HospitalInspections.org

Based on observation, interview,and record review , the facility failed to post conspicuously the required signage (per section 1867 of the Social Security Act) specifying the rights of individuals with respect to examination and treatment for emergency medical conditions (EMC) and women in labor and whether or not the hospital participated in the Medicaid program under a State plan (under Title XIX). The hospital failed to :

- to post the required EMTALA signage in the language understandable by the population served.

The hospital's EMTALA signage was posted in English only. A Spanish-speaking only patient presented for care and treatment on 09/10/2022 ( Patient # 1).

Findings included :

TX00432740

Record review of facility policy titled : "Emergency Medical Treatment & Active Labor Act (EMTALA)," review date April, 2016, showed:

"Sacred Heart Emergency Center shall post a sign (in English & Spanish) in a place or places likely to be noticed by all individuals entering the department (18 inches x 20 inches preferred) that included: The rights of patients with emergency conditions and women in labor; [and] a statement that Sacred Heart Emergency Center does not participate in Medicaid."

Observation on 09/28/2022 at 9:30 AM in the facility lobby showed the required EMTALA signage posted in English only. Interview at the time of observation with Staff -E, front desk staff, she said this was the only EMTALA signage posted in the lobby waiting area,


[ Refer to Tag A-2406 for details of Patient # 1's ER visit ]

Based on record review and interview, the facility failed to maintain a complete central log for each individual who came to the emergency department.
The facility failed to document Patient # 1 on the central log when she presented to the ER for care and treatment on 09/10/2022.

Findings included:

TX00432740

Record review of facility policy titled : "Emergency Department: Log Maintenance," dated April 2016, showed:

- A central log will be maintained on each individual who comes to the Emergency Department seeking assistance...and whether he or she refused treatment, was refused treatment or whether he or she was transferred, admitted and treated, stabilized and transferred, or discharged.

-Log is to be legible, accurate and complete and must not contain any blank lines.
_________

Record review of facility policy titled : "Patient Registration,"dated April 2016, showed:

-All patients will be registered by Emergency Center Front desk reception/registration.

-All Emergency Department patient information will be maintained in a central log.
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Record review on 09/28/2022 of facility ER patient log (form not titled) for September 2022 failed to show documentation of Patient# 1 presenting for care on 09/10/2022.

These findings were verified and acknowledged by Staff-C, RN.

[Refer to Tag A-2406 for details of Patient # 1's ER visit.]

Based on observation, interview and record review, the facility failed to provide a medical screening examination to Patient ID # 1 when she presented for care and treatment on 9/10/2022.

Findings included:

TX00432740

Record review of facility policy titled : "Emergency Medical Treatment & Active Labor Act (EMTALA)," review date April, 2016, showed:

"Any person who comes to Sacred Heart Emergency Center requesting assistance for a potential medical condition/emergency services or are in labor, will receive a medical screening performed by a qualified provider to determine whether an emergency medical condition or active labor exists."

"Qualified provider to perform a medical screening at Sacred Heart Emergency Center includes : a doctor of medicine of osteopathy."

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Record review of complaint intake #TX00432740 showed allegations that Patient #1 presented to the facility on 09/10/2022. Facility staff reported they could not provide care because they did not check her in. Patient delivered a premature newborn in the toilet of the lobby restroom.

Staff -G, front desk clerk:

During a telephone interview with Staff -G, front desk clerk, on 9/28/2022 at 3:15 PM, she verified she was on duty on 09/10/2022, the day Patient #1 and her husband came to the facility. Staff G stated, " the wife came in and went directly to the bathroom. The husband came to the registration window and I began to obtain information from him: like how much pain she was in , how long, everything. Trying to get how many months. The husband asked me if we can help deliver the baby? I told him we don't provide that service. He asked where they could go; because she was clearly in pain. I told him if he was looking for another place to go: there was a hospital right across from us. I told him where it was."

Staff-G went on to say:

- the husband went back in to the restroom. He came out and said 'can we get some assistance?--she had the baby already.' I went to get the nurse. "The husband stepped out and came back and he told me he called 911.

- she was talking with him for a few minutes-then his phone rang. He stepped outside. When he came back in, he handed her the phone. It was the EMS ambulance crew; they wanted to verify the address of the facility.

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Staff- C, RN:

During an interview (on-site) on 9/28/2022 at 3:15 PM with Staff-C, RN, she stated that she was on duty on 09/10/2022. The receptionist told her a "family came up to us and told us in Spanish : she thinks she miscarried, and she was 12 weeks pregnant." Staff -C, RN, stated, " I informed the ER doctor. He said we can give them two (2) choices: they can get checked in and stay and we screen her or they can go to a hospital for a 'D & C'. "

RN further stated that :

-when she got to the lobby she was told the patient was in the bathroom;
-she requested the receptionist to tell the husband she was going to check on the patient. They were Spanish-speaking only and receptionist spoke Spanish;
-the husband had already called 911;
-when RN entered the lobby, she saw the husband hand his cell phone to receptionist to talk with the ambulance people;
-RN walked to the entrance of the of bathroom and saw the patient on the commode. Patient did not want RN to come in. She asked the patient if she was OK.
- RN saw blood around her and on her clothes. At this time, EMS got there and took over. RN gave them a clean gown and a bag before they transported the patient.
_______________

Staff-H, ER physician :

During a telephone interview on 09/28/2022 at 8 PM with Staff -H, ER physician,he confirmed he was on duty the day of 09/10/2022.
Staff-H, ER physician said:

- the nurse came to him and said there is a woman checking in who had a miscarriage. I told her there is not much we can do about it; she may have to go to the hospital.
-He expected to see her. The nurse later came and told him the patient had the miscarriage in the lobby bathroom.
-He never saw this person-didn't know her name. He was told she was checking in-but she never checked in-she left. He fully expected to see her; but she called 911 and they left.
____________

EMS Dispatch 911 recordings:

Review of the audio EMS dispatch recordings, along with translation of same [Spanish to English by HHSC translation services] showed:

There were two (2) "911" telephone calls on 09/10/2022 related to Patient # 1. One was from the husband to 911. The other call was from EMS dispatcher to the 911 caller (husband). There was initially some confusion on location of patient. Dispatcher called back to verify address.

EXCERPTS from the translated 911 call documentation are as follows:

a. CALL # 1 made by husband of Patient # 1 to 911 dispatch on 09/10/2022 at 1014 :

HUSBAND: "...My wife had a miscarriage and they told us they cannot help us..."

b. CALL # 2 made by EMS 911 Dispatcher to husband of Patient # 1 on 09/10/2022 at 1028 AM

EMS DISPATCHER: "you are at an emergency room and they can't help you?"

HUSBAND: "No...she is bleeding a lot and had a miscarriage. I'm here at the hospital but they told us they can't help us because we are not their client..." [Dispatcher then asks to speak to a nurse ]

**[there was short discussion between dispatch and facility staff about correct address and location] ,then:

EMS DISPATCHER :" So, you're not the ER?"

FACILITY STAFF: "Uh..no"

**[additional address discussion] , then:

EMS DISPATCHER :"And are you an ER or you're just a clinic? [ pause ] Ma'am?

FACILITY STAFF: "Yes?"

EMS DISPATCHER: "Are you considered an emergency room or, or you're just a clinic or a private hospital?"

FACILITY STAFF: "Uh, we're like an ER."

EMS DISPATCHER: "What's the name of the hospital?"

FACILITY STAFF: "Sacred Heart Emergency Center "

EMS DISPATCHER: "Sacred Heart Emergency Center, and you cannot treat this person there?"

FACILITY STAFF: "No"

Interviews with EMS Personnel:

EMT # 1:

During a telephone interview on 10/4/2022 at 3:15 PM with EMT s# 1 , he stated that at first there was confusion about location; they had been given the wrong address by the 911 caller. This caused about a 20 minute delay. As soon as they arrived at the correct location:

- the nurse or whoever was at the front desk told us: "She is in there- she is all yours- we cant do anything with her....There is a woman over there who says she is 3 months pregnant. She is in the bathroom; she's crying and in pain. She is not our patient; she is yours."

- EMT # 1 said they found the patient alone in the bathroom, sitting on the toilet. We had to stand the patient up to change her gown and help her onto the stretcher. The patient said :" wait, there is something hanging from me." That's when my partner looked and saw the baby had been delivered into the toilet. The patient had not been aware until we stood her up.

-EMT # 1 removed the baby from the toilet and clamped and cut the cord. The baby looked to be premature: no pulse, no breathing, no movement.
We transported them to acute care hospital ER.

EMT # 2:

During a telephone interview on 10/4/2022 at 3:15 PM with EMT # 2 he verified he was on the ambulance run on 09/10/2022. He stated that :

- there was a lot of confusion about location.

- Front desk person told him the patient who had called 911 was in the bathroom in the lobby.

- one of the staff members said 'she hasn't signed in so we can't see here; she is not a patient of ours.' Staff said the patient came in with her husband having some stomach pains and asked where the bathroom was.

- He and his partner went into the bathroom where she was: found her crying and alone sitting on the toilet. Observed some blood on the toilet.

- EMT # 2 went and got the stretcher. Upon return, he and his partner stood the patient up and saw the baby was in the toilet water.

- "Baby looked like a stillborn. I expected a 2-3-month-old; did not expect it to look fully grown like that."

- One of the facility staff members came a few minutes later and asked :"is there anything you need? " EMT # 2 asked the staff person- Can you tell how old this baby is? Staff said: No, we can't tell you--she is not our patient -that's why you are here."