Based on documentation review and staff interview the facility failed to comply with (A2406) by not providing a medical screening exam, failed to comply with (A2407) by not providing stabilizing treatment and failed to comply with (A2409) by not providing for safe transfer for one of one labor patient. The hospital emergency department logs an average of 575 cases per month. The cumulative effect of this systemic practice resulted in the facility's inability to ensure that all patients presenting to the emergency department would receive a medical screening evaluation, stabilizing treatment and a safe transfer.

Based on facility documentation review and staff interview the facility failed to provide an appropriate medical screening exam for one of one labor patient (Patient E ) who presented to the emergency department. The total sample size was 20 records reviewed. The hospital emergency department averages 575 cases per month. Findings include: A review of the emergency department registration log was conducted on 4/21/16 from 9:00 AM through 11:30 AM. Interview with Staff A on 4/21/16 at 11:31 AM revealed an occurrence on 4/16/16 regarding a pregnant patient (Patient E) who presented to the hospital emergency department. Staff A reported that an RN working the morning of 4/16/16 observed a pregnant patient and her male companion present through the ambulance door entry. The RN (Staff E) asked the patient if she knew her due date and took her to an ED room and had her sit down. Staff E proceeded to tell the patient that this hospital does not have an Obstetrical unit and offered the option of remaining and receiving treatment or she could have the male companion that brought her in drive her to the hospital 30 minutes away where her Obstetrician would see her. The patient chose to go to where her Obstetrician was and Staff E escorted the patient out to her car. Staff E was interviewed on 4/21/16 at 12:15 PM. Staff E recalled the morning of 4/16/16 reporting that his/her shift began at 7:00 AM. Staff E reported shortly after the start of the shift a visibly pregnant female (Patient E) presented at the ambulance door entry. Staff E noticed her standing with a male companion. Staff E asked the patient if he/she could help her. The patient replied, "I think I'm leaking fluid". Staff E escorted the patient to Room 4 and had the patient sit down. Staff E asked the patient if she knew her due date and recalled the patient replied, "in July". Staff E informed the patient that this hospital does not have an Obstetrical unit, but informed the patient she needed to see her Obstetrician today. Staff E offered to treat the patient but informed her that she would ultimately need to be transferred to another hospital that had Obstetrical services. Staff E also offered to the patient that she could have her male companion drive her to the hospital where her Obstetrician practiced as she would need to be seen today. Staff E reported the patient was having dry heaves and decided she wanted to travel to the hospital of her Obstetrician's practice by private vehicle with her male companion. Staff E escorted the patient out of the ED to her private vehicle driven by the male companion. Staff E called the hospital where the patient was heading and told them of her pending arrival. Staff E reported, "a couple hours later, I called again to make sure she made it there safely." During the interview, Staff E confirmed he/she did not assess the patient further, did not provide stabilizing treatment and did not register the patient on the ED log. The interview with Staff E was conducted with the hospital CEO (Staff A) and the hospital DON (Staff B) present. Staff A confirmed on 4/21/16 at 11:31 AM that Patient E was not registered or listed on the ED log.

Based on facility documentation review and staff interview the facility failed to provide stabilizing treatment for one of one labor patient (Patient E ) who presented to the emergency department. The total sample size was 20 records reviewed. The hospital emergency department averages 575 cases per month. Findings include: Interview with Staff A on 4/21/16 at 11:31 AM revealed an occurrence on 4/16/16 regarding a pregnant patient (Patient E) who presented to the hospital emergency department. Staff A reported that an RN working the morning of 4/16/16 observed a pregnant patient and her male companion present through the ambulance door entry. The RN (Staff E) asked the patient if she knew her due date and took her to an ED room and had her sit down. Staff E proceeded to tell the patient that this hospital does not have an Obstetrical unit and offered the option of remaining and receiving treatment or she could have the male companion that brought her in drive her to the hospital 30 minutes away where her Obstetrician would see her. The patient chose to go to where her Obstetrician was and Staff E escorted the patient out to her car. Staff E was interviewed on 4/21/16 at 12:15 PM. Staff E recalled the morning of 4/16/16 reporting that his/her shift began at 7:00 AM. Staff E reported shortly after the start of the shift a visibly pregnant female (Patient E) presented at the ambulance door entry. Staff E noticed her standing with a male companion. Staff E asked the patient if he/she could help her. The patient replied, "I think I'm leaking fluid". Staff E escorted the patient to Room 4 and had the patient sit down. Staff E asked the patient if she knew her due date and recalled the patient replied, "in July". Staff E informed the patient that this hospital does not have an Obstetrical unit, but informed the patient she needed to see her Obstetrician today. Staff E offered to treat the patient but informed her that she would ultimately need to be transferred to another hospital that had Obstetrical services. Staff E also offered to the patient that she could have her male companion drive her to the hospital where her Obstetrician practiced as she would need to be seen today. Staff E reported the patient was having dry heaves and decided she wanted to travel to the hospital of her Obstetrician's practice by private vehicle with her male companion. Staff E escorted the patient out of the ED to her private vehicle driven by the male companion. Staff E called the hospital where the patient was heading and told them of her pending arrival. Staff E reported, "a couple hours later, I called again to make sure she made it there safely." During the interview, Staff E confirmed he/she did not assess the patient further, did not provide stabilizing treatment and did not register the patient on the ED log. The interview with Staff E was conducted with the hospital CEO (Staff A) and the hospital DON (Staff B) present.

Based on facility documentation review and staff interview the facility failed to provide for a safe transfer for one of one labor patient (Patient E ) who presented to the emergency department. The total sample size was 20 records reviewed. The hospital emergency department averages 575 cases per month. Findings include: Interview with Staff A on 4/21/16 at 11:31 AM revealed an occurrence on 4/16/16 regarding a pregnant patient (Patient E) who presented to the hospital emergency department. The RN (Staff E) asked the patient if she knew her due date and took her to an ED room and had her sit down. Staff E proceeded to tell the patient that this hospital does not have an Obstetrical unit and offered the option of remaining and receiving treatment or she could have the male companion that brought her in drive her to the hospital 30 minutes away where her Obstetrician would see her. The patient chose to go to where her Obstetrician was and Staff E escorted the patient out to her car. Staff E offered to treat the patient but informed her that she would ultimately need to be transferred to another hospital that had Obstetrical services. Staff E also offered to the patient that she could have her male companion drive her to the hospital where her Obstetrician practiced as she would need to be seen today. Staff E reported the patient was having dry heaves and decided she wanted to travel to the hospital of her Obstetrician's practice by private vehicle with her male companion. Staff E escorted the patient out of the ED to her private vehicle driven by the male companion. Staff E called the hospital where the patient was heading and told them of her pending arrival. Staff E reported, "a couple hours later, I called again to make sure she made it there safely."