Assessment will include chief complaint, subjective comments from patients, objective observations; (g) vital signs on all patients to include: Temp (temperature), pulse, respirations, B/P (blood pressure) pulse ox (oximetry) on all medical patients.

The facility policy, "OB Triage In Labor And Delivery" (dated 07/15) documented, obstetric patient at 20 weeks of gestation or greater, through 6 weeks postpartum, will be evaluated in the obstetric labor and delivery unit in accordance with Emergency Medical Treatment and Labor Act (EMTALA) regulations. The procedure: A registered nurse will assess the patient which will consist of a complete maternal and fetal assessment prior to calling the physician.

The facility policy, " Emergency Medical Treatment and Active Labor Act (EMTALA)/ Emergency Access policy" revised 2/15, documented, the hospital shall provide a medical screening examination to any individual who comes to the emergency department.

The facility failed to ensure that their policies and procedures were followed as evidenced by failing to ensure that an appropriate medical screening examination was provided by a physician or qualified medical personnel to include ancillary services (laboratory studies, Fetal heart tones, cardiac monitoring, Electrocardiogram, etc.) routinely available to the emergency department to determine whether or not an emergency medical condition existed for SP#1 on 9/9/2015. The facility also failed to ensure that on 9/9/2015 a maternal and fetal assessment was completed as stated in their Obstetrical Triage Labor and delivery Policy and Procedure when SP #1 who was 32 weeks pregnant presented to the obstetrical unit.

Based on reviews of medical records and policies and procedures, the facility failed to ensure that stabilizing treatment was provided for an individual that was within the capabilities of the staff and facilities at the hospital for further medical examination and treatment as required to stabilize the medical condition for 1 of 24 sampled patients (SP #1) who was 32 weeks pregnant.

The Findings included:

The medical record for SP #1 dated 9/9/2015 was reviewed. Review of the Condition of Services form revealed in part, " Consent to medical and surgical procedures " was signed by the patient and registrar. The consent specified in part, " I (SP#1) consent to the procedures which may be performed during this hospitalization or while I am an outpatient or emergency department patient. These may include but not limited to emergency treatment... "

The facility ' s policy entitled, " Emergency Medical Treatment and Active Labor Act/Emergency Access Policy " Policy # 200.13, last revision date 2/15 was reviewed. The policy documented in part, The Hospital will: (a) provide to an individual who is determined to have an emergency medical condition such further medical examination and treatment as is required to " stabilize " the emergency medical condition. "
The hospital failed to ensure that their stabilization Policy and Procedure were followed as evidenced by failing to provide stabilizing treatment as required to SP#1 when she presented to the Emergency Department (ED) and the Labor and Delivery Unit requesting medical assistance for her complaint of shortness of breath and being 32 weeks pregnant.

Based on reviews of medical records, policies and procedures, Motherhood Center Outpatient registration log and complaint letter, and interviews, the facility failed to ensure that an appropriate medical screening examination was provided to an obstetrical patient who was 32 weeks pregnant and complaining of shortness of shortness of breath, which was within the capabilities of the hospital ' s emergency department to include ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition exists for 1 of 24 sampled patients (SP#1). Refer to findings in Tag A-2406.
Based on reviews of medical records and policies and procedures, the failed facility to ensure that stabilizing treatment was provided for an individual that was within the capabilities of the staff and facilities at the hospital for further medical examination and treatment as required to stabilize the medical condition for 1 of 24 sampled patients (SP #1) who was 32 weeks pregnant. Refer to findings in Tag A-2407.

Based on reviews of medical records, policies and procedures, Motherhood Center Outpatient registration log and complaint letter, and interviews, the facility failed to ensure that an appropriate medical screening examination was provided to an obstetrical patient who was 32 weeks pregnant and complaining of shortness of shortness of breath, which was within the capabilities of the hospital ' s emergency department to include ancillary services routinely available to the emergency department to determine whether or not an emergency medical condition exists for 1 of 24 sampled patients (SP#1).

The findings:

Review of sampled patient (SP) #1 face sheet showed that the admit date/time to the facility was on 09/09/2015 at 01:43 AM. Her demographic information was completed, but there was no discharge date, chief complaint or diagnosis documented on the sheet.
There is no documented information recorded of the patient being triaged by the Emergency Department (ED) Nurse or that a medical screening evaluation for SP # 1 on 9/9/2015 when she presented to the ED and the hospital ' s obstetrical unit. There was no documentation that vital signs (Blood pressure, pulse, respirations, temperature, and pulse oximetry) were completed or that the patient was assessed by the ED triage Nurse or by a Nurse in the obstetrical unit.

Review of the "Motherhood Center Outpatient Registration Log," dated 09/09/2015 noted the patient (SP#1) arrived at 01:50 AM through the ER (Emergency Room). The chief complaint/reason for visit was listed as " IUP (intrauterine) pregnancy 32 week ' s shortness of breath. The disposition condition was "sent to ER for evaluation."
Review of a copy of a letter sent via the hospital ' s internet dated 09/18/2015 showed a complaint was made due to a refusal at the Labor and Delivery department. The letter documented, I was rushed at night due to shortness of breath. I'm 32 weeks pregnant. Since I wasn't in labor and they didn't have a doctor at the time to see me. I was never checked or seen by any nurse to make sure that my unborn baby was okay or that I was okay. They had me from L&D (Labor & Delivery) to the ER (Emergency Room) and back and forth. When I got to the front desk, the two ladies in the front were very gentle and professional and immediately called labor and delivery due to the fact that I'm 32 weeks pregnant. One of the ladies asked me if I was cramping, which I said only a little bit. She immediately told me that once I was taken to labor and delivery to say that I was cramping a little strong, if not the labor and delivery wouldn't see me since I was not in labor. I was taken upstairs by a nurse in a wheelchair, he also told me to say I was cramping, if not they weren't going to see me. Once I got to labor and delivery, the nurse asked me what was wrong, my boyfriend told him that I was cramping and that I couldn't breathe. Once he said, I couldn't breathe one of the nurses jumped immediately to call the guy who had taken me upstairs to come back because they couldn't see me, since I wasn't in labor and they didn't have a doctor to check me at that moment. The other two nurses told him to take me to the ER and once the ER was done doing an x-ray to make sure that I didn't have a blood clot then they were going to take me upstairs again to monitor me. I told them that I was 32 weeks pregnant and they said that it didn't matter that I still had to go to ER. The whole time I was there, they never checked my pulse, my temperature or check to make sure that my baby was okay. I didn't want to be in that back and forth from ER to Labor and Delivery, so I took my wristband off to walk out to go to another hospital. In Labor and Delivery, one nurse told me, to not walk out, to sit in the wheelchair, while another one told her, to let me go since I wanted to go home. Once the nurse took me to ER, we walked out because they were going to send me again to labor and delivery. I was never checked or seen by any doctor or nurse.

During interview on 09/29/2015 at 9:40 AM, the Director of Admitting stated, when the patients come to the emergency room they come to the window and fill out the information sheet, we put their demographic information into the computer, and then they go to the triage nurse who medically assesses them.

During interview on 09/29/2015 at 9:46 AM, the Director of Emergency Services stated, patients less than 20 (twenty) weeks stay here in the emergency department and those patients that are greater than 20 weeks with a medical complaint, the labor personnel will come down and assess them if it is a non-labor complaint. They are either cleared and stay here and eventually go home, or they will go upstairs to labor/delivery. He also stated, when a patient comes into the Emergency Room they are registered and screened by the Triage Nurse. When asked if SP# 1 was screened, he stated he did not know because he could not find the paper work.


During interview on 09/29/2015 at 10:40 AM, the Labor and Delivery Nurse Manger stated, the non-laboring patients go to triage and through the ED (Emergency Department). If they are not in labor, we get a FHR (fetal heart rate), if we can ' t handle the patient, we get an order from the OB (Obstetrician) and then transfer the patient to the emergency department. Sometimes they get triaged in OB (Obstetrics/Labor and delivery) and we monitor them. She stated, SP#1 was not assessed because she complained of shortness of breath and was sent back to the emergency room.

During interview on 09/29/2015 at 2:34 pm, the Director of the ED stated, SP #1 pre-registered and was assigned a medical record number and was given a band. She was seen in triage. There was a conversation and a quick account creation. She should have gone upstairs.

The Director of Labor and Delivery stated, on 09/29/2015at 3:45 PM, SP #1 was placed on our Labor and Delivery log. The log states, she was (SOB) short of breath and that she was sent to the emergency department and they would see her.



During interview (Staff N) an emergency department nurse stated on 10/02/2015 at 12:30 PM, I work in the triage area 3-4 shifts a week. As for pregnant patients greater than 20 weeks with a medical complaint, they remain in the ED and we call the Labor and Delivery department staff, one of the ED techs would escort the patient upstairs. Today, we had a staff meeting and moving forward, pregnant patients greater than 20 weeks with an OB complaint will be evaluated in the ED, and we will speak to the patient and get their chief complaint, and assess as needed. If non-related to the pregnancy and greater than 20 weeks, they will remain in the ED, and will go through the same process as the medical. This part has not changed.

During interview (Staff O) a registered nurse who works in Labor and Delivery (triage) and Postpartum department stated on 10/02/2015 at 1:25 PM, when we get a patient from the ED we place them on the monitor, obtain an admission number, obtain orders, call the doctor, and put the patient into the system. We then obtain FHT (Fetal Heart Tones), initial vitals, and initial complaint. Even if they come from the ED we have to see what is going on first. If the patient complains of SOB we put in a consult or call the doctor. Normally we don't send them downstairs unless they are cleared. The Director of Labor and Delivery then stated, if there is labored breathing, we call a "rapid response," then we would not move the patient.

The Director of Patient Access and Admissions stated on 10/02/2015 at 2:05 PM, the registration form is what the patient fills out so we can initiate the admission number, we scan it into the WEB (computer) system for that particular account. Once we do the other forms, we have them sign and then we scan them, and it (the form) is sent to medical records to be a part of the record.


Review of the facility ' s policy, "Obstetrical Patient Care in the Emergency Department, (review date 07/2015) documented, it is the policy of the hospital that patients who present to the Emergency Department for obstetrical care, or are in need of a obstetrical evaluation, regardless of physician assignment (staff, non-staff or none) will follow the guidelines within this policy. (The emergency department is available to the labor and delivery staff in the event of an emergency). The procedure: #5- Patient with an EGA (Estimated Gestational Age) of 20 weeks gestation or more with a non-pregnancy related complication will be evaluated and treated in the emergency department with the assistance of the labor and delivery staff, which will be notified to float to the ED to care for the patient/fetus. #6. An Emergency Department record must be completed on all patients who are evaluated or treated in the emergency department, either by the Emergency Department physician or the patient's private attending physician.

Review of the facility ' s policy, "Medical Screening" (review date 07/15) documented, the procedure: #2- Triage Nurse will interview all registered patients and verify: (a) include the reason for coming to the Emergency Room, Assessment will include chief complaint, subjective comments from patients, objective observations; (g) vital signs on all patients to include: Temp (temperature), pulse, respirations, B/P (blood pressure) pulse ox (oximetry) on all medical patients.

The facility policy, "OB Triage In Labor And Delivery" (dated 07/15) documented, obstetric patient at 20 weeks of gestation or greater, through 6 weeks postpartum, will be evaluated in the obstetric labor and delivery unit in accordance with Emergency Medical Treatment and Labor Act (EMTALA) regulations. The procedure: A registered nurse will assess the patient which will consist of a complete maternal and fetal assessment prior to calling the physician.

The facility policy, " Emergency Medical Treatment and Active Labor Act (EMTALA)/ Emergency Access policy" revised 2/15, documented, the hospital shall provide a medical screening examination to any individual who comes to the emergency department.

The facility failed to ensure that their policies and procedures were followed as evidenced by failing to ensure that an appropriate medical screening examination was provided by a physician or qualified medical personnel to include ancillary services (laboratory studies, Fetal heart tones, cardiac monitoring, Electrocardiogram, etc.) routinely available to the emergency department to determine whether or not an emergency medical condition existed for SP#1 on 9/9/2015. The facility also failed to ensure that on 9/9/2015 a maternal and fetal assessment was completed as stated in their Obstetrical Triage Labor and delivery Policy and Procedure when SP #1 who was 32 weeks pregnant presented to the obstetrical unit.

Based on reviews of medical records and policies and procedures, the facility failed to ensure that stabilizing treatment was provided for an individual that was within the capabilities of the staff and facilities at the hospital for further medical examination and treatment as required to stabilize the medical condition for 1 of 24 sampled patients (SP #1) who was 32 weeks pregnant.

The Findings included:

The medical record for SP #1 dated 9/9/2015 was reviewed. Review of the Condition of Services form revealed in part, " Consent to medical and surgical procedures " was signed by the patient and registrar. The consent specified in part, " I (SP#1) consent to the procedures which may be performed during this hospitalization or while I am an outpatient or emergency department patient. These may include but not limited to emergency treatment... "

The facility ' s policy entitled, " Emergency Medical Treatment and Active Labor Act/Emergency Access Policy " Policy # 200.13, last revision date 2/15 was reviewed. The policy documented in part, The Hospital will: (a) provide to an individual who is determined to have an emergency medical condition such further medical examination and treatment as is required to " stabilize " the emergency medical condition. "
The hospital failed to ensure that their stabilization Policy and Procedure were followed as evidenced by failing to provide stabilizing treatment as required to SP#1 when she presented to the Emergency Department (ED) and the Labor and Delivery Unit requesting medical assistance for her complaint of shortness of breath and being 32 weeks pregnant.