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Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to comply with 489.24 related to Medical Screening Examination.

Findings include:

The review of facility documents, medical records (MR), and staff interview (EMP) revealed the facility failed to ensure an appropriate Medical Screening Examination (MSE) was provided to a patient presenting to the Geisinger Medical (GMC) Childbirth Center, a dedicated emergency department, for one of 22 medical records reviewed (MR1).

Cross reference with:
489.24(a) and 489.24(c) - Medical Screening Exam

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure a patient presenting to the Geisinger Medical (GMC) Childbirth Center (a dedicated emergency department) was placed on the Emergency Medical Care Log for one of 22 patients presenting with an emergency medical condition (MR1).

Findings include:

Review of facility policy "EMTALA System Policy," last reviewed August 12, 2022, revealed "Purpose To identify guidelines for providing the appropriate setting for conduction medical screening examinations To identify providers eligible to perform emergency medical screening examinations To comply with the Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. 1395 and subsequent federal interpretive guidelines and state regulations ... Persons with emergency conditions will be treated and their condition stabilized without regard to ability to pay for services. EMTALA does not apply to in-patients. The triage process recognizes that triage and a medical screening are two separate processes. Definitions ... Emergency Medical Care Log is in the Geisinger's electronic health record which is maintained on all individuals who present to the emergency department seeking medical care ...

Interview with EMP3 and EMP4 on March 18, 2023, revealed MR1 presented to The Childbirth Center due to with contractions and intolerable pain, was allowed into the Center and presented to the Unit Clerk at the Registration Desk.

Interview with EMP3 and EMP4 revealed MR1 was not entered into the facility's system, i.e. the Emergency Medical Care Log. EMP3 and EMP4 noted there would be a wait time for cleaning and making a room available for the patient, and that a discussion took place with the patient's family member. A facility person in gray scrubs indicated another acute care facility was available with a shorter wait time. The patient and family member left the GMC Childbirth Center.

Cross Reference-
489.24(a) and 489.24(c) - Medical Screening Examination and Use of Dedicated Emergency Department for Non-emergency Services

Based on review of facility documents, medical records (MR), and staff interview (EMP), it was determined the facility failed to ensure an appropriate Medical Screening Examination (MSE) for one of 22 medical records reviewed (MR1).

Findings include:

Review of facility policy "Care of the Pregnant Patient in the Obstetric Exam Room," last reviewed December 20, 2022, revealed "Purpose Obstetric patients at 20 weeks of gestation or greater will be evaluated in the obstetric exam rooms or an available room on the obstetric unit, in accordance with Emergency Medical Treatment and Labor Act (EMTALA) regulations. Patients less than 20 weeks gestation, with a non-obstetric emergency or patients with suspected postpartum infections/complications will be diverted to the emergency department. ... Policy This document serves as a guide to examination of the obstetric patient with obstetric concerns. Procedure A. Obstetric patients at 20 weeks of gestation or more will be assessed in the exam room with the following exceptions: - Patients directly admitted to the obstetrics unit. - Patients who gave birth on their way to the hospital. - Patients with imminent delivery. ..."

Review of facility policy "EMTALA System Policy," last reviewed August 12, 2022, revealed "Purpose To identify guidelines for providing the appropriate setting for conduction medical screening examinations To identify providers eligible to perform emergency medical screening examinations To comply with the Emergency Medical Treatment and Labor Act (EMTALA), 42 U.S.C. 1395 and subsequent federal interpretive guidelines and state regulations ...Policy Any person who comes to a facility requesting assistance for a potential emergency medical condition/emergency service will receive a medical screening performed by a qualified provider to determine whether an emergency medical condition exists ... Emergency Medical Treatment and Labor Act EMTALA refers to Sections 1866 and 1867 of the Social Security Act,42, U.S.C. and 1395dd, which obligates hospitals to provide a medical screening, treatment and transfer of individuals with emergency medical conditions or women in labor. ... True Labor as defined by a qualifies medical provider means the process of childbirth beginning with the latent or early phase of labor and continuing through the delivery of the placenta. ..."

The security footage for the presentation of MR1 was reviewed on March 27, 2023, with EMP12 revealed the following:

On March 18, 2023, at 1036 the patient and family member were buzzed into The Childbirth Center and stood at the Unit Clerk's Reception desk until 1044. At that time, they had a conversation with staff. There was no audio for this security footage. Staff were not able to be identified.

At 1039, the patient left the Unit Clerk's Reception desk and went into the Triage area to use the restroom.

At 1044, the patient and family member exited the Center and went to the waiting room until 1050.

At 1048, a facility staff member dressed in a gray uniform, exited the Center, went into the waiting room, and had a conversation with the patient and family member. The patient and family member were the only persons in the waiting room.

At 1050 the facility staff person reentered the Center. The patient and family member left the waiting room.

Interview on March 27, 2023, with EMP12 confirmed the above security footage.

Interview with EMP2 on March 27, 2023, at 1035, confirmed there was no medical record to review for this patient (MR1) who presented to the GMC Childbirth Center on March 18, 2023, between 0816 and 1502.

Interview with EMP3 and EMP4 on March 18, 2023, revealed MR1 presented to The Childbirth Center due to with contractions and intolerable pain, was allowed into the Center and presented to the Unit Clerk at the Registration Desk.

Interview with EMP3 and EMP4 revealed MR1 was not triaged. EMP3 and EMP4 noted there would be a wait time for cleaning and making a room available for the patient, and that a discussion took place with the patient's family member. A facility person in gray scrubs indicated another acute care facility was available with a shorter wait time. The patient and family member left the GMC Childbirth Center.

Continued interview with EMP3 and EMP4 revealed when a pregnant women 20 weeks or greater presents to The Childbirth Center, they go the Unit Clerk at the Registration desk, are entered into the facility's system, sign the Authorization for Treatment form and then proceed to the Triage area for assessment.

Cross Reference-
489.20(r)(3)-Emergency Room Log