HospitalInspections.org

Based on a review of the Labor and Delivery (L&D log), a copy of the "No Record Statement", review of policies and procedure, and staff interviews, it was determined that the facility failed to make a Central Log entry for one (1) out of 20 sampled patients (Patient #1) when Patient #1 presented to the Women's Services entrance on 8/8/2020 with her two (2) children and was denied entrance due to the facility's COVID policy.

Findings were:

A review of the facility's Labor and Delivery (L&D) Log for 8/9/2020 revealed Patient #1 had not been entered into the Women's Services log when Patient #1 presented to the Women ' s Services entrance reporting that she was 28 weeks pregnant and bleeding.

A review of the "No Records Statement "provided by the facility revealed there was no medical record generated for Patient #1 for this visit.

Review of facility Visiting and Contacting A Patient Visitation Guidelines, Effective 7/24/20, revealed the following:
To help prevent the transmission and spread of the COVID-19 coronavirus, the Hospital is taking precautions to protect patients, family members, staff, and the community. Entry to the hospital and specialty facilities is restricted. Visitors will not be accepted at the Hospital.
Exceptions to the Visitor Policy:
--Women ' s Services will continue to permit one support person/care partner per patient.
--L&D patients are allowed one support person of the mother's choosing for the duration of the hospital stay. No substitutions are allowed.
--There may be additional exceptions as determined by hospital leadership for patients receiving end-of-life care, rapid decline in condition, emergency care, behavioral health concerns, or other unique patient conditions.
--The Hospital reserves the right to reduce visitation access at any time based on public health and safety concerns.
Visitor Screening Guidelines and Requirements, Visitors are required to:
--Wear a facemask/cloth face covering at all times while in the hospital,
--Perform frequent hand hygiene,
--Remain in the patient's room or other designated area, and
--Comply with the guidelines or they will be asked to leave the facility.
Visitors will be screened for symptoms of acute respiratory illness in accordance with the Centers for Disease Control and Prevention (CDC) guidelines before entering the facility:
--Visitors with a positive screen will not be permitted to enter the facility.
--Visitors with a negative screen will receive a colored armband each day. The band must be worn for the duration of each daily visit.
Infection control and prevention measures are always a priority at the Hospital. Our Infection Control specialists and clinical leadership have a coordinated and comprehensive plan to handle infectious disease patients, adhering to the CDC ' s recommendations and guidelines for prevention, surveillance, and treatment.

Review of facility policy entitled "Access to Emergency Medical Treatment," policy number F-013, effective 1/30/2020, revealed an appropriate medical screening examination (MSE) was to be provided to any person who comes to the ED or L&D Department and requests examination or treatment. If the MSE indicates the existence of an emergency medical condition (EMC), the Hospital will provide further examination and treatment to stabilize the medical condition or arrange an appropriate transfer to another medical facility in accordance with the following procedures.
PROCEDURES:
C. RECORD KEEPING
1. Daily Logs. The ED and L&D Department will each maintain daily logs of all persons presenting for medical examination or treatment, which will include patient disposition. Such logs shall also indicate if patients were transferred from another facility. Logs will be maintained for a minimum of five (5) years following the date of service.
D. VIOLATIONS OF POLICY. Any Hospital employee who becomes aware of a violation of this policy or any other incident indicating a need for further education or corrective action shall promptly report such incident to the Department Manager and Risk Management Department.

STAFF INTERVIEWS:

During an interview on 5/4/2021 at 1:10 p.m. in the Conference Room, RN FF explained that she has been a nurse for 22 years and has worked in the facility ' s L&D Unit for 15 years. RN FF stated her official title is "Team Leader" and that she is also an L&D relief Charge Nurse (CN). RN FF confirmed that on 8/9/2020 she was the L&D CN. She explained that she received a call from the COVID Screener (Clinical Informative Clinician GG) informing her that there was a lady at the Women ' s Services entrance who was bleeding, cramping, and was reportedly 28 weeks pregnant. RN FF said the COVID Screener explained that she was unable to let Patient #1 in because Patient #1 had her children in the car. RN FF said that on 8/9/2020 the policy allowed one (1) support person but no children under 18 years of age were allowed. RN FF said the COVID Screener explained that Patient #1 appeared to be upset and had gotten back in her car. RN FF said she told the COVID Screener that she would be right down to speak with Patient #1. RN FF said when she got to Patient #1's car she could see that Patient #1 was visibly upset. RN FF explained that she asked Patient #1 what was going on. Patient #1 replied that her (Patient #1 ' s) partner was out of town and she had no one available to watch her children. RN FF said Patient #1 explained that she had been informed that she could not come in with her children. RN FF said she informed Patient #1 that RN FF worked in the L&D department and that that was not the case. RN FF said her shift coordinator/Supervisor OO arrived and they both tried to get Patient #1 to come into the department and be evaluated. RN FF said she told Patient #1 not to think that the interaction Patient #1 had was reflective of how things were done in L&D.
RN FF said she and Supervisor OO tried numerous times to get Patient #1 to come into the department, but Patient #1 continued to refuse. RN FF said Patient #1 informed her that her OB physician was on vacation and that she was going to a nearby hospital where she had a friend that could watch her children.
RN FF said she did not think to get a refusal of care form signed because Patient #1 had not registered.
RN FF confirmed that she received EMTALA training upon hire and annually.

During a telephone interview on 5/4/2021 at 1:40 p.m. in the Conference Room, Clinical Informatics Clinician RN GG explained that she has worked at the facility for 26 years, and in her current position for 10 years. RN GG said that on 8/9/2021 Patient #1 came to the Women ' s Services entrance and reported that she was "here for a doctor ' s appointment". RN GG said it was Sunday and that she informed Patient #1 that no physicians had appointments during the weekend. RN GG said she also informed Patient #1 that no children were allowed per Hospital policy. RN GG explained that she asked Patient #1 if there was someone that could watch the children and Patient #1 replied "no". RN GG said Patient #1 left the building, then came back in yelling that she was bleeding. RN GG said that she told Patient #1 that she (RN GG) was going to get Patient #1 some help.
RN GG said she called the L&D CN and RN FF came down and went outside to speak with Patient #1. RN GG confirmed that she has not had EMTALA training.

During an interview on 5/4/2021 at 2:00 p.m. in the Conference Room, Security Officer EE explained that he has worked at the facility for 17 months. Security Officer EE said he recalled the situation with Patient #1, but that during Patient #1 and RN GG's conversation he was standing outside and could not hear the conversation. Security Officer EE said Patient #1 came out and asked for his name. He said he held up his name badge so the Patient could see his name. Security Officer EE said that he did see RN FF go out to speak with Patient #1 but that he could not hear the conversation. Security Officer EE said he is a hospital employee, but he has not received EMTALA training.

During an interview on 5/4/2021 at 2:45 p.m. in the Conference Room, Operation Manager for Women ' s Services NN confirmed that the Women ' s Services RN/Supervisor OO that was working 8/9/2020 no longer worked at this facility and was unavailable for an interview. She also confirmed that there were no video recordings from August 2020.