Hospital discharges woman who gave birth in car minutes later

ffemt8978

ffemt8978

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This is not really an EMTALA violation, and her demand that all patients in labor be allowed to see a provider is never going to happen - I had no idea how autonomous L&D nurses were until my L&D clinical rotation. Who's to say how far she was really dilated but if she legitimately didn't meet the dilation threshold which is presumably based on the standard of care, then I can see how this happened - especially if the L&D department was packed.
 
Healthy baby? Stuff happens... and she didn't get an L and D bill. Win.
 
It may not have technically been an EMTALA violation, but I can't really envision a defensible scenario where a G4P3 had been displaying increasingly strong and regular contractions over six hours and was still discharged without even briefly seeing a provider.
 
Wellp, that's one hospital that's not going to be skipping the "Is there any possibility you may be pregnant?" question for just about evvveerrryyyybody no matter how old or young (prob even guys too) for quite a while...
 
FiremanMike said:
This is not really an EMTALA violation, and her demand that all patients in labor be allowed to see a provider is never going to happen - I had no idea how autonomous L&D nurses were until my L&D clinical rotation. Who's to say how far she was really dilated but if she legitimately didn't meet the dilation threshold which is presumably based on the standard of care, then I can see how this happened - especially if the L&D department was packed.
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I can see that point, but delivery 8 minutes later puts that into question...assuming the article is accurate
 
FiremanMike said:
This is not really an EMTALA violation, and her demand that all patients in labor be allowed to see a provider is never going to happen - I had no idea how autonomous L&D nurses were until my L&D clinical rotation. Who's to say how far she was really dilated but if she legitimately didn't meet the dilation threshold which is presumably based on the standard of care, then I can see how this happened - especially if the L&D department was packed.
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Please explain... don't all patients who enter the ER see a provider before discharge? Yes, nurses are autonomous in some areas, and, assuming she was in the L&D department, I would have thought a provider would have evaluated her sometime during her stay, even if they were packed.. if this statement is true:
"We can agree a woman is active labor should not be sent away without seeing a doctor," Lambert said.
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and she was in active labor and was never evaluated by a doctor... and was discharged... Then I have questions. unless she was evaluated by an allied health provider (NP or PA), in which case, they are omitting critical information, and that changes the critical situation completely. I think we should also wait until we hear the results of the hospital's investigation...
 
DrParasite said:
Please explain... don't all patients who enter the ER see a provider before discharge? Yes, nurses are autonomous in some areas, and, assuming she was in the L&D department, I would have thought a provider would have evaluated her sometime during her stay, even if they were packed.. if this statement is true:

and she was in active labor and was never evaluated by a doctor... and was discharged... Then I have questions. unless she was evaluated by an allied health provider (NP or PA), in which case, they are omitting critical information, and that changes the critical situation completely. I think we should also wait until we hear the results of the hospital's investigation...
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I'll walk back on some of my statements once I thought through them a bit more. Nurses can't discharge so I'm certain a provider was involved at some point.
 
FiremanMike said:
I'll walk back on some of my statements once I thought through them a bit more. Nurses can't discharge so I'm certain a provider was involved at some point.
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Involvement could be a phone call from the triage nurse with a verbal order to discharge. But in the end, like every other generic media take on medical decision making, there is more to this story. Precipitous deliveries happen in first time pregnancies (albeit uncommon) let in alone multi-parous women. What really happened is probably not all that exciting.
 
DrParasite said:
Please explain... don't all patients who enter the ER see a provider before discharge? Yes, nurses are autonomous in some areas, and, assuming she was in the L&D department, I would have thought a provider would have evaluated her sometime during her stay, even if they were packed.. if this statement is true:
Click to expand...
I believe the EMTALA verbiage is "a medical screening exam" which can be a RN following established protocols. In the L&D world where primips show up all day long just because they are having sensations they've never felt before, it's pretty common to be seen by just a RN.

In this case, however, a woman who has already birthed 3 babies complaining of contractions increasing in frequency and intensity over several hours should definitely have been seen by a OB/GYN or CNM before being discharged.

This isn't a perfect analogy, but it's almost like a young, healthy patient complaining chest pain with no CVD risk factors and S/S strongly suggestive of musculoskeletal origin and a perfectly normal EKG, vs. someone whose EKG is also fine but they do have CVD risk factors and S/S suggestive of a cardiac event. One you would possibly send home based on protocols, the other you would definitely have seen by a provider first.
 
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