Based on record review, policy review, and staff interview it was determined the facility failed to provide an appropriate screening examination that included ancillary services and failed to provide an appropriate transfer to 1 (#21) of 21 sampled patients. Please refer to A2406 and A2409.

Based on record review, policy review and staff interview it was determined the facility failed to provide an appropriate screening examination to one (#21) of 21 sampled records. Findings included: The Emergency Provider Report dated 11/17/16 at 1:54 p.m. and signed by the Emergency physician included Patient #21 was 27 weeks pregnant and had been experiencing pain in her upper abdomen for the previous 2 days. The Physical Exam included the patient ' s vital signs were normal according the ambulance staff (EMS). The patient was not in acute distress. EMS reported no abnormal heart rhythm. The abdomen was described as gravid. There was no evidence of the physician's evaluation of the intensity of the patient's abdominal pain at the time she arrived nor at the time she departed. The record contained no evidence Patient #21 was offered diagnostic testing nor any treatment to relieve her pain before continuing in the same ambulance to the next hospital. The facility policy titled EMTALA-Screening and Stabilization, no policy number, effective 5/24/16 was reviewed on 11/28/16. The policy included documentation indicating the facility is required to provide an appropriate medical screening examination within the capability of the hospital's emergency services, including ancillary services routinely available to determine whether or not an Emergency Medical Condition (EMC) exists to any individual who requests services or presents in such a manner as a reasonable person would conclude an examination is necessary. An interview was conducted with the Vice President of Quality on 11/28/16 at approximately 10:00 a.m. She indicated she was present on 11/17/16 when the Director of Emergency Services called to say the department secretary observed a physician going out to examine a patient who was still in the ambulance. The Vice President of Quality and the Director of Emergency services determined from their interview with the ED physician that he had examined Patient #21 in the ambulance without bringing the patient into the facility and instructed the ambulance crew to take the patient to another hospital. She confirmed the above findings.

Based on record review, policy review, and staff interview it was determined the facility failed to ensure one (#21) of 21 sampled patients was provided an appropriate transfer from the Emergency Department to another hospital. Findings included: The Emergency Provider Report dated 11/17/16 at 1:54 p.m. and signed by the Emergency physician included Patient #21 was 27 weeks pregnant and had been experiencing pain in her upper abdomen for the previous 2 days. The Physical Exam included the patient's vital signs were normal according the ambulance staff (EMS). The patient was not in acute distress. EMS reported no abnormal heart rhythm. The abdomen was described as gravid. The Emergency Provider Report included, "Patient seen and examined in the ambulance bay and found to be medically cleared and stable to transfer to [another hospital]. Patient not in active labor but having abdominal pain for one day. My clinical reasoning is that this 3rd trimester patient with abdominal pain is not in labor but may start labor, so she should be at a facility with obstetrical and gynecologic services..." There was no evidence the ED physician contacted the receiving facility at any time to ensure the receiving facility had the capability and capacity to accept the transfer of Patient #21. There was no evidence copies of the Provider Report, the only clinical information in the medical record, were sent to the receiving facility. The record did not include a Certificate of Transfer indicating the ED physician had provided Patient #21 with the information required for her to make an informed decision regarding her transfer, nor was there evidence the physician discussed the potential risks of transferring versus receiving treatment at this facility. The facility policy titled EMTALA-Transfer Policy, no policy number, effective 5/24/16 was reviewed on 11/28/16. The policy included documentation any transfer of an individual with an Emergency Medical Condition (EMC) must be initiated either by a written request for transfer or by a physician order with the appropriate physician certification as required under EMTALA. The policy required the physician to sign a certification that based upon the information available at the time of transfer the medical benefits of transfer outweighed the increased risks of the transfer, and the patient has been informed of the potential risks prior to making a decision. The policy indicated a transfer will be appropriate if the transferring hospital provided medical treatment within its capacity, the receiving hospital has available space and qualified personnel to provide appropriate treatment, and the transferring hospital sends the receiving hospital copies of all medical records related to the EMC. An interview was conducted with the Vice President of Quality on 11/28/16 at approximately 10:00 a.m. She indicated she was present on 11/17/16 when the Director of Emergency Services called to say the department secretary observed a physician going out to examine a patient who was still in the ambulance. The Vice President of Quality and the Director of Emergency services determined from their interview with the ED physician that he had examined Patient #21 in the ambulance without bringing the patient into the facility and instructed the ambulance crew to take the patient to another hospital. She confirmed the above findings.