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Based on record review, and interview, the facility's Emergency Room (ER) Staff failed to provide documented evidence on the ER central log for two(2) of six (6) women in labor, who came to the Emergency Room seeking Medical attention between the period May 1, 2010 and July 19, 2010.

The facility failed to provide information on the ER Logs regarding the condition of the women on arrival to the ER, whether or not they were treated and the final outcome of their visits. Citing Patient #s 1 and 2.

Findings:

Patient # 1

Review of complaint narrative TX00133533 revealed allegations that patient # 1 was in labor and went to the Emergency Room(ER) at North Cypress Medical Center on 7/16/10. She was informed the facility did not provide Labor and Delivery services and she should go to "Hospital B" in her own private vehicle with the caution light on.

During an interview on 7/28/10 at 3:30 pm with Staff # 57 ( Nurse Director for "Hospital B"Emergency Room) she stated the patient arrived at the facility in labor and stated she was sent from North Cypress Hospital. She was told to put the caution lights in her car on.

During a telephone interview on 7/29/10 at 9:15am with Patient # 1 she stated she was having labor pain and went to North Cypress Hospital to have her baby. According to Patient # 1 when she arrived at the hospital a Doctor came out and told her "there was no service to deliver babies at that hospital and she should go to "Hospital B".

Review of the facility's Emergency Room logs for 7/16/10 revealed the patient's name did not appear on the log. There was no information that the patient came to the hospital.

Patient # 2

Review of complaint narrative revealed allegations that Patient # 2 who was pregnant went to the ER on 7/19/10 with complaints of shortness of breath and was told by a " staff in a white lab coat" that Gynecological services was not provided at the facility, the patient was told to go to "Hospital B" in her own private vehicle.

Review of the facility's ER Logs for 7/19/10 revealed the patient's name did not appear on the log. There was no information that the patient came to the emergency room.

The facility's Medical Records Department had no information on the patients. There was no medical records for the patients.

During an interview on 7/29/10 at 10:30 am with Staff # 51 (Registration Clerk) in the ER, the clerk stated all patients who entered the ER were registered with their name, age and reason for the visit . The registration information was kept. A search of the registration system by Staff # 52 Emergency Room Registered Nurse Director she was able to verify that both patient #s 1 and 2 were registered at the facility on the date of their arrival.

The registration information had date of arrival, chief complaint and no information regarding treatment, the patients' condition and the outcome of the visit.

During an interview on 7/29/10 at 11:40 am in the ER with Staff # 53 , Medical Director for the ER, he stated the patients should have been triaged, examined, and entered into the ER log. He further stated systems would be implemented to correct the problem.

Based on interview, and record review, the facility's Emergency Room (ER) staff failed to provide an appropriate medical screening examination by a Qualified Medical Personnel( QMP) to determine if an emergency medical condition exist for patients #s 1&2. Two (2) of six (6) women in labor were informed there was no labor and delivery services at the facility and were told to go to facility "B" in their own private vehicles.

Findings:

Patient # 1

Review of complaint narrative TX00133533 revealed allegations that patient # 1 was in labor and went to the Emergency Room (ER) at North Cypress Medical Center on 7/16/10. She was informed the facility did not provide Labor and Delivery services and she should go to "Hospital B" in her own private vehicle with the caution light on.

During an interview on 7/28/10 at 3:30 pm with Staff # 57 ( Nurse Director for "Hospital B" Emergency Room) she stated the patient arrived at the facility in labor and stated she was sent from North Cypress Hospital. She was told to put the caution lights in her car on.

During a telephone interview on 7/29/10 at 9:15am with Patient # 1, she stated she was having labor pain and went to North Cypress Hospital to have her baby. According to Patient # 1 when she arrived at the hospital a Doctor came out and told her "there was no service to deliver babies at that hospital and she should go to ''Hospital B". Patient # 1 stated she was not examined by any one, she said "no one put hands on her."

During an interview on 7/29/10 at 2 pm in the ER with Staff # 50 (Charge Nurse at North Cypress Hospital) ,he stated the patient came to the ER but he was not sure if the patient was triaged.

According to Staff # 50, the ER physician ( Staff # 54) went to the waiting room and spoke to the patient in Spanish. The physician explained the plan of care to the patient. The patient was told that there were no delivery services at the facility. The patient decided she wanted to go in her own vehicle.

According to Staff # 50 the ER Physician instructed him to call "Hospital B" and give them a " heads up that the patient was coming", which he did. Staff # 50 said he did call the facility later that morning to ensure the patient got there ok

During the interview Staff # 50 further stated he wrote a note immediately after the patient left the facility and the physician wrote a history and physical.

Staff # 50 stated when an OB patient comes to the ER they are checked in at registration. The ER physician is informed and he/she will go to the front and check the patient. Patients who have a pregnancy greater than twenty (20)weeks will be informed that there was no OB services and they have the option to leave in their own vehicle or be transported.

The Staff was not able to tell whether or not the facility had offered the patient transportation.

Review of a report on a single sheet of paper dated 7/16/10 at 7:21am written by Staff # 50 revealed the following information:

"Patient present with parent, states she is pregnant and having contractions. Patient appears uncomfortable, clutching stomach and moaning,

Abdomen appears distended. Patient does not know how far long she is. Reports contraction began 0400 and is now 5 minutes apart. Dr. # 54 to ER Lobby to speak with patient. Patient advised by Dr. #54 that no ob services are available and patient decides to drive to "Hospital B". Leaves with family " .

Review of a History of present illness written by Dr. #54 revealed the following information:

" Patient with abdominal cramping no prenatal care advised patients we did not have ob and advised her family did not refuse care but informed them we had no ob and L&D patient did not know what an ob doctor was and did not understand what prenatal care was and where she was to deliver directions given to "Hospital B" by myself and registration in Spanish and family opted to go there directly they preferred to leave directly and not be triaged and wanted to leave immediately."

Patient # 2


Review of complaint narrative revealed allegations that Patient # 2 went to the ER on 7/19/10 with complaints of shortness of breath, she was also pregnant. The patient was told by a " staff in a white lab coat" that the hospital did not have Gynecological services and the patient should drive to "Hospital B" in her own private car.

Review of the facility's ER Logs dated 7/19/10 revealed the patient's name did not appear on the log. There was no information that the patient came to the emergency room.

The facility's Medical Records Department had no information on the patient.

During an interview on 7/29/10 at 10:30 am with Staff # 51 (Registration Clerk) in the ER, regarding registration procedures at the facility It was revealed that all patients who came to the ER were registered and that the facility kept the registration records. It was later discovered that the patient was registered as entering the ER on 7/16/10.


Review of the registration information for Patient # 2 revealed date of arrival, complaint of difficulty breathing and that she was seven (7) months pregnant. There was no information regarding assessment, examination, vital signs or treatment. There was no information regarding the patients' condition and the outcome of the visit.

During an interview on 7/29/10 at 11:40 am in the ER with Staff # 52 , Medical Director for the ER, he stated the patients should have been triaged, examined, monitored and appropriately transferred as needed. The Medical Director further stated systems would be implemented to correct the problem.
Review of the facility ' s Medical Screening Guidelines dated January 2009 documented that: "

Any individual who comes to the Hospital Emergency Department requesting examination or treatment shall be provided with an appropriate medical screening examination. "

" In providing a medical screening examination, the Hospital shall not discriminate against any individual because of diagnosis, financial status, race, color, and national origin or handicap. "