The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

Based on record review, document review, policy and procedure review, staff interview and patient interview, the facility failed to provide one (1) of 21 patients reviewed, Patient #21:

1. an appropriate medical screening exam within the capability of the hospital;

2. necessary stabilizing treatment to an individual in labor; and

3. an appropriate transfer of a woman in labor if benefits outweigh risks and requested by the woman.

Findings Include:

Cross Refer to C-2406 for the facility's failure to provide an appropriate Medical Screening Exam within the capability of the hospital for Patient #21.

Cross Refer to C-2407 for the facility's failure to provide Patient #21 with necessary stabilizing treatment when she presented to the Emergency Department in labor.
Based on document review, patient interview, staff interview and policy review, the hospital failed to provide an appropriate medical screening within the capability of the hospital for Patient #21, one (1) of 21 patients reviewed.

Findings Include:

Emergency Department Log review revealed no documented evidence that Patient #21, who was in active labor, was logged in as a patient at Hospital #1.

An interview was held with the Administrator on 7/07/14 between 2:15 p.m. and 2:30 p.m. He stated that he probably knew which person was involved in the investigation. He proceeded to discuss a pregnant woman who came to the ED. He stated that the nurse told her and her mother that "We don't deliver babies here" and that she should go to a hospital that does deliver babies. The Administrator also stated that the nurse had worked at this facility for a long time and had stated that she knew she should not have told that to the patient. The nurse was suspended for three (3) days. The last baby delivered in their hospital was 06/20/2012.

On 7/07/17 at 2:50 p.m. the Director of Nursing (DON) was asked to show where in the ED the delivery of a baby would be done, if needed. Observation of the room, designated for that purpose, revealed a table equipped with stirrups. The tables's drawers contained numerous supplies for female patient care. There was an Emergency Obstetrical (OB) Kit, and an Isolette that contained the items needed when a baby is first born (eye drops, material for foot printing, infant resuscitation supplies ...).

On 7/08/14 between 9:30 a.m. and 9:55 a.m. an interview was held with Registered Nurse (RN) #2. The nurse hand wrote and signed her account of what she remembered about the nightshift on 6/26/14 when an OB patient presented to the ER (emergency room ). In her written statement she stated: "On 6/26/14 on night shift, admission clerk came to ER dept (department) stating, "There's a pregnant lady out here." No other information given. Went to ER waiting room and pt was there. Ask pt who was her OB doctor and pt stated OB doctor was in Jackson and that is where she was to deliver. Asked pt how she arrived at (Hospital #1)... Pt states she was visiting with her mother in Mendenhall and her mother brought her here. Jokingly I said to pt, "Well, y'all passed by the hospital that delivers baby. We don't normally deliver babies." Did not tell pt that she could not be seen and assessed. Mother walks in and I told her the same and before any other questions could be asked, mother tells pt to "Come on...let's go." Pt leaves facility. While talking to the mother I did not state for pt to go to (Hospital #2) Both pt and mother neither requested any desire to see a physician or receive any medical screening to me during the process of talking with patient."

Review of the "Job Description" for the Job Title: Registered Nurse (approved on July 1, 2011) revealed: ...the RN performs under the direct supervision of the Director of Nursing and is delegated an assignment by the coordinator to achieve quality patient care ....
Qualifications: Mental Demands: ...this includes the ability to set priorities. Goals that measure physician partnerships that drive more effective patient care: 1. Collaborates with physicians (and other members of the patient care team) in a manner to ensure a patient will have access to services required and will achieve quality clinical outcomes and efficiency."

An interview was held with the Admissions Clerk on 7/08/14 between 11:00 a.m. and 11:20 a.m. He had previously written his account of what occurred in the ED Waiting Room on 6/26/14 at approximately 8:15 p.m. The clerk's written statement stated:
"Thursday, June 26, 2014 Night
(Patient #21) entered (Hospital #1) through the Admission/ER doors.
(Patient #21) was noticeably pregnant and clutching her stomach.
I, (clerk's name) exited the admissions office to see about her.
After seeing that she was hurting, (Patient #21) verified this.
I asked her to come into the admission office so she could sit down.
I told (Patient #21) that I would be right back and that I would go get a nurse. I told her that I felt it was a good idea to have a professional better assess her situation. He found a nurse to come out and check on her. The nurse entered the Admission Office and asked Patient #21 how far along she was with her pregnancy. (Patient #21) replied that she was around 37 weeks. The nurse asked where her primary doctor was located. She told the nurse he was in Jackson and that she lived in (a neighboring county). The nurse told the patient that our facility was unable to provide proper care for child deliveries and that she would be in better hands if she went to (Hospital #2) for an assessment and treatment. A lady came in then who was with (Patient #21). The nurse voiced that she believed it would be better if (Patient #21) was taken to (Hospital #2) for better treatment, due to their facility not being equipped to handle delivery and prenatal care. Both (Patient #21) and the lady with her voiced their understanding and they then exited the hospital..."

Telephone interview with Patient #21 on 7/09/14 between 2:45 p.m. and 2:58 p.m. revealed that she was at Hospital #1's Emergency Department (ED) on 6/26/14 at approximately 8:15 p.m. She stated that she had been in St. Dominic Hospital earlier that week and they had told her she was two (2) centimeters dilated, but not in labor. On 6/26/14 she was at her mother's house and started hurting so her mother drove her to Hospital #1. In the ED a white male came out in the waiting room to see her, and then he went to get a nurse. She stated, "I started hurting so bad. I told the black nurse that I needed to be checked." The black nurse stated, "We don't do pregnant women and haven't in 30 years." Patient #21 stated that no one in the ED checked her. As she was leaving the black nurse stated, "I'm sorry there's nothing we can do." Patient #21 said that her mother drove her directly to Hospital #2 (approximately 32 minutes away), she was taken immediately from the ED to Labor and Delivery and she delivered her five (5) pound -eight (8) ounce baby boy a little over an hour later. She stated that this was her second child and they were both doing well.

Review of Hospital #1's "Transfer and Triage Categories" policy (Revised March, 2010) revealed: "1V. Evaluating Emergency Patients:
When any patient presents to the emergency department and a request is made for treatment or evaluation, emergency room personnel must provide an appropriate medical screening exam to determine whether or not an Emergency Medical Condition exists or if the patient is in Active Labor ...A determination is made by the evaluator as to whether the patient is in Active Labor or is experiencing an Emergency Medical Condition. If the patient is in active labor, emergency department personnel must provide treatment to the patient ... ".

Review of Hospital #1's "Emergency Department Triage/Treatment Policy And Procedure" (Revised March 2010) revealed:
"II. Medical Screening Examination...The ER provider will make a determination regarding whether the patient has an EMC (Emergency Medical Condition) only after the MSE (Medical Screening Exam) is performed and the results shall be documented. If the patient's condition is deemed to be an EMC, necessary stabilizing treatment will be rendered or an appropriate transfer will be arranged.
According to U.S. Code: Title 42,1395dd the term emergency medical condition means: A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) such that the absence of immediate medical attention could reasonably be expected to result in 1) 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, 2) serious impairment of bodily function, or 3) serious dysfunction of any bodily part or organ.
With respect to a pregnant woman who is having contractions - 1) that there is inadequate time to effect a safe transfer to another hospital before delivery, or 2) that the transfer may pose a threat to the health or safety of the woman or the unborn child.
*Patients that are under 2, over 65, Pregnant, psychiatric, on dialysis, in active military, or patients in custody of law enforcement will be seen regardless of the results of the Medical Screening Examination.
III. Registration Process - Every patient who comes to (Hospital #1's) Emergency Department will be seen...everyone who comes to (Hospital #1's) Emergency Department seeking treatment will receive a Medical Screening Examination (MSE) to determine if there is an Emergency Medical Condition (EMC)...Step 2: The MSE is conducted by the Doctor or Nurse Practitioner..."

Review of Hospital #1's "emergency room Screening Examination" (Revised March 2010) revealed:
"All patients have a right to a medical screening examination...
If you have a medical emergency or are in labor, you have the right to receive within the capabilities of this hospital's staff and facilities: An appropriate medical screening examination, Necessary stabilizing treatment (including treatment for an unborn child) if necessary, An appropriate transfer to another facility...
Every patient who comes to (Hospital #1's) Emergency Department will be seen...everyone who comes to (Hospital #1's) Emergency Department seeking treatment will receive a Medical Screening Examination (MSE)..."

Review of Hospital #1s "Emergency Services Policies and Procedure Manual" (approved October 01, 2013) revealed:
"ADMISSION - A. Any patient who presents himself to the emergency room is eligible for a medical screening examination ... D. An initial Medical Screening Examination and appropriate treatment of true emergencies will be offered to all patients... G. Standing procedures on admissions are as follows: 1. All patients are assessed and observed for physical findings...
Procedures Not To Be Done In The Emergency Department -
D. Births. Routinely and whenever possible, maternity patients in labor should be transported immediately upon being assessed unless they are greater than six (6) centimeters dilated and a birth is imminent. "

Review of Hospital #2's Admission record for Patient #21 revealed:
admitted /Time: 06/26/14 20:45 (8:45 p.m.)
Reason For Admission: Onset of Labor
LD - Admission Assessment 06/06/14 21:00
Pain Scale - 10 (scale of 1 to 10 with 10 being the highest)
Contractions - Frequency (min) 2 Duration (sec) 50-70 Quality - Strong
Vaginal Exam - Dilatation 7-8 Effacement (%) 100
EGA (Estimated Gestitional Age) 37.4 (weeks)
Delivery Summary: 06/26/14 22:46 (10:46 p.m.)
Delivery Complications: Precipitous Labor (<3hrs)
Based on patient interview, staff interview, and policy review, the facility failed to provide Patient #21, one (1) of 21 patients reviewed, further examination and treatment as required to stabilize the medical condition.

Findings Include:

Cross Refer to C-2406 for the facility's failure to provide Patient #21 with stabilization treatment when she presented to the Emergency Department in labor.