HospitalInspections.org

Based on a review of the facility Bylaws, Rules and Regulations, medical record (MR) review, facility policy and procedure, and interviews with staff it was determined the hospital failed to:


1. Provide an appropriate medical screening examination (MSE) within the capability of the hospital's obstetrics (OB) department to determine whether an emergency medical condition exists for all patients who presented to the Emergency Department (ED) seeking care for an OB related condition.

2. Ensure the patients received an appropriate transfer from the facility.

These deficient practices affected 10 of 14 patients that presented to the OB department for an MSE, and one of two patient transfers from the facility.

Findings Include:

Cross Refer to findings at A 2406 and A 2409.

Based on a review of medical records (MR), facility Bylaws, Rules and Regulations, facility policy and procedure, and interviews with the staff it was determined the hospital failed to provide an appropriate medical screening examination (MSE) within the capability of the facilities obstetrics department to determine whether an emergency medical condition exists for all patients who presented to the Emergency Department (ED) seeking care for an Obstetric (OB) related condition.

This did affect 10 out of 14 OB patients, to include Patient Identifier (PI) # 1, PI # 2, PI # 3, PI # 6, PI # 7, PI # 8, PI # 10, PI # 16, PI # 19, PI # 20, and had the potential to affect all OB patients served by the facility.

Findings include:

A review of the facility Bylaws, Rules and Regulations revealed no documentation of who is qualified to perform the MSE.

Facility policy: Qualified Medical Personnel
Audience: Labor and Delivery
Policy /Procedure # Ld060
Revision date: 4/17/24

I. Purpose:

A. To provide a procedure to ensure appropriate medical screening and timely medical intervention for patients seeking care for emergency obstetrical conditions.

II. Criteria

A. Alabama State Board of Nursing allows Registered Nurses (RNs) to perform Medical Screening Exams.

B. Criteria for those qualified to perform the MSE in Labor and Delivery:

1. Labor and Delivery RN licensed to practice in Alabama.

a. Must have at least 6 months Labor and Delivery nursing experience...

f. Approved yearly by the Board of Trustees to function in this capacity.

2. A physician...

Facility Policy Title: Evaluation and Treatment of Pregnant Patients Presenting to the Emergency Department in a Facility with an OB Department.

Audience: ED Nursing, OB Nursing, ED Registration.
Policy number: none listed
Revision date: 4/17/24

I. Purpose:
To establish a systematic approach in evaluation and treatment of the pregnant patient presenting to the Emergency Department in hospitals with an OB department.

II. Policy:
The obstetric patient presenting to the ED for emergency care is provided base upon her current medical condition and in consideration of her gestational age,

III. Procedure:

...4) Patients presenting with pregnancy 20 weeks or greater and an obstetrical complaint are transported to Labor and Delivery via wheelchair or stretcher accompanied by clinical personnel as determined by the ED RN...

Examples of obstetrical complaints (*may include but not limited to)
1. Uterine contractions..
4. Abdominal pain- for possible uterine rupture, abruption and epigastric pain.
5. Vaginal discharge...
8. Pelvic pressure..

F. Patients with pregnancy 20 weeks or greater presenting only with obstetrical complaints are transported to obstetrical department for evaluations.

1. PI # 1 presented to the facility ED on 1/22/25 at 3:20 PM with a chief complaint of lower abdominal cramps for three days and vaginal discharge 5 days ago.

A review of the MR revealed the MSE was performed on 1/22/25 at 3:57 PM by an RN and not a physician.

2. PI # 2 presented to the facility ED on 1/23/25 at 2:11 AM with a chief complaint of pelvic pain and abdominal pain for one week.

A review of the MR revealed the MSE was performed on 1/23/25 at 2:40 AM by an RN and not a physician.

3. PI # 3 presented to the facility ED on 1/23/25 at 12:50 PM with a chief complaint of leaking and decreased movement.

A review of the MR revealed the MSE was performed on 1/23/25 at 1:06 PM by an RN and not a physician.

4. PI # 6 presented to the facility ED on 2/4/25 at 12:32 PM with a chief complaint of vaginal bleeding.

A review of the MR revealed the MSE was performed on 2/4/25 at 12:58 PM by and Licensed Practical Nurse (LPN) and not a physician.

5. PI # 7 presented to the facility ED on 3/13/25 at 10:05 AM with a chief complaint of bleeding this morning with pain.

A review of the MR revealed the MSE was performed on 3/4/25 at 10:34 AM by an RN and not a physician.

6. PI # 8 presented to the facility ED on 3/17/25 at 7:12 AM with a chief complaint of cramping in abdomen and lower back.

A review of the MR revealed the MSE was performed on 3/17/25 at 7:54 AM by an RN and not the physician.

7. PI # 10 presented to the facility ED on 4/17/25 at 9:38 PM with a chief complaint of abdominal and back cramping, pelvic pressure since 1:30 PM today.

A review of the MR revealed the MSE was performed on 4/17/25 at 10:58 PM by an RN and not a physician.

8. PI # 16 presented to the facility ED on 7/1/25 at 2:00 PM with a chief complaint of nausea, vomiting, light headed, abdominal cramping.

A review of the MR revealed the MSE was performed on 7/1/25 at 3:15 PM by an RN and not a physician.

9. PI # 19 presented to the facility ED on 4/28/25 at 1:57 PM with a chief complaint of a fall and labor pains.

A review of the MR revealed the MSE was performed on 4/28/25 at 2:05 PM by an RN and not a physician.

10. PI # 20 presented to the facility ED on 5/18/25 at 4:24 AM with a chief complaint of abdominal pain.

A review of the MR revealed the MSE was performed on 5/18/25 at 5:00 AM by an RN and not the physician.

An interview was conducted on 7/10/25 at 12:00 PM with Employee Identifier # 1, Chief Quality Officer who confirmed the RN's and LPN's performed the MSE, not the physician, and the facility's Bylaws, Rules and Regulations did not contain who was considered a qualified medical professional to perform the MSE.

Based on medical record (MR) review, hospital policy and procedure, and interviews with staff it was determined the facility failed to ensure patients received an appropriate transfer from the facility.

This affected Patient Identifier (PI) # 13, one of two medical records containing transfers, and had the potential to affect all patients transferred from this facility.

Findings include:

Facility Policy Title: EMTALA Policy

Version: 6

Revision date: 7/14/22

Introduction: The purpose of this policy is to define the relevant terms and provide an overview of the Emergency Medical Treatment and Labor Act (EMTALA)...

IV. Transfer of Individuals

A. Transfer Requirement
If the patient is determined to have an Emergency Medical Condition (EMC)following an Medical Screening Exam and either: (a) the patient requests a Transfer; or (b) the treating physician determines that the hospital has exhausted it capabilities to stabilize the patient's EMC, and that the benefits of an appropriate transfer outweigh the risks of such transfer, the hospital shall take reasonable steps to initiate an appropriate transfer...

1. PI # 13 presented to the facility ED on 5/30/25 at 8:13 AM with a chief complaint of mouth swelling and toothache.

A review of the MR revealed the patient was transferred to an outside facility via Emergency Medical Service ground. The MR contained no documentation of the physician certification, risk and benefits, patient consent to transfer, and medical records being sent to the accepting facility.

An interview was conducted on 7/10/25 at 12:11 PM with Employee Identifier # 1, Chief Quality Officer, who confirmed there is no documentation of the physician certification, risk and benefits, patient consent to transfer, and medical records sent to accepting facility for PI # 13.