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Based on document review and interview, the Hospital failed to ensure compliance with 42 CFR 489.24.

Findings include:

1. The Hospital failed to ensure an appropriate medical screening exam (MSE) was performed to determine if an emergency medical condition existed for patients presenting with obstetrical issues/pregnancy. See deficiency at A-2406.

Based on document review and interview, the Hospital failed to ensure that the central ED log included each individual who presented to the hospital's emergency department seeking treatment for 1 patient (Pt. #1) who presented to the ED (emergency department) seeking pregnancy related care.

Findings include:

1. On 9/2/2025, the Hospital's policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA) policy" (dated 1/30/2024) was reviewed and required, "...Central Log is a log the Hospital is required to maintain on each individual who comes to a Dedicated Emergency Department seeking care for an emergency medical condition. The central log documents whether the individual refused treatment, or whether the individual was admitted, transferred, or discharged."

2. On 9/2/2025, the Hospital's policy titled, "Assessment of Patients in the Obstetrical Emergency Department (OBED)" (dated 2/6/2025) was reviewed and required, "An individual who come to the OBED in need of requesting medical services is entitled to and will receive, regardless of diagnosis, race, religion, gender, ethnicity, national origin, age, handicap, marital status, sexual orientation, immigration status, or source of payment of care, an appropriate Medical Screening Exam (MSE) by a Qualified Medical Person (QMP) to determine if the individual has an Emergency Medical Condition (EMC). ...Patients seen in the OBED are usually between 16 weeks gestation to 12 weeks postpartum. Patients will be seen in the OBED for obstetrics complaints only... All patients presenting to the OBED will be triaged using the Maternal Fetal Triage Index, which entails the clinical assessment of the patient's presenting signs and symptoms at the time of arrival at the hospital, in order to prioritize when the individual will receive an appropriate medical screening examination ...Disposition of the patients without an emergency medical condition will be a collaborative decision between the QMP, RN and Charge RN and will occur between 2-3 hours from arrival to OBED ..."

3. On 9/2/2025, the Hospital's ED log and OBED Triage log (dated 7/22/2025 through 7/25/2025) was reviewed. Pt. #1 was not listed on ED log or OB Triage log.

4. On 9/2/2025 at 10:40 AM, an interview was conducted with complainant/ Pt. #1. Pt. #1 stated that Pt. #1 fell on Pt. #1's stomach when Pt. #1 tripped on a curb. Pt. #1 stated that Pt. #1's arm and thigh were bleeding. Pt. #1 stated that Pt. #1 came to Hospital A's [this hospital] ED on 7/23/2025 around 1:00 PM and was transported by wheelchair by the ED staff to OB Triage Area. Pt. #1 stated that Pt. #1 had Pt. #1's toddler with her at the time. Pt. #1 stated that Pt. #1 just wanted Pt. #1's fetus to be checked out to make sure everything was ok. Pt. #1 stated that Pt. #1 was "dismissed" in the OB Triage area. Pt. #1 stated that Pt. #1 overheard the nurse say, "this always happens." Pt. #1 stated that when Pt. #1 got to the OB Triage area, they did not assess Pt. #1. Pt. #1 stated that the ED did not assess Pt. #1 either. Pt. #1 stated that the staff in the OB Triage area told Pt. #1 that they could not help Pt. #1. Pt. #1 stated that the staff in the OB Triage area did not offer any assistance or tell Pt. #1 what Pt. #1 needed to do. Pt. #1 stated that Pt. #1 left the OB Triage area and immediately drove 45 minutes to [Hospital B - outside hospital] to get an exam. Pt. #1 stated that Pt. #1 didn't understand why [Hospital A] did not have a process in place so Pt. #1 could be examined.

5. On 9/2/2025 at 10:20 AM, an interview was conducted with the Manager of Labor & Delivery (L&D, E #1). E #1 stated that Pt. #1 was taken back to the labor and delivery triage room on 7/23/2025. E #1 told the staff that Pt. #1 had 1 hour to find childcare. E #1 stated that if a patient comes to the OB Triage area, the patient should be documented on the OB log.

6. On 9/2/2025 at 11:50 AM, an interview was conducted with the Unit Secretary (E #10). E #10 stated that when a patient comes up to OB and has a minor child, the patient is instructed to find childcare. E #10 stated that in the case of when the mother cannot find childcare, E #10 communicates with the Charge RN. E #10 stated that E #10 recalls a situation not too long ago (similar timeframe/description of Pt #1 - Pt who presented with a toddler), when a patient came to L & D with a toddler child. E #10 stated that the patient remained in the waiting room while attempting to call for childcare for the toddler. E #10 stated that that patient did not go to the back L & D triage area as we were hoping that the patient was able to find childcare. E #10 stated the patient eventually left due to frustration and was not seen. E #10 stated that E #10 did not register the patient in the system.

Based on document review and interview, the Hospital failed to ensure an appropriate medical screening exam was performed to determine if an emergency medical condition existed for 1 of 4 (Pt. #1) patients presenting with obstetrical issues/pregnancy (of a total ED sample of 20 patients).

Findings include:

1. On 9/2/2025, the Hospital's policy titled, "Emergency Medical Treatment and Active Labor Act (EMTALA) policy" (dated 1/30/2024) was reviewed and required, "Standards for Medical Screening Examinations - Patients who come to a Dedicated Emergency Department requesting examination and treatment will be triaged and receive a Medical Screening Examination by a QMP (qualified medical personnel). The Medical Screening Examination (MSE) extends until the point that the QMP determines that an emergency medical condition does or does not exist. A patient should continue to be monitored based on the patient's needs, and monitoring should continue until the individual is stabilized or admitted or appropriately transferred ..."

2. On 9/2/2025, the Hospital's policy titled, "Assessment of Patients in the Obstetrical Emergency Department (OBED)" (dated 2/6/2025) was reviewed and required, "An individual who come to the OBED in need of requesting medical services is entitled to and will receive, regardless of diagnosis, race, religion, gender, ethnicity, national origin, age, handicap, marital status, sexual orientation, immigration status, or source of payment of care, an appropriate Medical Screening Exam (MSE) by a Qualified Medical Person (QMP) to determine if the individual has an Emergency Medical Condition (EMC). If the patient is determined to have an emergency medical condition, the hospital must either stabilize the patient or arrange for an appropriate transfer to an accepting facility ...Patients seen in the OBED are usually between 16 weeks gestation to 12 weeks postpartum. Patients will be seen in the OBED for obstetrics complaints only. Patients with a gestational age of less than 16 weeks may be seen to rule out premature rupture of membranes, if ordered by the QMP. All patients presenting to the OBED will be triaged using the Maternal Fetal Triage Index, which entails the clinical assessment of the patient's presenting signs and symptoms at the time of arrival at the hospital, in order to prioritize when the individual will receive an appropriate medical screening examination. The Registered Nurse will perform a physical assessment, and assess the patient's temperature, blood pressure, pulse, respirations, and fetal heart tones, and uterine activity (when applicable) ...A medical screening examination will be provided by the QMP appropriate to an individual's presenting signs and symptoms to determine whether or not an emergency medical condition exists ...The RN will initiate care according to the physician's orders as related to presenting complaints and document in patient's medical record ...Attending physician will be notified of every patient who presents to the OBED. Disposition of the patients without an emergency medical condition will be a collaborative decision between the QMP, RN and Charge RN and will occur between 2-3 hours from arrival to OBED ..."

3. On 9/2/2025, the Hospital's ED log and OB ED Triage log (dated 7/22/2025 through 7/25/2025) was reviewed. Pt. #1 was not listed on ED log or OB Triage log. Therefore, there was no medical record for Pt #1.

4. On 9/2/2025 at 10:40 AM, an interview was conducted with complainant/ Pt. #1. Pt. #1 stated that Pt. #1 fell on Pt. #1's stomach when Pt. #1 tripped on a curb. Pt. #1 stated that Pt. #1's arm and thigh were bleeding. Pt. #1 stated that Pt. #1 came to Hospital A's ED on 7/23/2025 around 1:00 PM and was transported by wheelchair by the ED staff to OB Triage Area. Pt. #1 stated that Pt. #1 had Pt. #1's toddler with her at the time. Pt. #1 stated that Pt. #1 just wanted Pt. #1's fetus to be checked out to make sure everything was ok. Pt. #1 stated that Pt. #1 was "dismissed" in the OB Triage area. Pt. #1 stated that Pt. #1 overheard the nurse say, "this always happens." Pt. #1 stated that when Pt. #1 got to the OB Triage area, they did not assess Pt. #1. Pt. #1 stated that the ED did not assess Pt. #1 either. Pt. #1 stated that the staff in the OB Triage area told Pt. #1 that they could not help Pt. #1. Pt. #1 stated that the staff in the OB Triage area did not offer any assistance or tell Pt. #1 what Pt. #1 needed to do. Pt. #1 stated that Pt. #1 left the OB Triage area and immediately drove 45 minutes to [Hospital B - outside hospital] to get an exam. Pt. #1 stated that Pt. #1 didn't understand why [Hospital A] did not have a process in place so Pt. #1 could be examined. See deficiency at A-2406 (A). Pt. #1 stated that everything was alright with Pt. #1's baby after Pt. #1 was examined at Hospital B.

5. On 9/2/2025, Pt. #1's clinical record from Hospital B (dated 7/23/2025) was reviewed and noted the following:
Pt #1 arrived at Hospital B on 7/23/2025 at 3:38 PM with a chief complaint of "Fall at 1300 [1:00 PM] this afternoon." Pt #1's vital signs were Temperature: 37, Pulse: 93, Blood pressure: 131/53, Respirations: 16, SpO2 (oxygen level): 99%. Fetal heart rate at 4:00 PM was 155 bpm (beats per minute). Physician was notified/assigned and evaluated Pt #1 at 4:09 PM.
ED Course included:
- 4:13 PM Pt. #1 fell on the curb and hit Pt. #1's abdomen. CBC (complete blood count), coagulation panel, ultrasound ordered.
- 6:38 PM -Ultrasound appears normal, await coagulation panel results
- 6:55 PM - PTT (partial thromboplastin time -measures how long it takes for your blood to clot)
- Awaiting coagulation panel results
- ED Course User Index - FHTs (Fetal Heart Tones) Addendum: Ultrasound is unremarkable. FHTs are positive; cervix is closed. Will await coagulation panel results. Addendum: Coagulation panel is normal. Pt. #1 has a UTI (urinary tract infection); will prescribe Keflex (antibiotic medication) and discharge. Follow up with OB physician in one to two days. Case discussed with Pt. #1's OB physician.
- Final diagnosis: IUP at 18 weeks, Pt. #1 fell, UTI and dehydration, normal ultrasound
- ED Disposition - Discharge, push fluids at home. Pt #1 was discharged to home on 7/23/2025 at 7:19 PM

6. On 9/2/2025 at 10:20 AM, an interview was conducted with the Manager of Labor & Delivery (E #1). ). E #1 stated that Pt. #1 was taken back to the labor and delivery triage room on 7/23/2025. E #1 told the staff that Pt. #1 had 1 hour to find childcare. E #1 stated that if a patient comes to the OB Triage area, the patient should be documented on the OB log. E #1 stated that regardless of a child accompanying a patient, the patient should be assessed and treated. E #1 stated that a social worker should have been contacted if Pt. #1 could not find childcare. E #1 stated that E #1 does not know what happened to Pt. #1 because E #1 was leaving work.

7. On 9/3/2025 at 9:15 AM, an interview was conducted with the Assistant Manager of labor & delivery (E #3). E #3 stated that E #3 was able to recall Pt. #1's name. E #3 stated that E #3 doesn't really know what happened with Pt. #1. E #3 stated that it was E #3's understanding that Pt. #1 came to OB Triage department and was not seen in the OB Triage. E #3 stated that the OB Triage department does see patients with children. E #3 stated that the process when a patient comes to the OB Triage area with a child is that the clerk in the OB Triage area registers the patient and then the patient is brought back to the triage/exam area. E #3 stated that a mother who fell on her stomach would be a patient that should be seen right away. E #3 stated that the assessment should include a doppler (equipment used to monitor fetal heart tones). E #3 stated that an ultrasound may be ordered. E #3 stated that labs may be ordered as well. E #3 stated that a patient should be assessed and examined, even if the patient comes to the OB Triage area with a child.

8. On 9/3/2025 at 10:00 AM, an interview was conducted with MD #1 (OB/Gyne Department Chair). MD #1 stated that the process when a patient comes to the OB Triage who is 18 weeks pregnant and had a fall on her stomach needs to be examined. MD #1 stated that there is a risk of placenta abruption (a serious problem during pregnancy that involves the placenta, the organ that brings oxygen and nutrients to the baby. Placenta abruption happens when the placenta separates from the inner wall on the womb, also called the uterus. The cause is often unclear. But it can happen due to an injury to the stomach area, such as from a car crash or fall). MD #1 stated that there is an urgency to examine a pregnant patient who has fallen due to the risk of placenta abruption. MD #1 stated that the patient needs to be assessed right away and not wait until the next day. MD #1 stated the normal assessment for a patient who has fallen includes fetal heart tones, vital signs, look for bruising, ultrasound and coagulation (clotting) labs. MD #1 stated that the patient should receive a medical screening examination from ED Physician or senior resident in the OB Triage area. MD #1 stated that MD #1 was not aware that Pt. #1 came to the OB Triage area on 7/23/2025. MD #1 stated the goal of the OB Triage area is to care for the patient. MD #1 stated that MD #1 has seen patients with children present in the OB Triage area. MD #1 stated that the social services assist in helping find childcare, but the OB Triage area works around children being present in order to care for the patient. MD #1 stated that each patient in the OB Triage area should receive a MSE.