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.
|WELCH COMMUNITY HOSPITAL||454 MCDOWELL STREET WELCH, WV 24801||April 30, 2015|
|VIOLATION: COMPLIANCE WITH 489.24||Tag No: A2400|
|Based on document review, record review and staff interview it was determined the facility failed to ensure staff complied with the regulations for EMTALA at 489.20 and 489.24. The facility failed to provide an appropriate Medical Screening Exam to an individual whom presented to the emergency department (see tag A 2406), failed to provide necessary stabilizing treatment to an individual with an Emergency Medical Condition, or an individual in labor, and failed to enact an appropriate transfer (see tag A 2409).|
|VIOLATION: MEDICAL SCREENING EXAM||Tag No: A2406|
|**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**
Based ondocument review, record review and staff staff interview it was determined the facility failed to provide an appropriate medical screening examination for patients who presented to the Emergency Department (ED) and requested treatment. This deficient practice was identified in one (1) of one (1) records reviewed (patient #1). This failure has the potential for patients to not receive appropriate care and services.
1. Hospital policy titled, "Emergency Delivery Of Obstetrics (OB)", last reviewed 4/13, states, in part: "If a patient is in labor and her delivery is inevitable, the infant is delivered by the doctor on call in the emergency room . Blood pressure, pulse, temperature, respirations, pulse oximeter and fetal heart tones are performed on arrival. The ED physician may call the OB physician on-call for consultation regardless of complaint ANY TIME it is deemed necessary."
2. Review of Patient #1's medical record revealed the patient (MDS) dated [DATE] at 9:10 p.m. with complaints of lower abdominal pain and back pain. The patient stated she was thirty-eight (38) weeks pregnant, her water broke and this was her third (3rd) pregnancy. The patient was triaged at 9:10 p.m., and no fetal heart tones were performed. She was medically screened by the ED physician at 9:13 p.m. The medical record revealed the screening exam did not include ongoing evaluation of fetal heart tones, regularity and duration of uterine contractions, fetal position and station, cervical dilation, and status of the membranes. The ED physician documented he performed a cursory exam of the heart, lungs and abdomen. He also documented a vaginal exam was not performed.
3. During a telephone interview conducted on 04/29/15 at 10:00 a.m. with the ED physician, he stated he does not perform vaginal exams very often and he is uncomfortable with the exams. There was an OB physician on-call, but he never thought to contact him regarding the patient.
4. The above record was reviewed with the ED Nurse Manager on 04/29/15 at 11:30 a.m. and she stated she concurred with the findings.
|VIOLATION: APPROPRIATE TRANSFER||Tag No: A2409|
|Based on document review, record review and staff interview it was determined the facility failed to provide stabilizing treatment within its capability and capacity, and to enact an appropriate transfer for one (1) of twenty (20) records reviewed (Patient #1). This failure has the potential to negatively impact all patients when an inappropriate transfer is enacted without providing stabilizing treatment to minimize risks to the individual's health.
1. The Hospital Policy titled, "Patient Transfer", last reviewed on 3/13, states, in part: "It is the intent of this facility to provide the receiving medical facility with all medical records (or copies thereof), and any pertinent medical documentation related to the medical condition of the patient being transferred. It is of VITAL importance that the physician documents the risks versus the benefits of transfer, and this information be discussed with the patient being transferred by the physician. It is also of VITAL importance the patient's condition be documented by the physician prior to transfer. Copies of all pertinent medical records and a transfer form shall accompany the patient to the receiving medical facility. The facility should telephone a report to the Registered Nurse (RN) on duty in the Emergency Department (ED) prior to the patient leaving the facility, and transfer the patient with qualified personnel and transportation equipment as required, including the use of necessary medically appropriate life support measures."
2. Review of Patient #1's medical record revealed the ED physician documented the patient as being stable for transfer without performing the required medical exam for a woman in labor. Treatment was not provided to minimize the risks of transfer and the ED physician did not obtain the consent of the receiving hospital to accept the transfer before the patient left the facility. The patient's chart was completed after she had left the facility by ambulance and all pertinent records were not sent with her to the receiving hospital. The patient was transferred by ambulance with only Basic Life Support certified personnel, and there was no ongoing monitoring for fetal heart tones. The patient left the facility at 9:22 p.m. and delivered the infant in the ambulance at 9:30 p.m.
3. During a telephone interview conducted on 04/29/15 at 10:00 a.m. with the ED physician, he stated: "I did not contact the receiving facility about the transfer. I assumed the triage RN had already given report to the ED physician. I felt the patient was stable enough for transfer because we were on Obstetric Diversion and did not have sufficient staff to provide care for the mother and baby if she would deliver in the ED. I did contact the facility to speak with the ED physician after the patient had left by ambulance."
4. Documentation in the medical record revealed the ED physician did not contact the receiving facility to obtain consent for the transfer. The patient's medical records, including the transfer forms, were faxed to the receiving facility after the patient actually left the hospital by ambulance. Documentation was present in the medical record of the physician contacting the facility after the patient had already left by ambulance.
5. The above record was reviewed with the ED Nurse Manager on 04/29/15 at 11:30 a.m. and she concurred with the findings.