Based on interviews, medical record review and policy review, the facility failed to comply with (A2406) by failing to provide an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition exists. The cumulative effect of this systemic practice resulted in the facility's inability to ensure that all patients arriving to the facility seeking medical treatment would receive a medical screening examination. The average monthly census of the Emergency Department is 2,117 patients.

Based on policy review, interviews, facility documentation and review of an EMS run report and unusual occurrence report, the facility failed to provide an appropriate medical screening examination within the capability of the hospital's emergency department to determine whether or not an emergency medical condition existed for one (Patient #21) of 21 medical records reviewed. Findings include: Review of facility documentation regarding Patient #21 revealed the following timeline of events: Dated 7/31/15, 4:57 a.m. (approximate time)-Call notification occurred from EMS to the facility's Labor and Delivery Department of impending patient transport. Report given that Patient #21 was scheduled for caesarian section on Monday and was bleeding and having contractions. Labor and Delivery nurse notified Nurse in Charge of arriving patient. Nurse Supervisor was present. Nurse in Charge asked Staff E to call back and see if they can take this patient to a different facility. Supervisor obtained number for nurse of EMS dispatch. 5:10 a.m.-Outgoing call from Labor and Deliver to EMS dispatch to take patient to a different facility due to activity of department. "Needed to divert this patient". The EMS dispatch agreed. The EMS dispatch notified the EMS. 5:11 a.m.-After receiving the call from dispatch, the EMS then called the facility's Labor and Delivery unit and told them they were just pulling in the parking lot. Staff E stated "I am so sorry but can you take Patient #21 to a different facility?" The EMS stated they could. Patient went to competitor, a different facility. Review of the EMS run report from the facility Patient #21 was diverted to revealed the following: Dispatched code three for a [AGE] year old female (Patient #21) complaining of labor pains. Patient states that she is 39 weeks pregnant and has been having irregular contractions throughout the evening. Patient #21 states her water has not broken and no mucus plug lost. Patient denies any previous medical history, no medications, and has not had any complications throughout this pregnancy. Patient is Parity 0 (the number of >20-week births), Gravida 1(number of times the woman has been pregnant) Abortus 0. Patient wants to be taken to the facility for evaluation. Patient has irregular contractions throughout transport and denies pressure feeling. Upon arrival to the facility, the EMS was diverted to a different facility by Labor and Delivery staff per dispatch. The EMS called the facility to inform them that the EMS was at their facility and EMS was still asked to transport Patient to a different facility. Staff B was interviewed on 08/04/15 at 12:47 PM regarding Patient #21. Staff B reported Staff E, who spoke to the EMS, admitted knowing Patient #21 was on site when the nurse diverted the EMS. On 08/04/15 at 3:32 PM, Staff E, who spoke to the EMS regarding Patient #21, was interviewed. Staff E reported the charge nurse instructed Staff E to call the EMS and have the EMS take Patient #21 to a different facility. Staff E reported the facility did not have the staff to handle Patient #21. Staff E stated the EMS called the Labor and Delivery unit and Staff E instructed the EMS to take Patient #21 to a different facility. The EMS reported to Staff E that they were "pulling in" the facility. On 08/04/15 at 3:48 PM, Staff D was interviewed via phone. Staff D reported the EMS driver stated he/she pulled onto the driveway for maternity and stopped. The EMS driver called upstairs and was told to divert Patient #21. The EMS driver backed out of the driveway and took Patient #21 to a different facility. On 08/05/15 at 9:20 AM, Staff C reported the driveway which the EMS stopped on was the facility's property. The EMS Unusual Occurrence report from 07/31/15 was reviewed. The report stated the EMS was transporting Patient #21 to the facility. Upon pulling into the parking lot, dispatch advised the EMS that they were being diverted. The EMS crew called the Labor & Delivery unit to confirm this and the Labor & Delivery staff advised the EMS that they can no longer accept Patient #21 and that Patient #21 must be taken to another facility. On 08/04/15 at 12:45 PM, Staff A reported Labor and Delivery patients are only evaluated in the Emergency Department if they walk in. Staff A reported all Labor and Delivery patients greater than 20 weeks are immediately transferred to the Labor and Delivery unit unless they are in active labor. Staff A reported Patient #21 should have been diverted by the Labor and Delivery unit to the Emergency Department. On 08/04/15 at 2:15 PM, Staff A and Staff B reported the facility was not on diversion when the EMS arrived with Patient #21. The facility's emergency department logs were reviewed and did not contain a visit for Patient #21 on 07/31/15. The facility's Ambulance Diversion policy was reviewed. The policy stated the decision to divert is to be made by the Chairman of the Department of Emergency Medicine or his designee. The facility's Triage of the Obstetric Patient in Emergency Department policy was reviewed. The policy stated all pregnant patients that present to the facility will be evaluated by a medical professional before being discharged , transferred or admitted . In no case will a pregnant patient who presents to the facility for evaluation be sent home without an exam by a medical professional. The policy states any patients, who are in their 20th week or more of pregnancy, bypass the Emergency Department and go directly to the labor and delivery unit. The labor and delivery unit has a physician present 24 hours a day. Patient #21's medical record from the facility Patient #21 was diverted to was reviewed. The record noted the following admission information Abstract Report: admitted /Time: 07/31/15 05:47 AM Admission type: Urgent Diagnosis: Active labor at term Cesarean Section Note Time: 7/31/15, 7:55 AM Complications: None Condition: Infant stable to general nursery and mother stable discharged [DATE] at 7:42 PM to home