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Based on review of hospital records, staff interviews and hospital policy and procedure, it was determined that the hospital failed to obtain or attempt to obtain written and informed refusal of an appropriate transfer for one (Patient #1) of 21 medical records reviewed. Patient #1 was driven by her spouse to Hospital #2 and delivered her baby within five (5) minutes of arrival. Hospital #1's failure to provide an appropriate transfer, or document Patient #1's refusal of transfer via Emergency Medical Services (EMS), placed the patient and her unborn child at increased risk of illness, organ dysfunction, and/or death.

Findings Include:

A review of Patient #1's Emergency Department (ED) medical record titled, "Emergency Room Nursing Note" documented the patient arrived at the ED on 01/13/2025 at 8:38 a.m. in "Mild Distress" with 10 out of 10 abdominal pain described as cramping. The description of the pain was noted as diffuse, moderate in severity, radiating to her back with a duration of 45 minutes. Hospital nursing staff documented Patient #1's "Labor/Pregnancy Focused Assessment" as sudden onset with normal fetal movement and Fetal Heart Tones at 146 beats per minute. Nursing staff documented Patient #1 was 39 weeks pregnant and having contractions at three (3) minutes apart. A nursing note documented at 8:45 a.m. noted, "MD [Physician #1 last name] went in and assess patient and patient water hadn't broke and patient and spouse made the choice to leave PMC [Panola Medical Center] ED and head to Baptist Oxford where they offer labor and delivery services." A nursing note timed at 8:50 a.m. documented "Patient leaves ED by POV [Privately Owned Vehicle] headed to Baptist Oxford." The hospital nursing note documented Patient #1 was discharged "Home" accompanied by her spouse at 8:55 a.m. The "Transfer" section of the note was marked "N/A [Not Applicable]."

Cross Refer to O2409.

Based on review of hospital records, staff interviews and hospital policy and procedure, it was determined that the hospital failed to obtain or attempt to obtain written and informed refusal of an appropriate transfer for one (Patient #1) of 21 medical records reviewed. Patient #1 was driven by her spouse to Hospital #2 and delivered her baby within five (5) minutes of arrival. Hospital #1's failure to provide an appropriate transfer, or document Patient #1's refusal of transfer via Emergency Medical Services (EMS), placed the patient and her unborn child at increased risk of illness, organ dysfunction, and/or death.

Findings Include:

A review of Patient #1's hospital medical record, "ER Provider Note" dated 01/13/2025 at 8:56 a.m., documented by Physician #1 revealed "Chief Complaint: 9 month OB contractions, 37 weeks gestation; c/o [complaint of] abdominal pain; possible early labor; contractions every 5 minutes; denied breaking her water; denied any vaginal bleeding; trauma / fall or injury." The ED Provider Physical Exam documented, "ED course: Patient refused vaginal exam: possible to break water during the exam; husband at bedsite [sic]; decided to go to Baptist [O]xford for further evaluation and treatment. Initial Impression: active labor. Differential Diagnoses: Braxton [H]icks contractions / active labor / false labor."

Interview with Registered Nurse (RN) #1 on 02/11/2025 at 4:30 p.m., conveyed Physician #1 exited Patient #1's room and stated, "They refused an exam, and they are going to [Hospital #2]." RN #1 said she then assisted the patient into a wheelchair and to their personal vehicle. Further interview with RN #1 revealed they did not offer an AMA (against medical advice) form because Patient #1 was discharged.

Interview with Physician #1 on 02/12/2025 at 10:10 a.m. revealed Patient #1 presented with labor pain requesting pain medication. After triage, appropriate staff were called to the Emergency Department (ED) for a live birth and to obtain supplies and equipment to support a live birth. Physician #1 confirmed while trying to complete an assessment to determine the plan of care for delivery or transfer, Patient #1 refused a vaginal examination and just wanted pain medication. Physician #1 said he explained the need for further assessment to make an appropriate plan of care, but the patient and husband refused and said they wanted to go Hospital #2 since this facility [Panola Medical Center] does not provide labor and delivery services. Physician #1 revealed he encouraged the Patient #1 to go by Emergency Medical Transport Services (EMS) and explained the timeline for transport. Physician #1 said the husband chose to go to Hospital #2 by private vehicle. Physician #1 said he instructed the staff nurse to have the patient and husband sign an Against Medical Advice (AMA) form.

Review of the hospital's Emergency Medical Treatment and Labor Act (EMTALA) policy, last review date 09/13/2023, no policy number revealed: "Purpose: The purpose of this policy is to set forth policies and procedures for Panola Medical Center's use in complying with requirements of the Emergency Medical Treatment and Labor Act (EMTALA)."
"Policy: H. Transfer of Unstable Individuals

1. A decision regarding patient transfer may be made by either patient request or physician certification.
a. Upon Individual request. An individual may be transferred if the individual or the person acting on the individual's behalf is fully informed of the risks of the transfer, the alternatives (if any) to the transfer, and of the Hospital's obligations to provide further examination and treatment sufficient to stabilize the individual's emergency medical condition, and to provide for an appropriate transfer. The transfer may then occur if the individual or person acting on the individual's behalf: (i) makes a request for transfer to another medical facility, stating the reasons for the request (document reason for request on the transfer form or in the medical record); and (ii) acknowledges his or her request and understanding of the risks and benefits of the transfer in writing;"
"2. When the Hospital transfers an individual with an unstabilized emergency medical condition to another facility, the transfer shall be carried out in accordance with the following procedures.
a. The Hospital shall, within its capability, provide medical treatment that minimizes the risks to the individual's health and, in the case of a woman who is having contractions, the health of the unborn child.
b. A representative of the receiving facility must confirm that:
(1) The receiving facility has available space and qualified personnel to treat the individual; and
(2) The receiving facility agrees to accept transfer of the individual and to provide appropriate medical treatment.
c. The hospital must send to the receiving facility copies of all pertinent medical records available at the time of transfer, including: (1) history; (2) records related to the individual's emergency medical condition; (3) observations of signs and symptoms; (4) preliminary diagnoses; (5) results of diagnostic studies or telephone reports of the studies; (6) treatment provided; (7) results of any tests; (8) the written patient consent or physician certification to transfer; ...
d. The transfer must be affected through appropriately trained professionals and transportation equipment, including the use of necessary and medically appropriate life support measures during the transfer. The physician is responsible for determining the appropriate mode of transport, equipment, and transporting professionals to be used for the transfer.

J. Enforcement

All Hospital staff and Medical Staff whose responsibilities are affected by this policy are expected to be familiar with the basic procedures and responsibilities created by this policy. Failure to comply with this policy will be subject to appropriate performance management pursuant to all applicable policies and procedures, including the Medical Staff Bylaws, Rules, and Regulations."

A review of Patient #1's medical record from Hospital #2 documented she presented on 01/13/2025 at 9:32 a.m., with a chief complaint of "Laboring" with regular contractions. Patient #1 had a spontaneous vaginal delivery on 01/13/2025 at 9:41 a.m.

Hospital #1's medical record failed to document the reason for Patient #1's refusal of a transfer, being fully informed of the risks of the transfer, the alternatives (if any) to the transfer, and of the Hospital's obligations to provide further examination and treatment sufficient to stabilize Patient #1's emergency medical condition, and to provide for an appropriate transfer.

During the exit conference on 02/13/2025 with the Chef Executive Officer, Chief Strategy Officer, Safety Officer, and Emergency Department Registered Nurse findings were discussed and no further documentation was submitted for review.