Based on medical record review, document review, and interview, in 4 (four) of 4 (four) medical records reviewed, it was determined that the facility failed to ensure: (a) that obstetric patients received an appropriate medical screening examination by a Qualified Medical Practitioner (QMP), and (b) EMTALA (Emergency Medical Treatment and Labor Act) training is provided for all staff. (Patient #3, #16, #17 & #18). This failure may have placed patients at risk for potential harm. Findings include: See TAG A-1104.

Based on medical record review, document review and interview, in 4 (four) of 4 (four) medical records reviewed, it was determined that (a) obstetric patients did not receive an appropriate medical screening examination by a Qualified Medical Practitioner (QMP), and (b) that EMTALA (Emergency Medical Treatment and Labor Act) training is provided for all staff. (Patient #3, #16, #17 & #18). Findings include: (a) A review of the medical record for Patient #3 revealed the following: Patient #3 presented on August 7, 2016 at 10:54 AM with a complaint of "not feeling the baby move." She had not received prenatal care and had just relocated to New York. She assessed by the nurse and an ultrasound was done which showed a single live intrauterine gestation of 19 weeks. The nurse reported the results of her assessment and the ultrasound via a telephone call to a physician who instructed her to discharge the patient home. The medical record did not contain a telephone order to discharge the patient home. The patient was discharged home without an appropriate medical screening examination by a QMP. A review of the medical record for Patient #16 revealed: the patient presented on August 2, 2016 at 9:15 PM complaining of abdominal tightening since 5:00 PM that day and pressure on urination. The patient's expected date of delivery was 11/15/16. The nursing assessment and evaluation determined the FHR (fetal heart rate) was normal and by 9:30 PM, the patient reported feeling less cramping. The urine results were negative and the ultrasound to evaluate the cervical length was normal. The physician instructed the nurse to discharge the patient home one (1) hour after her contractions had stopped. She was discharged at 10:30 PM that night. The patient was discharged home without an appropriate medical screening examination by a QMP. Review of the medical record for Patient #17 revealed: the patient presented on August 2, 2016 at 10:00 PM complaining of urinary symptoms and she reported that she had been bleeding on the tissue after voiding. The patient was 22 weeks pregnant and had been treated 2 weeks prior for a Urinary Tract Infection but the symptoms had not gone away. According to the nurse's notes the maternal review of systems was normal and the urine analysis was within normal limits. The nurse gave " a telephone report" to the physician who requested a urine culture and that a vaginal examination should be done. These procedures were done and they were found to be normal. The nurse discussed her findings with the physician over the phone and he instructed her to discharge the patient home with instructions for follow-up care with the physician. The patient was discharged home without an appropriate medical screening examination by a QMP. Similar findings were identified for Patient #18. The patient was 39 weeks and 2 days of gestational age and presented on August 8, 2016 at 3:32 AM with a complaint of abdominal cramping along with a possible leakage of clear fluid since 8:00 AM on August 7, 2016. The patient was examined by a nurse, the nurse discussed the results with the physician, and discharged the patient home as advised by the physician. The patient was discharged home without an appropriate medical screening examination by a QMP. During an interview on August 12, 2016 at 10:15 AM with Staff A, the Vice President of Quality, she confirmed this process of the nurses in the obstetrical unit performing the function of a QMP. She stated that the facility had not designated these nurses to serve as QMP's. (b) A random sample of 12 personnel files consisting of the Director of Obstetric Department, an obstetrician, and Registered Nurses who worked on the L&D Unit were reviewed. This review revealed none of the 12 employees had received training on Emergency Medical Treatment and Labor Act requirements. This finding was acknowledged by Staff A, the Vice President of Quality on 08/17/16 at 3:00 PM.

Based on review of surveillance video, medical record review, document review, and staff interview, in one (1) of 40 medical records reviewed, it was determined the facility failed to ensure that the names of every individual who presented to the facility seeking emergency care was entered into the central log or the obstetric log. (Patient #1). Findings include: Review of video surveillance camera revealed that on July 31, 2016 at 10:36 PM, Patient #1 entered the main lobby of the hospital with a companion and they approached a security guard who was sitting at the front desk. She was given a pink paper, which is the facility's protocol for patients who have been referred to the Labor and Delivery Unit (L&D) on the 6th Floor and they proceeded to the 6th Floor. Another video surveillance camera revealed the patient arriving at the nurses station in the L&D unit at 10:40:34 PM and she remained standing at the station for approximately 1 minute. The patient and her companion are then seen leaving the nurses station and the unit at 10:41:26 PM that night. A nurse is seen in view of the camera as the patient leaves the unit. During an interview conducted on 08/12/16 at 10:30 AM Staff B, the Nurse Manager of the L&D Unit, confirmed that there was an interaction between the patient and Staff C, who is a registered nurse. Staff B also stated that Staff C performed a verbal assessment of the patient and instructed the patient to go to another facility. A review of the ED central log and the obstetric log revealed there was no documented evidence that the patient's name was documented in either logs on July 31, 2016, when she went to the L&D unit seeking emergency medical care. The policy titled "ED Daily Log Reconciliation Process" which was last reviewed 07/11/2016 states, "all patients presenting to the hospital seeking treatment for an emergency medical condition are to be recorded on the Central ED Log." This finding was confirmed during an interview with the Director of Maternal and Child Health on August 16, 2016 at 3:00 PM.

The deficiencies cited below are a result of a Federal Title 18 EMTALA (Emergency Medical Treatment and Active Labor Act) survey (NY 730), conducted on 8/12, 8/15, 8/16, and 8/17/16 in accordance with EMTALA (Emergency Medical Treatment and Active Labor Act) 42 CFR Part 489 Conditions of Participation for Hospitals, specifically for regulations that apply to Medicare participating hospitals for meeting the Emergency Medical Treatment And Labor Act (EMTALA) statue codified at § 1867 of the Social Security Act (The Act), the accompanying regulations in 42 CFR § 489.24, and the related requirements at 42 CFR 489.20 (I), (m), (q), and (r). The plan of correction must relate to the care of all patients and prevent such occurrences in the future. Intended completion dates (X5) and the mechanism(s) established to assure ongoing compliance must be included. A review of video surveillance camera of the 6th Floor L&D Unit, revealed that on July 31, 2016 at approximately 10:40:34 PM, Patient #1 and her companion arrived at the nurses station and she remained standing at the station for approximately 1 minute. The patient and her companion are seen leaving the nursing station and the L&D unit at 10:41:26 that night. A nurse is seen in view of the camera as the patient leaves the unit. The patient presented to another facility that night where she delivered a live infant at 6:25 PM on August 1, 2016. There was no evidence on the video that any members of staff escorted the patient to a room for an examination or that her vital signs were taken. During an interview with Staff B, the Nurse Manager of the L&D, conducted on August 12, 2016 at 10:10 AM, she stated that Staff C, a registered nurse, conducted a "verbal assessment" of the patient when she asked the patient the purpose of her visit to the unit and where she received prenatal care. Staff B stated that Staff C reported that the patient had back pain and that she was a high risk patient who received care at another facility. Staff B also stated that Staff C (registered nurse) instructed the patient to go to that facility without performing a medical screening examination to determine if the patient had an emergency medical condition. The policy titled "Guidelines for the Safe Transfer of Emergency Department patients in accordance with EMTALA Regulations," last reviewed on 06/01/2016 states, "White Plains Hospital provides appropriate medical screening and stabilizing treatment to any individual presenting for care to determine whether an emergency medical condition exists." A review of the medical record for Patient #2 revealed the following: Patient #2 presented on August 7, 2016 at 10:54 AM with a complaint of "not feeling the baby move." She had not received prenatal care and had just relocated to New York. She was assessed by the nurse and an ultrasound was done which showed a single live intrauterine gestation of 19 weeks. The nurse reported the results of her assessment and the ultrasound via a telephone call to a physician who instructed her to discharge the patient home. The medical record did not contain a telephone order to discharge the patient home. The patient was discharged home without an appropriate medical screening examination by a Qualified Medical Practitioner (QMP). A review of the medical record for Patient #34 revealed: the patient presented on August 2, 2016 at 9:15 PM complaining of abdominal tightening since 5:00 PM that day and pressure on urination. The patient's expected date of delivery was 11/15/16. The nursing assessment and evaluation determined the FHR (fetal heart rate) was normal and by 9:30 PM, the patient reported feeling less cramping. The urine results were negative and the ultrasound to evaluate the cervical length was normal. The physician instructed the nurse to discharge the patient home one (1) hour after her contractions had stopped. She was discharged at 10:30 PM that night. There was no documentation of the telephone order to discharge the patient home. The patient was discharged home without an appropriate medical screening examination by a QMP. Review of the medical record for Patient #35 revealed: the patient presented on August 2, 2016 at 10:00 PM complaining of urinary symptoms and she reported that she had been bleeding on the tissue after voiding. The patient was 22 weeks pregnant and had been treated 2 weeks prior for a Urinary Tract Infection but the symptoms had not gone away. According to the nurse's notes the maternal review of systems was normal and the urine analysis was within normal limits. The nurse gave " a telephone report" to the physician who requested a urine culture and that a vaginal examination should be done. These procedures were done and they were found to be normal. The nurse discussed her findings with the physician over the phone and he instructed her to discharge the patient home with instructions for follow-up care with the physician. The patient was discharged home without an appropriate medical screening examination by a QMP. Similar findings were identified for Patient #41. The patient was 39 weeks and 2 days of gestational age and presented on August 8, 2016 at 3:32 AM with a complaint of abdominal cramping along with a possible leakage of clear fluid since 8:00 AM on August 7, 2016. The patient was examined by a nurse, the nurse discussed the results with the physician, and discharged the patient home as advised by the physician. The patient was discharged home without an appropriate medical screening examination by a QMP. During an interview on August 12, 2016 at 10:15 AM with Staff A, the Vice President of Quality, she confirmed this process of the nurses in the obstetrical unit performing the function of a QMP. She stated that the facility had not designated or credentialed these nurses to serve as QMP's.

Based on medical record reviews, document reviews and staff interviews, it was determined the facility failed to ensure that all patients received care that was consistent with prevailing standards of practice Specifically, assessments were not thorough. This was identified in 1 of 20 medical records reviewed (MR #1). Findings include: 1. The physician's assessment was not thorough and it was inadequate in the case of patient (MR) #1. A review of patient #1's medical record on July 8, 2015 revealed this twenty-six year old patient presented to the emergency department (ED) on March 10, 2015 at 1:49 AM with a sudden onset of left ear pain which had awoken her from her sleep that night. The nurse documented that the patient reported that she had a sore throat a few days ago and was been treated for the flu. The pain score was 9 on a scale of 0 (no pain) to 10 (most severe pain). The patient was seen by the physician at 2:08 AM who noted the patient didn't haven't any symptoms of recent upper respiratory infection which contradicts the triage nurse's finding. The physician's assessment revealed there was minimal erythemia in the left ear and that the lungs were clear. There was no documentation that the patient's throat was examined given the nurse's notation of sore throat and flu symptoms. Patient #1 was given Motrin 600 mgs at 2:10 AM that night for pain that was throbbing, constant and the patient was grimacing. The patient was discharged at 2:22 AM that morning without a reassessment. Review of the facility's policy titled "Management of the patient experiencing pain and safe use of opioids" which was last reviewed on 8/27/13 states a "nurse will monitor for effectiveness and any adverse effects based on the medications route of administration in 60 minutes after PO administration." Patient #1 was discharged from the ED on March 10, at 2:22 AM with instructions to take Motrin for pain. There was no documented evidence that the patient was informed of the dosage and the frequency that the medication should be taken. Nor was there any evidence that the patient was given a prescription to continue this dosage of the drug. This finding was confirmed during an interview with the nurse manager of the ED on July 8, 2015 at approximately 11:30 AM.