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Based on the review of facility documents, video footage and staff (EMP) interviews, it was determined the facility failed to comply with 489.20 related to Policies and Procedures which address Anti-Dumping Provisions.

Findings include:
A review of facility policy "Trinity Health Mid-Atlantic, Mercy Fitzgerald Hospital, Rules and Regulations, Final Draft....ARTICLE II. ADMISSION AND DISCHARGE...2.2 UNASSIGNED EMERGENCY PATIENTS" revealed "The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that for all patients who present to the Emergency Department, the Hospital must, at a minimum, provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The Hospital policy is "EMTALA (Emergency Medical Treatment and Active Labor Act)."
A review of facility policy effective date March 3, 2022, "EMTALA (Emergency Medical Treatment and Active Labor Act)" revealed in section "DEFINITIONS: 2. Emergency Medical Condition: A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in either: 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; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. Emergency medical condition also includes, with respect to a pregnant woman who is having contractions, a circumstance where there is inadequate time to affect a safe transfer to another hospital before delivery, or where the transfer may pose a threat to the health or safety of the woman or the unborn child....3. Labor: Means the process of childbirth beginning with the latent or early phase of labor and continuing through the delivery of the placenta. A woman experiencing contractions may be transferred if a physician certifies that the woman is not in active labor....4. Medical Screening Examination: The process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an emergency medical condition exists or a woman is in active labor....5. To Stabilize or Stabilized: With respect to an emergency medical condition, that the individual is provided such medical treatment as is necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from, or occur during, the transfer of the individual from the Hospital, as determined by a physician or other qualified medical personnel when a physician is not readily available. With respect to a pregnant woman who is having contractions and who cannot be transferred before delivery without a threat to the health or safety of the woman or unborn child, that the woman has delivered the child and placenta." A review of section "Policy" revealed: "It is the policy of the Hospital to provide an appropriate medical screening examination to individuals who present to the emergency department and request medical care." Also, a review of section "Procedure" revealed in subsection "I. Medical Screening and Stabilization" subsubsection "1. Individuals who present to the Hospital emergency department or at any other on-campus Hospital department requesting examination or treatment of a medical condition will be provided a medical screening examination and stabilizing medical treatment, if necessary. A medical screening examination shall be performed by an emergency department physician or the physician's designee in order to determine whether an emergency medical condition exists or if the individual is pregnant, whether she is in labor."
A review of the facility policy effective October 27, 2021, "OBSTETRICAL PATIENTS IN THE ED ... POLICY " revealed "The Emergency Department will identify patients presenting to the Emergency Department requiring obstetrical care and provide evaluation and treatment or transfer."
A review of video footage on March 4th, 2022, revealed on February 26, 2022, at 9:19 PM pregnant female patient arrived in parking lot of Mercy Fitzgerald Hospital. At 9:22 PM pregnant female patient arrived inside to the security desk. EMP4 went to get assistance. At that time, EMP5 and EMP6 spoke with female. EMP6 was observed walking behind female in labor talking to her.
Interview conducted on March 8, 2022, at 11:00 AM with EMP7 revealed that the provider was on duty February 26, 2022. EMP7 stated "I was working that shift but was not aware of the event until the ED (Emergency Department) Nurse Manager told me about it until Tuesday or Wednesday ( February 28 or March 1, 2022). I got most of my information from the security tape and other staff. The patient never got back to the bays in the ED. The patient did not get back to the clinical staff. From what I know security went back to talk with the PCT (Patient Care Tech). The PCT talked with the patient."
Interview conducted on March 8, 2020, at 12:00 PM with EMP4 revealed that EMP4 was the security guard on duty that shift. EMP4 stated "My encounter with the patient was when she entered the ED. I greeted her and asked her why she was here. The patient said that she was in labor. I ran to the back and shouted the lady is in labor. Two techs (PCTs) jumped and ran out to talk with the patient. That was my extent of my interaction with the patient."
Interview conducted on March 8, 2022, at 1:30 PM with EMP6: "Lady came in and said that she was in labor. The other tech took over, you know how some people take over and act like they can give advice. The other tech advised the patient to go to another hospital. We do not have OB (Obstetrician) at this hospital. The patient agreed to go to another hospital. I repeatedly asked the patient if she was okay to drive and the patient said yes. I asked the patient if she wanted to a doctor. The patient said she would drive to the other hospital. I asked her if she was okay to drive and she said yes." When asked if he had EMTALA training, EMP6 stated "no" he did not have that training.
Interview conducted on March 8, 2022, at 2:00 PM with EMP5: "I was near fast track around room 24, security came to tell them there was a pregnant woman who looked calm cool and collected - unphased. Since Delaware County is only six minutes away, if you feel capable you can go, but if you can't handle it we can see you here. Another gentleman continued to talk to her when I returned to the unit." When EMP5 was asked if she received EMTALA Training EMP5 stated: "I am new, November 2021, I couldn't remember if that was part of orientation, but I did receive orientation with a lot of information in it. I don't recall that specific Act." When EMP5 was asked to describe the proper procedure for when a patient arrives in the Emergency Department, EMP5 stated: "I would come in and notify RN (Registered Nurse) or Doctor basically it's out of my scope of practice." When EMP5 was asked if she contacted a physician or nurse when patient arrived in Emergency Department, EMP5 stated: "No, I did not."
A review of Personnel Files revealed EMTALA Training was completed for PF1 on June 30, 2021; PF2 on November 17, 2021; and PF3 on October 21, 2021.
The Emergency Department (ED) logs were reviewed. The patient in question was not entered on the ED logs. When a patient is not entered into the log a medical record is not generated, therefore, patients medical record was not reviewed. EMP1 verified that patient had not been seen by the facility on February 26, 2022.
There was no documentation that PT1 received a Medical Screening Evaluation and stabilizing treatment on first presentation to the Emergency Department on February 26, 2022.

Cross reference with:
489.20(l) In the case of a hospital as defined in 489.24(b) to comply with 489.24

Based on review of facility policy and medical records (MR) and staff (EMP) interview, it was determined the facility failed to maintain a complete Emergency Department (ED) control log for October 2021, through February 2022.

Findings include:
Review on March 8, 2022, of the facility policy "EMTALA (Emergency Medical Treatment and Active Labor Act)" effective March 3, 2022, revealed "VIII Signs and Records...4. The Hospital will maintain a central log on each individual who comes to the hospital 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."
A review of video footage revealed on February 26, 2022, at 9:19 PM pregnant female patient arrived in parking lot of Mercy Fitzgerald Hospital. At 9:22 PM pregnant female patient arrived inside to the security desk. EMP4 went to get assistance. At that time, EMP5 and EMP6 spoke with female. EMP6 was observed walking behind female in labor talking to her.
Interview conducted on March 8, 2020, at 12:00 PM with EMP4 revealed that EMP4 was the security guard on duty that shift. EMP4 stated "My encounter with the patient was when she entered the ED. I greeted her and asked her why she was here. The patient said that she was in labor. I ran to the back and shouted the lady is in labor. Two techs (PCTs) jumped and ran out to talk with the patient. That was my extent of my interaction with the patient."
Interview conducted on March 8, 2022, at 1:30 PM with EMP6: "Lady came in and said that she was in labor. The other tech took over, you know how some people take over and act like they can give advice. The other tech advised the patient to go to another hospital. We do not have OB (Obstetrician) at this hospital. The patient agreed to go to another hospital. I repeatedly asked the patient if she was okay to drive and the patient said yes. I asked the patient if she wanted to a doctor. The patient said she would drive to the other hospital. I asked her if she was okay to drive and she said yes." When asked if he had EMTALA training EMP6 stated "no" he did not have that training.
Interview conducted on March 8, 2022, at 2:00 PM with EMP5: "I was near fast track around room 24, security came to tell them there was a pregnant woman who looked calm cool and collected - unphased. Since Delaware County is only six minutes away, if you feel capable you can go, but if you can't handle it we can see you here. Another gentleman continued to talk to her when I returned to the unit." When EMP5 was asked if she received EMTALA Training EMP5 stated: "I am new, November 2021, I couldn't remember if that was part of orientation, but I did receive orientation with a lot of information in it. I don't recall that specific Act." When EMP5 was asked to describe the proper procedure for when a patient arrives in the Emergency Department, EMP5 stated: "I would come in and notify RN (Registered Nusre) or Doctor basically it's out of my scope of practice." When EMP5 was asked if she contacted a physician or nurse when patient arrived in Emergency Department, EMP5 stated: "No, I did not."
Review on March 8, 2022, of the facility's ED (Emergency Department) Central Log from October 2021 through February 2022, revealed that the patient was not entered in the ED Central Log upon this initial presentation to the Emergency Department.

Based on a review of facility policy and staff (EMP) interviews, it was determined that Mercy Fitzgerald Hospital failed to provide a medical screening examination to a patient that presented to the Emergency Department.
Findings include:
A review of policy "Trinity Health Mid-Atlantic, Mercy Fitzgerald Hospital- Rules and Regulations" section " 2.2 UNASSIGNED EMERGENCY PATIENTS" revealed "The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that for all patients who present to the Emergency Department, the Hospital must, at a minimum, provide for an appropriate medical screening examination within the capability of the hospital's emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists."
A review of facility policy effective date March 3, 2022..."EMTALA (Emergency Medical Treatment and Active Labor Act) " revealed in section "DEFINITIONS: 2. Emergency Medical Condition: A medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain, psychiatric disturbances, and/or symptoms of substance abuse) such that the absence of immediate medical attention could reasonably be expected to result in either: 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; serious impairment to bodily functions; or serious dysfunction of any bodily organ or part. Emergency medical condition also includes, with respect to a pregnant woman who is having contractions, a circumstance where there is inadequate time to affect a safe transfer to another hospital before delivery, or where the transfer may pose a threat to the health or safety of the woman or the unborn child....3. Labor: Means the process of childbirth beginning with the latent or early phase of labor and continuing through the delivery of the placenta. A woman experiencing contractions may be transferred if a physician certifies that the woman is not in active labor....4. Medical Screening Examination: The process required to reach with reasonable clinical confidence, the point at which it can be determined whether or not an emergency medical condition exists or a woman is in active labor ...5. To Stabilize or Stabilized: With respect to an emergency medical condition, that the individual is provided such medical treatment as is necessary to assure, within reasonable medical probability, that no material deterioration of the condition is likely to result from, or occur during, the transfer of the individual from the Hospital, as determined by a physician or other qualified medical personnel when a physician is not readily available. With respect to a pregnant woman who is having contractions and who cannot be transferred before delivery without a threat to the health or safety of the woman or unborn child, that the woman has delivered the child and placenta." A review of section "Policy" revealed: "It is the policy of the Hospital to provide an appropriate medical screening examination to individuals who present to the emergency department and request medical care." Also, a review of section "Procedure" revealed in "I. Medical Screening and Stabilization" subsubsection "1. Individuals who present to the Hospital emergency department or at any other on-campus Hospital department requesting examination or treatment of a medical condition will be provided a medical screening examination and stabilizing medical treatment, if necessary. A medical screening examination shall be performed by an emergency department physician or the physician's designee in order to determine whether an emergency medical condition exists or if the individual is pregnant, whether she is in labor."
Interview conducted on March 8, 2020, at 12:00 PM with EMP4 revealed that EMP4 was the security guard on duty that shift. EMP4 stated " My encounter with the patient was when she entered the ED. I greeted her and asked her why she was here. The patient said that she was in labor. I ran to the back and shouted the lady is in labor. Two techs (PCTs) jumped and ran out to talk with the patient. That was my extent of my interaction with the patient."
Interview conducted on March 8, 2022, at 1:30 PM with EMP6: "Lady came in and said that she was in labor. The other tech took over, you know how some people take over and act like they can give advice. The other tech advised the patient to go to another hospital. We do not have OB (Obstetrician) at this hospital. The patient agreed to go to another hospital. I repeatedly asked the patient if she was okay to drive and the patient said yes. I asked the patient if she wanted to a doctor. The patient said she would drive to the other hospital. I asked her if she was okay to drive and she said yes." When asked if he had EMTALA training EMP6 stated "no" he did not have that training.
Interview conducted on March 8, 2022, at 2:00 PM with EMP5: "I was near fast track around room 24, security came to tell them there was a pregnant woman who looked calm cool and collected - unphased. Since Delaware County is only six minutes away, if you feel capable you can go, but if you can't handle it we can see you here. Another gentleman continued to talk to her when I returned to the unit." When EMP5 was asked if she received EMTALA Training EMP5 stated: "I am new, November 2021, I couldn't remember if that was part of orientation, but I did receive orientation with a lot of information in it. I don't recall that specific Act." When EMP5 was asked to describe the proper procedure for when a patient arrives in the Emergency Department, EMP5 stated: "I would come in and notify RN (Registered Nurse) or Doctor basically it's out of my scope of practice." When EMP5 was asked if she contacted a physician or nurse when patient arrived in Emergency Department, EMP5 stated: "No, I did not."
Interview conducted on March 8, 2022, at 11:00 AM with EMP7 revealed that the provider was on duty February 26, 2022. EMP7 stated "I was working that shift but was not aware of the event until the ED (Emergency Department) Nurse Manager told me about it until Tuesday or Wednesday (February 28 or March 1, 2022). I got most of my information from the security tape and other staff. The patient never got back to the bays in the ED. The patient did not get back to the clinical staff. From what I know security want back to talk with the PCT (Patient Care Tech). The PCT talked with the patient."
There was no documentation that PT1 received a Medical Screening Evaluation on this first presentation to the Emergency Department on February 26, 2022.