HospitalInspections.org

Based on interviews, record reviews, review of the Plan for the Provision of Care and review of Hospital and EMTALA (Emergency Medical Treatment and Labor Act) Policies and Procedures, Hospital # 1 failed to:

A. Ensure and appropriate Medical Screening Examination (MSE) was conducted for Patient Identifier (PI #1), a preterm pregnant female who presented with an elevated blood pressure and abdominal pain on 8/10/2013. Refer to findings under A2406.

B. Failed to provide stabilizing treatment on 8/10/13 for PI # 1, when Hospital # 1 had the capacity and capability to provide treatment.
Refer to findings under A2407.

C. Prevent the inappropriate transfer of PI # 1, a patient who required further evaluation and treatment to stabilize her EMC (Emergency Medical Condition), to another facility (Hospital # 2) when Hospital #1 had the capacity and capability to provide the necessary care on 08/10/2013. Refer to findings under A2409.

This deficient practice effected PI #1, one of 26 ED (Emergency Department) sampled patients and had the potential to effect other patients who presented to Hospital #1's Emergency Department with similar obstetrical symptoms.

Based on review of Patient Identifier # 1's medical record, review of hospital policies and procedures, review of Plan for the Provision of Care and interviews, Citizen's Baptist Medical Center (Hospital # 1) failed to provide an appropriate medical screening examination to include ancillary services routinely available to the emergency department to determine if a medical emergency condition existed for Patient Identifier (PI) # 1, a pregnant female who presented to the Emergency Department (ED. This failure affected one (PI#1) of 26 sampled patients.


Findings include:
A. PI # 1's Medical Record Review - Citizen's Baptist Medical Center (Hospital # 1):

Reason for Visit on 8/10/2103 at 16:02 PM : Contractions. Hurting since Monday.

Labor Admission History and Physical 8/10/2013 at 16:10:

Subjective:

Patient Identifier # 1 is a 22 year old Gravida 1 (a woman who is pregnant for the first time) Para 0 female with EDC (estimated date of confinement) 9/11/2013 at 35 and 3/7 weeks
gestation who is being admitted to L and D (Labor and Delivery) for labor evaluation. Her OB (obstetrician) is Dr. (physician's last name) in (name of town.) Current obstetrical history is significant for unknown history. Patient reports back and abdominal pain. Fetal movement: normal.


Objective:

Temperature: 100.5 F. (Fahrenheit) (Normal body temperature 98.6 F orally) (information obtained from WebMd website)
Pulse: 84
Respirations: 18
Blood Pressure: 173/96 (Blood pressure is high if the top number is more than 140 millimeters of mercury (mm Hg), or if the bottom number is more than 90 mm Hg.) Information obtained from WebMd website)


General: Alert. Appears stated age and cooperative.

Lungs/Heart: No documentation.

Abdomen: Soft, non-tender, bowel sounds normal, no organomegaly.


FHT (Fetal Heart Tones): 160 beats per minute.
Uterine Size: Size equals dates.
Presentation: Cephalic.
Cervix:
Dilation: Closed
Effacement: Long
Station: Floating
Consistency: Firm
Position: Posterior


Lab Review: OB (obstetrical) labs unknown.


Assessment / Plan:

35 and 3/7 weeks gestation (The period of development in the uterus from conception until birth; pregnancy).

Not in labor.

Obstetrical history significant for elevated BP and temp of 100.5.


Patient is stable enough to go by private car to Hospital # 2 for obstetrical care by her chosen OB provider. Advised patient she has elevated BP and temp and needs to do directly to Hospital # 2 Labor and Delivery for evaluation and treatment.


Discharge Orders:
Patient to go by private car to Hospital # 2 where her OB provider is on staff and delivers. She is to go directly there.


Nurse's Note:
RN (Registered Nurse) Note: Report called to Hospital # 2 Women's Unit about patient and VS (vital signs) given. Patient to go by car with family to Hospital # 2 to see her OB/GYN (physician). Report given to (name of RN).

Final Diagnosis: Other threatened labor, (Pre-term labor-onset of labor before 37 week gestation), antepartum (period before childbirth).


PI # 1 admitted as an outpatient to Hospital # 1's Labor and Delivery Unit at 16:02 and discharged at 16:18.



B. Policy and Procedure: Hospital # 1:

Policy Name: EMTALA Policy
Policy Number: CTZ ED 0004
Approved: May 24, 2013

... C. Policy
The hospital will comply with the following:

1. Provide an appropriate medical screening exam (MSE) to any individual who comes to the emergency department; including individuals who present to the hospital campus requesting emergency care or appearing to be in need of emergency care;

2. Provide necessary stabilizing treatment to an individual with an emergency medical condition (EMC) or an individual in labor;

3. Provide for an appropriate transfer of the individual if either the individual requests the transfer or the hospital does not have to capability or capacity to provide the treatment necessary to stabilize the EMC...

Policy Name: Obstetrical Patients that present to the ED (Emergency Department)
Policy Number: CTZ_WIS 0011 Approved June 23, 2009

Policy:

Obstetrical patients who present to the ED should first be asked if they have a physician that is presently caring for them for obstetrical services...

All obstetrical patients who are less than 20 weeks gestation, or who present with medical problems not related to pregnancy, should be assessed by the ED physician and the OB (Obstetrical) on call should be notified.

Procedure:
1) Determine pregnancy status of patient

2) Determine OB physician of patient

3) Determine gestational age of pregnancy

4) Determine whether complaints are or are not pregnancy related

5) Determine where patient should be treated (refer to above policy)

6) If pregnant, greater than 20 weeks gestation, with OB related complaints, notify OB nurse notified that patient is here, give patients name, chief complaint, physician and estimated date of conception and escort patient to the OB unit...

Plan for the Provision of Care (Hospital # 1):
Updated: 7/27/2013

...2. Women's Services of Hospital # 1 offers care for child bearing age women for pregnancies including normal deliveries, cesarean deliveries, medial treatment of pregnancy induced complications (hypertension, eclampsia...), assessment and prophylactic treatment of pre-term labor...


... 8. Emergency Department: The Emergency Department is a Level III emergency treatment facility which is open 24 hour a day, seven days a week. The purpose is to provide prompt, quality, professional medical and nursing care to all patients who present to the department ...

a) Scope of Care - The Emergency Department (ED) provides evaluation and treatment for patients with varying severity of illness and injury. ED patients are initially assessed by a Triage nurse to identify patients with life threatening, acute or urgent needs. Patients with life threatening, acute or urgent needs will be taken to the treatment area ... The ED physician evaluates the patients and orders diagnostic testing and treatment based on individual patient needs. The ED physician evaluates the patient's diagnostic tests and treatments to determine if the patient may be discharged or requires a sub-specialty consult for further treatment and/or admission to the hospital ...

C. Interviews:

Interview with on-call Obstetrician at Hospital #1, Employee Identifier
(EI) # 1, on 8/20/2013 at 2:30 PM:

The obstetrician stated he examined PI # 1 and determined she was not in labor. The physician said he thought the patient had preeclampsia (Preeclampsia - a condition during pregnancy when there is a sudden sharp rise in blood pressure, and swelling. Swelling tends to occur in face, hands and feet) based on her facial edema. (Presence of facial edema not documented in PI # 1's medical record.) The patient revealed the name of her obstetrician who practices in (name of town). According to PI # 1, she had been calling her obstetrician's office to report her complaint of abdominal pain. Allegedly, PI # 1 was told by staff that her obstetrician was out of town and she could not be seen until the following week.



EI # 1 (Obstetrician at Hospital # 1) advised PI # 1 she needed to be admitted because her blood pressure was elevated. According to EI # 1, he told the patient he was not refusing to admit her at Hospital # 1. According to EI # 1, he advised the patient a physician was on call for her attending obstetrician at Hospital # 2 and asked the patient what she wanted to do. The patient said she wanted to go to Hospital # 2. The obstetrician reported he advised the patient to go directly to Hospital # 2. "Looking back, I should have drawn lab, started an IV (intravenous access) and given meds (medications.)" The facility failed to ensure that an appropriate Medical screening examination was provided to include ancillary services (lab test, ultrasound) routinely available at the emergency department to determine whether or not on 8/10/2013 patient Identifier #1 had an emergency medical condition. This failure resulted in the lack of identification of an emergency medical condition for this patient (PI#1) and posed and immediate and serious threat to the patient and unborn child ' s health and safety and resulted in a delay in treatment and stabilization for this patient.



Interview with Registered Nurse (RN) Labor and Delivery, EI # 2 on 8/20/2013 at 3:00 PM:

EI # 2 was assigned to care for PI # 1 on 8/10/2013 when the patient presented to the Labor & Delivery (L & D) unit. The RN obtained the patient's blood pressure, 173/96 and temperature, 100.5, and reported the results to the obstetrician.


According to the RN, (EI # 1) examined the patient and determined the patient's cervix was closed. (EI # 1) told the patient her blood pressure and temperature was up a little, but she was not in labor. (EI # 1) and the patient discussed the fact that PI# 1's private physician was in (name of nearby town). (EI # 1) told the patient he understood if she wanted to deliver with her primary physician or she could let us take care of her at Hospital # 1. The patient said she wanted to go to (name of town where Hospital # 2 is located). The RN said (EI # 1) at Hospital 1 asked her to call the nurse in the Labor and delivery Unit at Hospital # 2. The RN removed the monitor and advised the patient to wait until she returned with the discharge "papers." However, the RN said the patient was gone when she returned to the room.


Interview with Registered Nurse (RN) Labor and Delivery, EI # 3 on 8/20/2013 at 4:10 PM:

The RN said the patient was seen on the Labor & Delivery unit versus the Emergency Department because she was greater than 20 weeks pregnant. EI # 3 said the patient was placed on a monitor and her vital signs were checked. EI # 3 overheard the obstetrician (EI # 1) tell the patient she was not in labor, but her blood pressure was high and the baby would probably need to be delivered. (EI # 1) advised the patient she could stay here (Hospital # 1) or she could go to (name of Hospital # 2) where her obstetrician was located. (EI # 1) advised the patient if she chose Hospital #2, she should proceed directly to Hospital # 2. The RN stated she could not hear the patient's response, but later was advised the patient left the unit.


The facility failed to ensure that their EMTALA policy (CTZ ED0004) was followed as evidenced by failing to ensure that when PI#1 Gravida 1 para 0 presented to the Emergency department on 8/10/2013 requesting emergency care ( Triage Report ...Patient reports.. back and stomach hurts, .....contractions: yes ... every 2-7 minutes.. pain yes ...constant..pain scale 6) or appearing to be in need of care ( " Labor admission History and physical... Obstetrical History significant for elevated BP and temp(temperature) 100.5 " ) received an appropriate medical screening examination.

Based on interviews, reviews of Patient Identifier (PI) # (Number) 1's medical record , EMTALA (Emergency Medical Treatment and Labor Act) Policies and Procedures, and Preeclampsia Foundation website, Hospital # 1 failed to provide stabilizing treatment for PI # 1. These actions resulted in a delay in treatment of PI # 1, who required stabilizing treatment at Hospital # 2 prior to transfer to Hospital # 3. This failure affected one of 26 sampled patients. This deficient practice affected PI # 1, one of 26 sampled patients, but has the potential to negatively impact all pregnant females who present to Hospital # 1 who are determined to have an Emergency Medical Condition and require stabilizing treatment.

Findings include:

Hospital # 1: EMTALA Policy
Policy Number: CTZ ED 0004
Approved: May 24, 2013
... C. Policy
The hospital will comply with the following:
...2. Provide necessary stabilizing treatment to an individual with an emergency medical condition (EMC) or an individual in labor..


1.) Review of PI # 1's Medical Record at Hospital # 1:

Reason for visit on 8/10/2103: Contractions. Hurting since Monday.

Labor Admission History and Physical 8/10/2013:

Subjective:

Patient Identifier # 1 is a 22 year old Gravida 1 Para 0 female with EDC (estimated date of confinement) 9/11/2013 at 35 and 3/7 weeks gestation who is being admitted to L and D (Labor and Delivery) for labor evaluation. Her OB (obstetrician) is Dr. (physician's last name) in (name of town.) Current obstetrical history is significant for unknown history. Patient reports back and abdominal pain. Fetal movement: normal.


Objective:

Temperature: 100.5 F. (Fahrenheit) (Normal body temperature 98.6) (Information obtained from WebMd website)
Pulse: 84
Respirations: 18
Blood Pressure: 173/96 (Blood pressure is high if the top number is more than 140 millimeters of mercury (mm Hg), or if the bottom number is more than 90 mm Hg.) (Information obtained from WebMd website)


Lungs/Heart: No documentation.

Abdomen: Soft, non-tender, bowel sounds normal, no organomegaly.

FHT (Fetal Heart Tones): 160 beats per minute.
Uterine Size: Size equals dates.
Presentation: Cephalic.
Cervix:
Dilation: Closed
Effacement: Long
Station: Floating
Consistency: Firm
Position: Posterior


Lab Review: OB labs unknown.


Assessment / Plan:

35 and 3/7 weeks gestation.

Not in labor.

Obstetrical history significant for elevated BP and temp of 100.5

Patient is stable enough to go by private car to Hospital # 2 for obstetrical care by her chosen OB provider.



Hospital # 2:

Triage Report:

Arrived: 8/10/2013 17:20
From: Another Hospital (Hospital # 1)
Via: Ambulatory

Final EDC (Estimated Date of Confinement): 9/11/2013

35 weeks, 3 days
Gravida: 1; Para: 0

Reason for Visit: Observation/ Evaluation

Chief Complaint: Back and stomach hurts

Patient Reports:
Activity Fetus: Active
Contractions: Yes
Frequency: 2 minutes to 7 minutes
Intensity: Mild
Membrane Status: Intact
Pain: Yes
Type: URQ (upper right quadrant) and back, constant
Scale: 6 Acceptable Level of Pain: 1


Fetal Heart Rate (FHR) Evaluation:
FHR: 180 bpm (beats per minute)
Variability: Minimal (less then equal to 5 bpm)
Acceleration: Absent
Deceleration: Absent

Vaginal Examination by nurse:

Dilation: 1
Effacement: 50 %
Station: - 3
Bleeding: None
Presentation: not documented

Vital Signs:

Blood Pressure: 192/115
Temperature: 102.2
Pulse: 96
Respirations: 24

Disposition:

Admitted 8/10/2013 at 18:10

Notes:

8/10/13:

17:19: Patient Type: Observation

17:27: FHR Mode: U/S started ?? ultrasound

17:27: UC (Uterine Contraction) Mode: TOCO (Tocolytic Monitor-medications used to suppress pre-mature birth; used for threatened preterm labor) started

17:29: 192/115

17:30: FHR Baseline: 175 bpm
Variability: Moderate
Accelerations: Present
Decelerations: Absent
Contractions: Irritability pattern

17:46: 183/105, 97

17:48: FHR Baseline: 180 bpm
Variability: Minimal
Accelerations: Absent
Decelerations: Early


18:00: U/C: Evaluation:
Frequency: 1.5 - 5 minutes
Duration: 40 - 90 seconds
Intensity: Mild per TOCO monitor

18:00: Oriented x 3
Edema: Non-pitting bilateral pedal
Patient complaints of epigastric pain and headache
Respiratory: Shortness of Breath
Visual Disturbances: Patient denies

18:03: Critical Lab (Platelets 20K-(normal reference range 150,000 - 400,000 platelets per microliter (mcL).)) marked decrease reported to RN
18:03: Family Practitioner Paged

18:04: 181/105, 92

18:08: Family Practitioner notified
18:08: Orders Received: PIH (Pregnancy Induced Hypertension) labs, start IV, start Magnesium (Mag.- Drug of choice in treatment of Preeclampsia ) 4 g (gram) bolus (a large dose of a substance/medication given by injection for the purpose of rapidly achieving the needed therapeutic concentration in the bloodstream). Coming in.

18:09: Primary IV initiated, Left wrist, LR (Lactated Ringers) 1000 ml (milliliters), Rate: 75 ml/hour

18:19: 180/109

18:40: Magnesium Sulfate 4 g bolus started; Family Practitioner at bedside

18:48: 177/100, pulse 100

19:04: Magnesium Therapy: 2 gm / hr per IV (intravenous)

19:05: 187/106, 104, respirations 16 per minute

19:06: Temperature: 101.6

19:19: 176/111; Labetelol (medication used to treat high blood pressure)10 mg. IV

19:33: 187/109

19:34: Labetelol 10 mg. IV

19:45: 178/106, pulse 105

19:46: Apresoline (medication used to treat high blood pressure)10 mg IV

19:51: Penicillin (medication used to treat infections)G (grams) 5 million units IV

19:53: 186/102

19:59: Apresoline 10 mg IV

20:01: 181/96, pulse 109

20:02: Labetelol 10 mg. IV

20:11: 165/87, 116

20:13: Labetelol 10 mg. IV

20:20: 173/89

20:30: Report called to Hospital # 3

20:30: FHR Evaluation:
Baseline: 165 bpm
Variability: Minimal
Accelerations: Present
Decelerations: Absent

20:30: U/C Evaluation
Frequency: 2-3 minutes
Duration: 50 -60 seconds

20:55: 165/94
20:55: Stadol (medication used for the management of pain)1 mg. IV

20:56: 162/84

21:00: To Hospital # 3 via EMS (Emergency Medical Services). FHT: 160's en route. BP: 140/80 during transport. Tolerated transfer without distress.


Labor and Delivery Admission History and Physical Assessment of Patient Identifier # 1:

Date: 8/10/2013
Time: 1900

G (Gravida): 1 P (Para): -
SROM (Spontaneous Rupture of Membranes): No


Chief Complaint: Pain, SOB (Shortness of Breath), swelling

Working EDD (Estimated Date of Delivery): 9/11/2013

EGA (Estimated Gestational Age) on Admission: 35 Weeks / 3 Days

Risk Factors: O positive...

Medications: PNV (Prenatal vitamin), Tramadol, Flexeril


Examination:

Temp: 102.5, Pulse 96, Blood Pressure 192/115


Comments:

HENT (Head, Ears, Nose, Throat): Facial edema
Chest: Decreased breath sounds on right, clear
Heart: Tachycardia, no murmur
Extremities: Edema
Abdomen: Soft, right flank tenderness

Presentation: Vertex (Baby's head enters the pelvis first).
Fetal Heart Rate: 180's, decreased variability
Dilation: 1
Effacement: 50 %
Station: -3
Position: Post Ferning
Consistency: Moderate


Assessment:

- Preterm pregnancy
- HELLP (Hemolysis, Elevated Liver Enzymes, Low Platelets) Syndrome (HELLP: A life-threatening pregnancy complication usually considered to be a variant of preeclampsia. H (hemolysis, which is the breaking down of red blood cells), EL (elevated liver enzymes) and LP (low platelet count). Symptoms reported by the pregnant woman developing HELLP syndrome may include one or all of the following: headache, nausea, vomiting, indigestion with pain after eating, epigastric (abdominal) or substernal (chest) tenderness and right upper quadrant pain (from liver distention), shoulder pain or pain when breathing deeply, bleeding, visual disturbances and swelling.
Signs to look for include: high blood pressure, protein in the urine
(Preeclampsia Foundation Website)

- Thrombocytopenia


Plan:

Patient presented from Hospital # 1 by personal vehicle with increased blood pressure, right flank pain, sob (shortness of breath) x 1 week.


Initial labs showed:

Platelets: 20k (normal reference range 150,000 - 400,000 platelets per microliter (mcL).)

Alt/Ast (Liver enzymes): 281/439

Total Bilirubin: 3.7 (normal ranges: 0.3 to 1.0 mg/dL {milligrams/deci-liter}) (Information obtained from WebMd website)


BUN(Blood Urea Nitrogen)/Creatinine: 12/1.0 (Lab to indicate kidney function)

Urine: 4 + Protein (normal: none) (Information obtained from WebMd website)


Discussed with Dr. (physician's first and last name at Hospital # 3) who will accept transfer.


Short Stay Summary - Hospital # 2:

History: The patient is a 22 year old gravida 1 at 35 weeks and 3 days gestation who presented to labor and delivery after being discharged from Hospital # 1 for "flank pain and elevated blood pressure." She states she has noted facial swelling for the past week. She has also had some increase in her lower extremity edema. She has been having right back and flank pain that has worsened over the past several; days. She initially presented to Hospital # 1 and was told to travel by personal vehicle to Hospital # 2 for further treatment and evaluation. On presentation, her blood pressure was 192/115, pulse 96 and temperature was 102.5.


Physical Examination:

Extremities: 2 + bilateral lower extremity edema noted.

Chest x-ray shows lungs are clear.


Assessment:
1. Preterm Pregnancy
2. HELLP Syndrome
3. Thrombocytopenia


Hospital Course: On arrival, the patient was given a 4 gram magnesium sulfate bolus (a large dose of a substance/medication given by injection for the purpose of rapidly achieving the needed therapeutic concentration in the bloodstream). This was continued at 2 grams per hour. She was also started on Labetelol IV and at present has received 40 mg of Labetelol and 20 mg of Hydralazine IV. Currently, her blood pressures are in the 150s/80s.

She was also contracting on arrival and initially had contractions every 5 to 8 minutes. The contractions have increased to every two minutes. Her cervical exam was unchanged after one hour.


The patient was discussed with (name of physician at Hospital # 3). Due to low platelets and the risk of bleeding with delivery, the physician accepted transfer of the patient. The patient will be transferred to Hospital # 3 via ambulance. The patient was also started on "GBS" protocol due to her preterm status.


B. Interview:

Interview with the on-call Obstetrician at Hospital #1, Employee Identifier (EI) # 1, on 8/20/2013 at 2:30 PM:

The obstetrician stated he examined PI # 1 and determined she was not in labor. The physician said he thought the patient had pre-eclampsia based on her facial edema. (Facial edema not documented in PI # 1's medical record.)...

EI # 1 (Obstetrician at Hospital # 1) advised PI # 1 she needed to be admitted because her blood pressure was elevated. According to EI # 1, he told the patient he was not refusing to admit her at Hospital # 1.

According to EI # 1, he advised the patient a physician was on call for her attending obstetrician at Hospital # 2 and asked the patient what she wanted to do. The patient said she wanted to go to Hospital # 2. The obstetrician reported he advised the patient to go directly to Hospital # 2. "Looking back, I should have drawn lab, started an IV (intravenous access) and given meds (medications.)"

The facility failed to ensure that their policy and procedure was followed as evidenced by failing to provide necessary stabilizing treatment as required for PI #1 on 8/10/2013.

Based on medical record reviews, interviews and review of Policy and Procedure, Hospital # 1 failed to arrange an appropriate transfer for Patient Identifier (PI) # 1, a 35 week pregnant unstable patient with an elevated blood pressure (BP), from Hospital # 1 to Hospital # 2; hospital # 1 also failed to send PI # 1's medical record to Hospital # 2; and failed to effect an appropriate transfer through qualified personnel and transportation. As a result, PI # 1 was transferred to Hospital # 2 for treatment and required subsequent transfer to Hospital # 3, resulting in further delay of treatment.




Findings include:


Hospital # 1: Policy and Procedure: Maternal Transfers

Policy Number: CTZ WIS 0044

Effective Date: 4/11/2012


A maternal transfer should be considered when clinical conditions include but are NOT limited to preterm labor or ruptured membranes at less than 35 weeks gestation... or high risk conditions such as diabetes and hypertension are poorly controlled. Transfer contraindications include but are not limited to insufficient stabilization...


Procedure:

1. The referring physician should provide a documented informed consent discussion with the patient or family member if the patient is unable to consent, concerning the need for a transfer... Signed consent for transfer should be obtained...


2. The referring physician should communicate directly with the receiving physician... and should complete transfer forms and document transfer orders.


3. A copy of the patient's prenatal and antenatal hospital record will accompany the patient.


4. Ensure there is at least one secured intravenous site.


5. The nurse should verify all ordered medications have been administered prior to transport....


PI # 1 presented to Hospital # 1 on 8/1/0/2013 with complaints of contractions, and was evaluated by Employee Identifier (EI # 1)/ Obstetrician (OB). EI # 1 determined PI # 1 had an elevated BP and temperature, but was stable enough to go to Hospital # 2 by private care for obstetrical care by her chosen OB physician. The facility failed to effect a transfer through qualified personnel and transportation equipment, as required, including the use of necessary and medically appropriate life support measures as evidenced by instructing and allowing patient identifier #1, to go to Hospital #2 which was 23 miles away via private vehicle for obstetrical care. PI #1 presented to hospital #1 with complaint of back pain, reported contractions (labor), elevated temperature, and elevated blood pressure, and required transportation equipment and personnel appropriate to her individuals needs on 8/10/2013.


There was no documentation by Hospital # 1's staff to indicate that PI # 1's medical records were sent with the patient when she was directed to go to Hospital # 2 by private care. There was no documentation in the medical record to indicate that EI # 1 at Hospital # 1 contacted the on-call physician/obstetrician at Hospital # 2 regarding the transfer of PI # 1 prior to directing PI # 1 to Hospital # 2 via private vehicle.


An interview was conducted on 8/20/13 at 2:30 PM with Employee Identifier (EI) # 1, Obstetrician at Hospital #1. EI # 1 stated that he examined PI # 1 and determined she was not in labor. The physician said he thought the patient had preeclampsia based on her facial edema (Presence of facial edema, which was not documented in PI # 1's medical record.)


EI # 1 (Obstetrician at Hospital # 1) advised PI # 1 she needed to be admitted because her blood pressure was elevated. According to EI # 1, he told the patient he was not refusing to admit her at Hospital # 1. According to EI # 1, he advised the patient a physician was on call for her attending obstetrician at Hospital # 2 and asked the patient what she wanted to do. The patient said she wanted to go to Hospital # 2. The obstetrician reported he advised the patient to go directly to Hospital # 2. "Looking back, I should have drawn lab, started an IV (intravenous access) and given meds (medications.)"


The facility failed to follow its own Maternal Transfer policy (Policy Number: CTZ WIS 0044) by failing to provide and effect an appropriate transfer of PI #1 on 8/10/2013.