HospitalInspections.org

1. Based on interviews and document review, the hospital failed to enforce and maintain a central log as required in 42 CFR 489.20 (r)(3) and according to hospital policies and procedures.

2. Based on observations, interviews, and document review, the hospital failed to provide a medical screening examination to all patients who present to the emergency department requesting examination or treatment of a medical condition.

Based on interviews and document review, the hospital failed to maintain a central log on each individual, who comes to the emergency department, seeking assistance whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged.

Findings:

On 12/28/2016 at 11:20 a.m., the hospital policy titled, "EMTALA: General EMTALA Policy and Procedure 7/15" was reviewed. This policy documented, "Central Log is a log that the Hospital is required to maintain on each individual who 'comes to the emergency department' seeking assistance that documents whether he or she refused treatment, was refused treatment, or whether he or she was transferred, admitted and treated, stabilized and transferred or discharged."

On 12/28/2016 at 11:49 a.m., during an interview, Staff G stated any patient that "was registered" in gets on the Emergency Department log. Staff G stated registration consisted of completing paperwork. Staff G stated if a patient came to the ED in a emergent condition, the patient would be seen immediately. Staff G stated sometimes a patient will come to the window for advice only or would want to ask a question. Staff G stated the staff does not give out information, and the patient must register. Staff G stated that she worked all shifts and had never had a patient not register. Staff G stated the nursing staff completes the log at time of patient discharge.

On 12/12/2016 at 10:01 p.m., Patient #8 presented to the hospital's Emergency Department (ED). Patient #8 said that she might be having Braxton-Hicks or was in real labor. During an interview, Staff F stated Patient #8 never began the registration process. Patient #8 and the nurse on duty (Staff D) had a two minute conversation regarding her symptoms, the facility/ED services, and ED policies, including transportation to another facility. Patient #8 did not get triaged, or receive a medical screening examination. Patient #8 left the ED on 12/12/2016 at 10:10 p.m.

On 10/28/2016 at 11.42 a.m., the ED's central log was reviewed. The log included patients who were transferred, admitted and treated, stabilized and transferred or discharged. On 12/12/2016, Patient #8 was not entered on the log.

Based on observations, interviews, and document review, the hospital failed to provide a medical screening examination to all patients, who present to the emergency department requesting examination or treatment of a medical condition.

This failure potentially affects all patients with an emergency medical condition,who present to the emergency department, and could result in an untoward outcome for the patient.

Findings:

On 12/28/16 at 11:20 am, the hospital policy titled," EMTALA: General EMTALA Policy and Procedure" was reviewed. The policy documented, "It is the policy of the Physicians' Hospital in Anadarko...to provide within the capabilities of the emergency department...an appropriate Medical Screening Examination...by a qualified medical personnel to determine if an Emergency Medical Condition...(or with respect to a pregnant woman having contractions, wheither the woman is in labor)...".

On 12/12/16, at 10:01 pm, Patient #8 presented to the hospital's ED. Patient #8 told the registration clerk (Staff F) that she might be having Braxton-Hicks contractions or might be in real labor and that she was in pain. Staff F notified the RN on duty (Staff D). Staff D went to talk to Patient #8 near the check-in and waiting area. The video cameras captured the time Patient #8 presented and left the hospital.

The physician on duty (Staff C) stated he was notified of Patient #8's arrival and request to determine if she was in labor. Staff C was later told that Patient #8 had checked in, but left without being seen. Staff C was asked if he ever delivered babies in the hospital's ED, and he replied that he has delivered babies at the hospital.

Staff D said she told Patient #8 that the doctor must check her and advised her to register at the desk. Staff D said Patient #8 requested that the hospital put an electronic fetal monitor on her. Staff D said she told Patient #8 that the ED did not have a fetal monitor, but the doctor could check her. Staff D asked for the name of her obstetric doctor and if he had been notified of her current condition, which Patient #8 stated "no". Staff D stated she continued to gather more information regarding her concerns, including length of pregnancy, pregnancy history, OB-GYN information, onset and regularity of pain. However, there was no documentation of this information in a medical record or documentation on why the patient elected not to stay or be treated.

Staff F and Staff D stated Patient #8 asked if they could provide transportation for her to go to another facility and if the hospital staff could tell if her contractions were real or Braxton-Hicks. If her contractions were real, to provide a transfer by ambulance to her doctor. Staff D stated she told Patient #8 that she must check in. Another RN (Staff E) stated he heard Staff D explain that the hospital could not arrange ambulance transportation for someone unless they were a patient.

During interviews, Staff D and Staff F stated Patient #8 went to the waiting area and began talking on her cell phone. Staff D stated she returned to a treatment room to clean it so that Patient #8 could be "brought back". Staff D thought Patient #8 was talking to her doctor.

Staff D stated she went to get Patient #8 and she was gone. Patient #8 left the facility ED at 10:10 pm (per the ED camera) without registering or seeing a practitioner. Seventeen minutes later, Patient #8 gave birth to a baby boy in her vehicle on the roadside, and was assisted by a policeman and EMT providers. She and the baby were taken to another facility.

Patient #8 did not get triaged, or receive a medical screening examination to determine if she was in active labor. Although the hospital does not provide services for obstetrics, the ED has the capability of delivering emergency babies and has delivered a couple of babies in the last three months. All the ED staff had obstetric experience and training.