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Based on medical record review, document review, and interview, the facility failed to ensure that individuals in labor received appropriate medical screening examination (MSE) by Qualified Medical Personnel. This was evident in 4 of 28 medical records reviewed (Patient #s 1, 2, 3 and 5).

Findings:

Review of the medical record for Patient #1 identified a 23-year-old female at 38.50 weeks of gestational age who presented to Labor and Delivery triage on 07/16/17, at 04:39 PM with complaints of contractions every 2-4 minutes apart and a pain intensity of 5 on a pain scale of 1 to 10.

Staff A, Registered Nurse (RN) assessed the patient and performed Fetal Heart Monitoring. At 05:00 PM, nurse noted that she reported her findings to the physician.

At 06:49, nurse documented that patient's contractions were irregular and milder; and that patient's physician was notified of the patient's status.

Review of the facility's "By Laws of the Medical Staff," revealed that obstetrical nurses are not privileged and are not designated as Qualified Medical Practitioner (QMP).

On 09/18/2017, at 01:15 PM, during the interview with Staff I, Obstetrician/Gynecologist (OB/GYN), he stated that he instructed the nurse to call a hospitalist for an evaluation of the patient prior to discharge.

During interview with Patient #1 on 09/26/2017 at 01:30 PM, she stated that she was not evaluated by a physician during her visit, and that the nurse was the only person she saw and spoke to. She reported that she was discharged on 9/26/17 at approximately 7:00 PM. The patient stated that she delivered her baby in the bathroom of her residence at 9:18 PM, two hours after discharge.

Similar findings were noted for patients #2, #3, #5. There was no documented evidence that a medical screening examination was done by a QMP.

On 09/18/2017, at 12:00 PM, these findings were discussed with Staff C, Assistant Director of Quality and, on 09/19/2017, at 10:30 AM with Staff F, Director of Quality, who acknowledged findings.