HospitalInspections.org

Based on review of documents and staff interviews, it was determined the hospital failed to follow policies and procedures regarding:

1. Ensuring a medical screening examination was provided to a pregnant woman complaining of abdominal pain and vomiting. (Patient #22)
2. Ensuring proper documentation was present in the medical record for a pregnant woman that left against medical advice. (Patient #7)
3. Ensuring a pregnant woman was offered all possible treatment and stabilization prior to discharge. (Patient #18)

Findings include:
1.
Policy titled, "EMTALA- Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to a Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination....DEFINITIONS: I. Emergency Medical Condition means: 1. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: a. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy ...L. Medical Screening Examination is the process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an Emergency Medical Condition exists or a woman is in labor. Such screening must be done within the facility ' s capability and available personnel, including on-call physicians ...The Medical Screening Examination is an ongoing process and the medical records must reflect continued monitoring based on the patient ' s needs and must continue until the patient is either stabilized or appropriately transferred ...Policy: Any individual who comes to the Hospital Property of Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exists ...D. Special Circumstances: Withdrawal of Request for Examination: ...2. If a patient leaves the Hospital without notifying Hospital personnel, this should be documented. The documentation must reflect that the patient had been at the Hospital and the time the patient was discovered to have left the premises ...."

Review of the hospital Emergency Department Log revealed Patient #22 arrived at the Emergency Department on 06/02/2024 at 12:48 with a presenting complaint of 13 weeks pregnant with abdominal pain and vomiting. Further review revealed Patient #22 was triaged at 13:11. Further review of the ED log review revealed Patient #22 was discharged on 06/02/2024 at 17:21 with disposition labeled Eloped: LWOT (left without treatment). Further review of the hospital Emergency Department Log for June 2024 revealed Patient #22 length of stay in the ED was 4 hours and 33 minutes without being evaluated by a medical provider for an Emergency Medical Condition.

Employee #3 confirmed on 11/20/2024 that Patient #22 left the ED before a MSE was performed.

2.
Policy titled, "EMTALA- Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to a Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination...If an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment with the Hospital's capabilities and/or are transferred if appropriate, all without regard to the patient's insurance coverage or ability to pay...D. Special Circumstances: Withdrawal of Request for Examination: 1. If a patient withdraws his or her request for examination or treatment, an appropriately trained individual from the emergency department staff should discuss the medical issues related to a voluntary withdrawal. In the discussion, the emergency department staff member should: a. Offer the patient further medical examination and treatment as may be required to identify and stabilize and/or Emergency Medical Condition; b. Inform the patient of the benefits or the examination and/or treatment, and of the risks of withdrawal prior to receiving the examinations and/or treatment; and c. Use reasonable efforts to get the patient to sign a form indicating that the patient has refused the recommended examination and/or treatment. The form should contain a description of risks discussed and of the examination and/or treatment that was refused ...2. If a patient leaves the Hospital without notifying Hospital personnel, this should be documented. The documentation must reflect that the patient had been at the Hospital and the time the patient was discovered to have left the premises ...."

Review of Patient #7 Emergency Department medical record physician documentation dated 03/21/2024 revealed: "...walk in with complaints of Abdominal pain 7 weeks preganant ...Differential diagnosis: Ectopic Pregnancy, Threatened abortion, Appendicitis, Colitis ...ED course: 0645 discussed again with patient and boyfriend the concerns regarding ectopic elevated white blood count, etc. She says she wants to leave but is convinced to stay ...0715 laying on the gurney to obtain the ultrasound she suddenly jumped up and says I am leaving, the ultrasound tech tries to reassure to stay but she refuses she grabs her clothes and runs to the exit. One of the nurses was able to take her IV out. Patient and boyfriend at this point are aware of the concerns regarding intra abdominal and intrauterine pathology and emergency. They understand the risks including miscarriage and death of the mother and baby. They have been encouraged to return at any time ...Disposition Summary: 03/21/2024 0725 Left Against Medical Advice ...."

Further review of Patient #7 Emergency Department medical record revealed no evidence of a completed Leaving Against Medical Advice form signed by the patient nor any documentation that staff attempted to get Patient #7 to complete the required form indicating the patient was refusing further care and treatment.

Employee #3 confirmed on 11/20/2024 that Patient #7 left against medical advice and the required AMA form was not present in the patient ' s medical record.

3.
Policy titled, "EMTALA- Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to a Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination...If an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment with the Hospital's capabilities and/or are transferred if appropriate, all without regard to the patient's insurance coverage or ability to pay...T. Stabilized with respect to an Emergency Medical Condition means that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from the facility or in the case of a woman in labor, that the woman delivered the child and the placenta. A patient deemed stabilized if the treating physician of the individual with an Emergency Medical Condition has been resolved ...U. To Stabilize means, with respect to an Emergency Medical Condition to either provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of individual form a facility or, in the case of a woman in labor, that the woman has delivered the child and the placenta ...V. Stable for Discharge: A patient is considered stable for discharge, when within reasonable clinical confidence, it is determined that the patient has reached the point where his/her continued care, including diagnostic work-up and/or treatment, could reasonably be performed as an outpatient or later as an inpatient, provided the patient is given a plan for appropriate follow-up care with the discharge instructions ...Policy: Any individual who comes to the Hospital Property of Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exists. If an Emergency Medical Condition is found to exist, the Hospital will (without regard for the patient ' s insurance coverage or ability to pay) provide: (a) stabilizing treatment within the capabilities of the Hospital and its staff (including on-call physicians and diagnostic services)...."

Review of Patient #18 Emergency Department provider note dated 05/18/2024 revealed: "....presents to the emergency department after leakage of fluid and some bleeding ...She is 16 weeks gestation with a Singleton pregnancy ...In the emergency department, fluid was essentially 0 ...Prognosis is very grim however, I did talk to the patient about antibiotic prophylaxis and her and her husband did decide to be admitted to labor and delivery for IV antibiotics ...ED Course: repeat ultrasound was performed at 3:50 p.m. there was no additional amniotic fluid, however cardiac tones were visualized on this effort at about 150-160 discussed in person with the OBGYN physician at the bedside who also visualized the ultrasound and agreed to admit the patient for oligohydramnios and observation in L and D ...Final Impression:Potentially rule out: IUFD ...Disposition Summary: Hospitalization ordered...."

Further review of Patient #18 Emergency Department medical record revealed no documented evidence that alternative treatments for stabilization were discussed or provided for Patient #18

Employee #3 confirmed on 11/20/2024, that Patient #18 was made Observation status with obstetrics and was given antibiotics.

Based on review of documents and staff interviews, it was determined the hospital failed to provide an MSE to a pregnant woman who presented to the Emergency Department with a complaint of abdominal pain (Patient #22). The patient waited approximately 4.5 hours before leaving the hospital without being seen by a medical provider.
Findings include:

Policy titled, "EMTALA- Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to a Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination....DEFINITIONS: I. Emergency Medical Condition means: 1. A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in: a. Placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy ...L. Medical Screening Examination is the process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an Emergency Medical Condition exists or a woman is in labor. Such screening must be done within the facility ' s capability and available personnel, including on-call physicians ...The Medical Screening Examination is an ongoing process and the medical records must reflect continued monitoring based on the patient ' s needs and must continue until the patient is either stabilized or appropriately transferred ...Policy: Any individual who comes to the Hospital Property of Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exists ...D. Special Circumstances: Withdrawal of Request for Examination: ...2. If a patient leaves the Hospital without notifying Hospital personnel, this should be documented. The documentation must reflect that the patient had been at the Hospital and the time the patient was discovered to have left the premises ...."

Review of the hospital Emergency Department Log revealed Patient #22 arrived at the Emergency Department on 06/02/2024 at 12:48 with a presenting complaint of 13 weeks pregnant with abdominal pain and vomiting. Further review revealed Patient #22 was triaged at 13:11. Further review of the ED log review revealed Patient #22 was discharged on 06/02/2024 at 17:21 with disposition labeled Eloped: LWOT (left without treatment).

Further review of the hospital Emergency Department Log for June 2024 revealed Patient #22 length of stay in the ED was 4 hours and 33 minutes without being evaluated by a medical provider for an Emergency Medical Condition.

Review of Patient #22 Emergency Department medical record dated 06/02/2024 revealed the following ED course:
12:51 Patient arrived in ED.
12:51 Patient moved to waiting
13:11 Triage completed
13:12 No physician assisted procedures were completed
13:13 Patient moved to ED waiting.

Further review of Patient #22 ED medical record dated 06/02/2024 revealed Patient #22 was triaged with an ESI of 3.

Further review of Patient #22 ED medical record dated 06/02/2024 revealed the following:
Outcome:
16:45 Eloped prior to medical screening exam.
17:20 Patient left the ED.
17:21 Patient left the ED.

Further review of Patient #22 ED medical record revealed a Physician Documentation note dated 06/02/2024 which revealed: "...Disposition Summary: 06/02/2024 17:20 Eloped, Disposition: Left Prior to Medical Screening Exam; Reason: Unknown reason ...."

Employee # 3 confirmed on 11/20/2024 that Patient #22 left the Emergency Department before a Medical Screening Examination was completed.

Based on review of documents and staff interview, it was determined the hospital failed to ensure:
1. proper documentation was present in the medical record for a pregnant woman that left against medical advice. (Patient #7)
2. a pregnant woman was offered all possible treatment and stabilization prior to discharge. (Patient #18)

Findings include:
1.
Policy titled, "EMTALA- Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to a Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination...If an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment with the Hospital's capabilities and/or are transferred if appropriate, all without regard to the patient's insurance coverage or ability to pay...D. Special Circumstances: Withdrawal of Request for Examination: 1. If a patient withdraws his or her request for examination or treatment, an appropriately trained individual from the emergency department staff should discuss the medical issues related to a voluntary withdrawal. In the discussion, the emergency department staff member should: a. Offer the patient further medical examination and treatment as may be required to identify and stabilize and/or Emergency Medical Condition; b. Inform the patient of the benefits or the examination and/or treatment, and of the risks of withdrawal prior to receiving the examinations and/or treatment; and c. Use reasonable efforts to get the patient to sign a form indicating that the patient has refused the recommended examination and/or treatment. The form should contain a description of risks discussed and of the examination and/or treatment that was refused ...2. If a patient leaves the Hospital without notifying Hospital personnel, this should be documented. The documentation must reflect that the patient had been at the Hospital and the time the patient was discovered to have left the premises ...."

Review of Patient #7 Emergency Department medical record physician documentation dated 03/21/2024 revealed: "...walk in with complaints of Abdominal pain 7 weeks preganant ...Differential diagnosis: Ectopic Pregnancy, Threatened abortion, Appendicitis, Colitis ...ED course: 0645 discussed again with patient and boyfriend the concerns regarding ectopic elevated white blood count, etc. She says she wants to leave but is convinced to stay ...0715 laying on the gurney to obtain the ultrasound she suddenly jumped up and says I am leaving, the ultrasound tech tries to reassure to stay but she refuses she grabs her clothes and runs to the exit. One of the nurses was able to take her IV out. Patient and boyfriend at this point are aware of the concerns regarding intra abdominal and intrauterine pathology and emergency. They understand the risks including miscarriage and death of the mother and baby. They have been encouraged to return at any time ...Disposition Summary: 03/21/2024 0725 Left Against Medical Advice ...."

Further review of Patient #7 Emergency Department medical record revealed no evidence of a completed Leaving Against Medical Advice form signed by the patient nor any documentation that staff attempted to get Patient #7 to complete the required form indicating the patient was refusing further care and treatment.

Employee #3 confirmed on 11/20/2024 that Patient #7 left against medical advice and the required AMA form was not present in the patient ' s medical record.

2.
Policy titled, "EMTALA- Medical Screening and Treatment of Emergency Medical Conditions", revealed: "...To ensure that individuals coming to a Valley View Medical Center's Dedicated Emergency Department seeking assessment or treatment for a medical condition, or coming to Hospital Property requesting (or obviously requiring) treatment for an Emergency Medical Condition receive an appropriate Medical Screening Examination...If an Emergency Medical Condition is determined to exist, such individuals are offered stabilizing treatment with the Hospital's capabilities and/or are transferred if appropriate, all without regard to the patient's insurance coverage or ability to pay...T. Stabilized with respect to an Emergency Medical Condition means that no material deterioration of the condition is likely, within reasonable medical probability, to result from or occur during the transfer of the individual from the facility or in the case of a woman in labor, that the woman delivered the child and the placenta. A patient deemed stabilized if the treating physician of the individual with an Emergency Medical Condition has been resolved ...U. To Stabilize means, with respect to an Emergency Medical Condition to either provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from or occur during the transfer of individual form a facility or, in the case of a woman in labor, that the woman has delivered the child and the placenta ...V. Stable for Discharge: A patient is considered stable for discharge, when within reasonable clinical confidence, it is determined that the patient has reached the point where his/her continued care, including diagnostic work-up and/or treatment, could reasonably be performed as an outpatient or later as an inpatient, provided the patient is given a plan for appropriate follow-up care with the discharge instructions ...Policy: Any individual who comes to the Hospital Property of Premises requesting examination or treatment is entitled to and shall be provided an appropriate Medical Screening Examination performed by a physician or other Qualified Medical Personnel to determine whether or not an Emergency Medical Condition exists. If an Emergency Medical Condition is found to exist, the Hospital will (without regard for the patient ' s insurance coverage or ability to pay) provide: (a) stabilizing treatment within the capabilities of the Hospital and its staff (including on-call physicians and diagnostic services)...."

Review of Patient #18 Emergency Department medical record revealed a physician documentation note dated 05/18/2024 revealed: "...presents to the emergency department after leakage of fluid and some bleeding ...She is 16 weeks gestation with a Singleton pregnancy ...In the emergency department, fluid was essentially 0 ...There was a good heart rate in the 150s ...Prognosis is very grim however, I did talk to the patient about antibiotic prophylaxis and her and her husband did decide to be admitted to labor and delivery for IV antibiotics ...She will be seeing me in the office on a weekly basis for lab work and close follow-up ...They both understand that there is a very high possibility that the baby will not survive ...Assessment/Plan: 1 g Zithromax by mouth
2 g ampicillin IV q 6hours for 48 hours and then patient will be discharged home with Augmentin
Regular diet
Heart tones Q shift
Patient understands there is a very high chance of intrauterine fetal demise
Once discharged, patient wishes to remain under my care for prenatal care and she will see me on a weekly basis for blood work and ultrasound in the office,
When discharged home,she will be on bedrest ...
Active Medications: Ampicillin 2 GM IV q 6H
Lactated ringers 1000ml one prn 999 ml/hr for fetal profusion-fetal distress ...
HPI: presents to emergency department with no fetal movement, vaginal bleeding. The estimated gestational age is 16 weeks ... Has had multiple evaluations at HRMC including previous ultrasounds revealing low volume amniotic fluid. Possible loss of additional gestations reported by patient and family ...the patient has been recently seen by a physician with similar presenting complaints and apparently given a diagnosis of Low amniotic fluid, possible loss of early gestation fetus ...Procedures: 1526 Emergency medicine ultrasound by physician in ED, Gravid pregnancy: Indications Vaginal Bleeding Views: Uterus, IUP, Other: Placenta; Other Oligohydramnios, Diagnosis: Fetal demise ...Differential diagnosis: Active labor, ectopic pregnancy, preeclampsia, rupture of membranes, vaginal bleeding, vaginal delivery, IUFD (intrauterine fetal demise)...ED Course: repeat ultrasound was performed at 3:50 p.m. there was no additional amniotic fluid, however cardiac tones were visualized on this effort at about 150-160 discussed in person with the OBGYN physician at the bedside who also visualized the ultrasound and agreed to admit the patient for oligohydramnios and observation in L and D ...Final Impression:Potentially rule out: IUFD ...Disposition Summary: Hospitalization ordered ...."

Further review of Patient #18 Emergency Department medical record revealed no documented evidence that alternative treatments for stabilization were discussed or provided for Patient #18

Employee #3 confirmed on 11/20/2024 that Patient #18 was made Observation status with obstetrics and was given antibiotics.