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 and interview, the facility failed to ensure inappropriate transfers are reported within 72 hours of the event, in 1 of 20 medical records reviewed (1). The cumulative effect of this deficiency potentially affects all patients transferred to the facility.

Findings include:

The facility failed to report an inappropriate transfer within 72 hours of the event, in 1 of 20 medical records reviewed (1).
Based on record review and interview, the facility failed to report an inappropriate transfer within 72 hours of the event, in 1 of 20 medical records reviewed (1). This deficiency directly affects patient #1 and potentially affects all transfers to the facility.

Findings include:

Per review of Patient #1's medical record on 10/18/17 at 3:00 PM, it revealed Patient #1 arrived in the Emergency Department on 10/12/17 at 6:32 PM via ambulance with complaints of abdominal pain and cramping. Per the emergency room Record completed by Physician E, Patient #1 was 20 weeks pregnant. The physical exam included palpation of contractions every 2-4 minutes, fetal heart tones of 125-130, and a closed, firm cervix (opening to uterus). The Plan included transfer to another facility that can to obstetric care. Just prior to transfer a vaginal exam revealed the cervix was softening, and the external os (opening at top of vagina) was more open.

Per review of the ambulance report dated 10/12/17, it states, "Pt (Patient #1) was walked to the Shell Lake Emergency Department (from jail) where the nurse on staff took Pt blood pressure, made a phone call and then stated to Pt and jail staff that Pt could not be seen there and they may want to call an ambulance to transport Pt. Jail staff stated They walked Pt back to jail where they called (this facility) ED (Emergency Department) and were told that yes (the facility) would accept the Pt."

Per interview with Emergency Department Manager C on 10/18/17 at 4:03 PM, Manager C said s/he received a phone call from the nurse that night (10/12/17) who said "I just received a phone call from police and I think it's an EMTALA." Manager C said s/he began investigating the next day.

Per telephone interview with Registered Nurse D on 10/18/17 at 4:23 PM, s/he said the deputy had called and said "...Shell Lake would not check out the patient."

Per interview with Director of Nursing A and Chief Executive Officer B on 10/18/17 at 2:35 PM, they said "We consulted the legal team, they said we had 72 hours from discovery" Director A said they consulted attorneys on 10/13/17, and left messages with Centers for Medicare and Medicaid Services phone numbers on 10/16/17.

Interview on 10/18/17 at 10:13 AM with Registered Nurse K revealed Patient #1 came from jail by foot complaining of contractions. Nurse K said s/he called the physician, who said the patient should be transported to a hospital that does obstetrics.

Per interview with Physician J on 10/19/17 at 2:28 PM, s/he was in the clinic when called and told (Patient #1) was 7 months pregnant. Physician J said "I told the nurse to tell (Patient #1) we don't deliver babies anymore. If not in distress, should go to her OB (obstetrician)."

Per interview with Deputy H on 10/19/17 at 3:33 PM, s/he walked Patient #1 to the emergency room (about 2 blocks away from jail) because the patient was complaining of severe cramping. Per Deputy H "We were taken into the exam room, the nurse put on a blood pressure cuff, asked how far along she was, her birth date and basic questions...The nurse left the room, came back and out while on the phone...Came back in the room and said 'Well you're gonna have to take her to Rice Lake...safest thing to do, call an ambulance." Deputy H said s/he was "dumbfounded" and walked Patient #1 back to jail, called (this facility) and an ambulance.