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WELLSPAN EPHRATA COMMUNITY HOSPITAL 169 MARTIN AVENUE EPHRATA, PA 17522 Feb. 7, 2020
VIOLATION: MEDICAL SCREENING EXAM Tag No: A2406
Based on a review of facility policy and staff interviews (EMP), it was determined that Wellspan Ephrata Community Hospital failed to provide a medical screening examination to a patient that presented to the Family Maternity Unit.

A review of facility policy On-Call Coverage, Medical Screening Examinations, (EMTALA)...Policy: Wellspan Ephrata Community Hospital (Hospital) will provide and document medical screening examinations, patient transfers and discharges in accordance with the COBRA 1986 Emergency Medical Treatment and Active Labor Act ("EMTALA"), 42 U.S.C. 1395, and all related Federal regulations. ... Purpose: To assure that (1) all patients who come to the hospital concerned with having an emergency medical condition receive appropriate Medical Screening Examination; (2) patients with an emergency medical condition are stabilized; (3) patients requiring a transfer are transferred appropriately; (4) staff are prospectively aware of which physicians are available on call to provide necessary treatment; and (5) adequate signage is in place for patients to have the opportunity to review their rights to a medical screening examination and stabilization for an emergency medical condition. ... Definitions: 1. Active Labor means the process of childbirth beginning with the latent or early phase and continuing through the delivery of the placenta. A women experiencing contractions is considered to be in labor unless a physician or midwife certifies that, after a reasonable time of observation, the woman is in false labor ... 3. Comes to the emergency department means, with respect to an individual requesting examination to treatment that the individual is on the hospital property. For the purpose of this section, "property" means the entire hospital campus, including the parking lots, sidewalks, and driveways ... 4. Emergency Medical condition means: a) A medical condition manifesting itself by acute symptoms or sufficient severity (including severe pain, active labor; psychiatric disturbances and/or symptoms of substance abuse) 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 ... b) With respect to a pregnant woman who is having contraction; ... 5) Qualified Medical Providers are: ... b) In the Labor &Delivery unit: i) Physicians ... ii) Advanced Practice Clinicians (Certified Nurse Midwives, Nurse Practitioners and Physician Assistants). iii Labor & Delivery Nurses. ... 6) Stabilized means, with respect to an "emergency medical condition" as defined in this policy. to provide such medical treatment of the condition as may be necessary to assure, within reasonable medical probability, that no deterioration of the condition is likely to result or occur during the transfer of the individual; or with respect to an Emergency Medical Condition involving a pregnant woman; that the woman has delivered (including the placenta) ... Responsibilities of Hospital, Hospital Personnel, and Physician: 1) Medical Screening Exam (MSE): ... h. No action by Hospital or any of its staff should suggest that the patient leave the Hospital prior to an MSE ... ."

A review of facility policy Family Maternity Unit revealed "... Purpose: ... This policy specifically addresses the performance of a medical screening examination on pregnant women through the use of medical staff approved protocols to be used by qualified RN staff in compliance with State and Federal Regulations ... Procedure Steps: Pregnant Patients Enters Labor and Delivery Unit: A. Immediate assessment of status of labor is made. 1. If delivery is imminent -Call Provider. 2. and prepare for immediate delivery. 3. If delivery is not imminent continue assessment ... Assessment of Labor Process: A. Abdominal palpation ... B. Assess position of presenting part ... C. Vaginal Examination ... 1. Determine the status of membrane ... 2. Determine descent of presenting part ... Determine the state of the cervix ... 4. Assess bleeding ... D. Assessment of fetal well-being: 1. Identify fetal heart rate patten with application of a Doppler or an electronic fetal monitor ... Qualified to Perform Labor Medical Screening Exam: A. A health care provider with appropriate obstetric clinical privileged who is physically present in the Labor and Delivery Department ... ."

An interview was conducted February 6, 2020, with EMP7 revealed, "was woken by a phone call from the birthing center who talked to a 1st time mom who was leaking and wanted to transfer care. Spoke to the nurse at desk about patient coming in and to expect paperwork. Both said (nurse and Midwife) that the NICU was on divert and I tried for 20 minutes to call Birth Care and unable to reach anyone to tell them NICU was on divert.
Patient arrived at the hospital and met her at the door making her aware NICU on divert, and that the baby may need NICU and would be sent out. Mother said she didn't want separated from her baby. I asked her a few questions and one was "are you leaking, and patient said 'no', patient said baby moving well and I did not feel in active labor. Patient wanted to know what choices were available. I called Women's and Babies and spoke with Labor and Delivery Facilitator. Did do a visual assessment and discussing patient was stable. Did the best assessment I could without admitting her. If I examined her, I would have had to charge her and was trying to keep from charging her. Had she presented in any other way, except stable, I would have made her stay. When asked if she was aware that the patient had ruptured membranes, 8 cm dilated, presented breach and had to have an emergency C-Section replied, 'no.' Stated "if I examined her and she had ruptured membranes would have had to admit her." I faxed the records to Women's and Babies and gave patient copy of the records from the Birthing Center. I was given two pager numbers and kept trying but could not get a hold of anyone. If patient was in our system would have made an encounter. Was not in our system and not put on the log.