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Hospital undergoes state review

In the aftermath of an incident last fall in which a baby was born at mile marker 119 on U.S. 160 after the mother was discharged from the Pagosa Springs Medical Center (formerly Pagosa Mountain Hospital), the hospital has instituted new policies to prevent such incidents from occurring again.

The baby boy was born after his mother was discharged from PSMC and told to go by private vehicle to Mercy Medical Center. The incident resulted in EMTALA (Emergency Medical Treatment and Active Labor Act) violations for the hospital.

Both Mercy Regional Medical Center (the receiving hospital) and PSMC reported the incident to the Department of Health and Human Services, resulting in a review of PSMC’s deficiencies in dealing with the incident (and others) and an action plan was developed to ensure such incidents don’t happen in the future.

The review was accompanied by visits from state employees on Feb. 1 and, more recently, a surprise visit Monday to check the hospital’s progress in correcting its deficiencies.

PSMC Chief Executive Officer Brad Cochennet reported that the hospital passed the visit and was doing what the state required.

“We self-reported to the state and had the state come down and review the things they thought we should do,” Cochennet said, adding that state employees also provided training for all employees involved in emergency medicine at the facility.

Additionally, Cochennet said the hospital had an obstetrician from Durango come over and discuss the various stages of labor with the Emergency Room staff.

In examining the woman in labor upon her arrival to the hospital in November, the physician tending to the woman decided the patient had time to complete the journey to Mercy prior to the baby’s arrival, and did not offer an ambulance for the transport.

In the review, it was determined the pregnant woman was discharged “before all usual assessments were completed, and no transfer forms were completed.”

An interview with the physician, as summarized in the report, revealed the assessments and forms were not completed due to the need to quickly send the woman to Mercy, and that the physician believed the woman had hours before she would deliver the baby.

The woman reported to The SUN last fall that the doctor informed her that deliveries were not performed at PSMC.

The woman was taken by car from the Pagosa facility by her brother-in-law and a friend and, after giving birth, was transported to Mercy via ambulance.

Following the woman’s arrival at Mercy, PSMC’s Chief Medical Officer, Dr. Al Caccavale, received a call from his counterpart at Mercy, Dr. Kip Boyd, notifying him of a potential EMTALA violation.

“We reviewed it and agreed it was a potential violation, then did our own review and filed,” Caccavale said.

Among other policy changes made at the hospital, Caccavale said the facility now has a course of action for patients who present in active labor. While the hospital still does not perform elective deliveries, by law, hospitals must tend to women in active labor.

The report to the Department of Health and Human Services sampled 20 cases from the hospital, focusing on the birth in question and one other incident that resulted in an EMTALA violation, in which a three-year-old child was brought by his or her parents to the ER with a deep tongue laceration.

The patient was discharged with instructions to the parents to go directly to Mercy. The patient’s record contained no evidence of a transfer form, however, and no coordination of care was apparent with the receiving hospital, according to the report.

The report also includes numerous corrective actions to ensure the same mistakes are not made again in the future.

Among those items on the action plan are:

• “All providers participating in ER care have read the EMTALA regulation and signed off that they have done so. They are aware they are being held accountable to this standard.”

Additionally, all employees will be trained in EMTALA regulations at the time of employment and annually.

• All patients will receive a medical screening upon their presentation to the ER.

• All patients are considered unstable until determined otherwise.

• All labor patients will be advised of an option to deliver at PSMC or transfer via ambulance to Mercy, “as appropriate medically.”

• Delivery of an infant at PSMC or a transfer to Mercy will be decided by the patient following the above advisement.

• The ER staff and ER provider will contact the receiving hospital regarding any potential transfer and will have an accepting physician established prior to arrival at the receiving hospital.

• “All patients will be advised as to the appropriate transport given their medical condition, and will be offered ambulance transfer.”

• All EMTALA transfer forms and a copy of medical records will accompany the patient to the receiving hospital.

• All transfers will be reviewed monthly by the ER lead nurse for compliance, with the results forwarded to the ER committee for further review and action.

• Should a patient decide to be transported by private vehicle, he or she must initial a section on a form stating that they are aware of the risks associated with private transfer.

• All ER providers will be educated in obstetrical assessment and care.

• All nurses will be educated in labor, delivery and the care of newborns.

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