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Based on record review and interview, it was determined that the facility failed to comply with the requirements of 42 CFR 489.24 [special responsibilities of Medicare hospitals in emergency cases], specifically the failure to stabilize and transfer 1 of 6 laboring patients (#6) who presented to the hospital. See A 2407.

Based on record review and interview the facility failed failed to stabilize 1 of 6 laboring patients (#6) by their lack of action, ultimately compromising the health of the unborn baby and patient #6, a total of 21 medical records were reviewed. Findings include:

On 12/11/2012 at approximately 1530 during medical record review, of patient #6, it was revealed that the patient had been transferred via ambulance to St. John Hospital from Hospital A. Presenting with vaginal bleeding and placed in Labor and Delivery (L&D) Triage for treatment. The patient was between 17 to 23 weeks pregnant and was diagnosed with an "inevitable abortion." The patient arrived at the hospital at approximately 0400 and stayed until 1000, approximately 6 hours. During this time the patient was tachycardic (105-125 beats per minute). Her vaginal bleeding was not documented in an actual amount (recorded as "positive" or "normal show"). Her emotional status was not documented. Blood pressure was documented only two times during the 6 hour stay. Fetal heart tones were recorded at 167 beats per minute. The last heart rate documented for patient #6 was 122 beats per minute. The patient was discharged to a private vehicle at 1000 before delivering the fetus. In a progress note dated 10/25/12 (no time was recorded) it was documented by the physician "Inevitable abortion - expected management". The physician who saw the patient stated in a document titled "Rounds Report" dated 10/25/12 "Extremely poor neonatal outcomes due to prematurity, decreased chance of survival. Pt at this time wishes to be discharged as is considering termination for which she is given directions to go to [Hospital B]."

On 12/11/12 at approximately 1600 during an interview with staff N it was stated "We are a Catholic institution and we do not perform abortions here if there are fetal heart tones." This surveyor asked "Do you have a policy to support when you would perform the procedure?" The manager replied "No, I don't think we do." It was confirmed on 12/11/12 at approximately 1700 with staff B that no such policy existed.

On 12/11/12 at approximately 1630 during an interview with staff O, who had cared for patient #6, it was stated "I remember the patient wanted to have the abortion completed because she knew the baby would not make it. I checked the fetal heart tones again before she left and they were still present. I was hoping that they would not be, then we would be able to do the procedure." This surveyor then asked "I do not see much documentation on her vaginal bleeding. Was it excessive?" Staff O responded "I kept cleaning her up because she didn't like the blood and fluids on her. But, she wasn't gushing." This surveyor then asked "What is considered excessive bleeding?" After a pause, staff O stated "If she is gushing, or saturating a pad an hour I guess." This surveyor asked why the patient's heart rate was elevated. Staff O stated "She was emotional. Crying and upset. That's why I thought her heart rate was elevated at the time." This surveyor asked "Where did the patient plan on going when she left?" Staff O stated "She was instructed by the [medical] resident to go directly to [Hospital B] to have the procedure [to terminate the pregnancy]." This surveyor then asked "So when the patient left, she was bleeding an unknown amount, emotional, tachycardic and there was no real plan confirmed with the patient, regarding where she would go for the abortion, if she was going, and how she would safely get there?" Staff O stated "Yes, but I thought she was going to Hospital B with who ever picked her up. I think it was her mom or her aunt. I just saw her get in a car with a woman. Do you know if she got care at Hospital B and if she is OK?"

Patient #6 required emergency surgery and 7 units of blood at Hospital B on 10/25/2012. Considering the patient's unstable heart rate, emotional status and bleeding, the patient should have been transferred via ambulance to a facility that would treat her.