Franciscan Health Olympia & Chicago Heights

“RN SUPERVISION OF NURSING CARE CFR(s): 482.23(b)(3) A registered nurse must supervise and evaluate the nursing care for each patient. This Standard is not met as evidenced by: 40079 Based on document review and interview, it was determined that for 1 of 4 (Pt.#21) clinical records reviewed for patients with a fall high risk score and fall precautions, the hospital failed to ensure that the registered nurse ensured that fall precautions were followed to prevent an injury while assisting a patient during a transfer (commode to chair). Findings include: 1. The hospital’s policy titled, “Fall Precautions Procedure” (revised 01/13/2025) was reviewed and required, “Falls can be a source of serious injury to patients ... Routine assessment with the application of patient tailored interventions based on risk identification approach to fall prevention ... Universal precautions are foundational patient safety standards and will be applied to all patients, these include ... use of safety equipment including, mobility aids, as appropriate. 2. The hospital’s “Job Description-Registered Nurse” (version date: 04/10/2019) was reviewed and required, “ ... Collaborates with patients and ... members of a multidisciplinary team, to ensure optimal patient outcomes and enhancements of the patient experience.” 3. The clinical record of Pt.#21 was reviewed on 05/19/2025. Pt.#21 was admitted on 02/06/2025 for an elective surgery and was transferred to a tertiary hospital on 02/19/2025. The clinical record included the following: -History and Physical, dated 02/06/2025 at 4:24 PM, “ ... (Pt.#21) admitted for postoperative management. Procedure per Ortho (orthopedics)was more complex than anticipated, requiring open reduction and internal fixation of the acetabulum (ball and socket joint of femur) due to an intraoperative finding ...” -Physician Order, dated 02/07/25 at 8:59 AM, “Patient is okay to start PT (Physical Therapy) without hip abduction brace. Patient will be non-weight bearing of left lower extremity ...” -Fall Risk Assessment flowsheets for 02/07/2025 through 02/19/2025 were reviewed and indicated that the predictive fall risk scores were completed and reviewed by the nurse. (Pt.#21) was stratified as high risk for falls (score from 94 to 100) with the following interventions in place; Patient oriented to room, instructed to call for help, environment free of clutter, Arm Band on, non-skid socks on, call-light within reach, bed in lowest position, bed wheels locked, side rails up x 2, and bed alarm on. -Nursing Progress Notes (E#5), dated 02/16/2025 at 6:30 PM, “Patient (Pt.#21) was being assisted by the PCT (Patient Care Technician/E#6) from the bedside commode to the chair. Patient stated (Pt. #21) misjudged as (Pt. #21) went to sit down and hit (Pt. #21) left hip on the left side of the recliner chair.” -Orthopedic Progress Note (MD#2), dated 02/17/2025 at 8:40 AM, “(Pt.#21) fell yesterday into (Pt.#21’s) chair. I responded immediately with my resident. X-ray and CT (Computed Tomography-images body) show that (Pt.#21) re-fractured their acetabulum and disassociated the prosthetic cup and dislocated the hip ball. (Pt.#21) will need to be transferred to a revision total hip specialist. We are trying to arrange this transfer today. Pain is under control. Neuro (neurologic) status is intact.” 4. An interview was conducted with the Orthopedic Surgeon (MD#2) on 05/20/2025 at 8:34 AM. MD #2 stated that the day of the incident (Pt.#21) called MD#2 directly and reported that something was wrong with (Pt.#21’s) hip. (Pt.#21) stated that they had fallen into their chair and hit their hip on the armrest. MD#2 stated that (MD#2) immediately sent the Resident to assess (Pt.#21) and ordered a stat (immediate) x-ray. MD#2 stated that (Pt.#21) is a rather large (person) about 6 feet tall and over 250 pounds, and the impact would be high when (Pt. #21) hit armrest. MD#2 stated that (Pt.#21) had to be transferred for revision because the surgery (Pt.#21) required was out of (MD#2’s) scope. 5. An interview was conducted with the Patient Care Technician (E#6) 05/20/2025 at 8:48 AM. E#6 stated that E#6 recalls (Pt.#21) and (Pt.#21) was very inpatient and had to be reminded to wait for staff for assistance. On the day that (Pt.#21) sustained the injury (Pt.#21) did not have a gait belt on, and (Pt.#21) was in a hurry to sit on the chair and did not listen to (E#6’s/PCT) cues to pivot because (Pt.#21) was not aligned with the chair and plopped down. (Pt.#21) started to scream, E#6 went to get the nurse (E#5) and reported the incident. 6. An interview was conducted with the Registered Nurse (RN/E#5) on 05/20/2025 at 9:45 AM. E#5 stated that, the patient was being transferred from the commode to the recliner. E#5 was not in room but during the incident (Pt.#21) plopped down on chair and was not aligned with chair and hit their left hip. E#5 stated that staff do use gait belts and is not sure if (E#6) used a gait belt during the incident.”

“RN SUPERVISION OF NURSING CARE CFR(s): 482.23(b)(3) A registered nurse must supervise and evaluate the nursing care for each patient. This Standard is not met as evidenced by: 40079 A. Based on document review and interview, it was determined that for 1 of 4 (Pt.#1) clinical records reviewed for fall risk assessements and precautions, the hospital failed to ensure that the registered nurse appropriately assessed or re-evaluate the patients’ for fall risk and implement additional fall precautions. Findings include: 1. The hospital’s policy titled, “Fall Precautions Procedure” (revised 10/14/24) was reviewed and included, “This procedure applies to all Nursing Staff withing the Inpatient Care Units ... ED ... Universal Precautions are fundamental patient safety standards will be applied to all patients, these include, Bed low and locked, purposeful rounding, call within reach, side rails up x2 ... The Nurse will assess and/or review fall risk and document interventions at the following times: A. Within four (4) hours of arrival ... Change in patient condition or level of care ... As stated above, all (low risk) patients will have Universal Fall Precautions in place.” 2. The clinical record for Pt.#1 was reviewed on 04/11/25. Pt.#1 presented to the Emergency Department (ED) on 12/19/24 at 2:18 PM, with a chief complaint of fatigue and dizziness. The clinical record included the following: -ED Triage Note, dated 12/19/24 at 2:30 PM, “To ED from home with complaint of feeling tired and dizzy for the past day ... is diaphoretic and lethargic in triage. Unable to get BP (blood pressure) or temperature despite multiple attempts. (Pt.#1) taken straight to main Ed.” -ED Notes dated 12/20/24 at 12:21 AM, “(Pt.#2) getting out of bed multiple times. Attempts to reorient back to reality unsuccessful. Refusing all medical help ... Requested possible medication from MD. MD stated waiting for daughter’s arrival before re-evaluating.” -Fall Risk Assessments during 12/19/24 at 2:45 PM to 12/20/24 at 2:00 PM were reviewed. The fall risk score on 12/19/24 at 4:00 PM was stratified as Low Risk, there was no documentation of fall precautions implemented. The flowsheets did not include a fall risk re-assessment after (Pt.#1) showed change in mental status during this time. 3. An interview with an ED Registered Nurse (E#2) was conducted on 04/11/25 2:06 PM. E#2 stated that all patients are assessed for fall risk and depending on their score fall precautions are implemented. Patients presenting with dizziness or fatigue would not be considered a low risk for falls and precautions should be implemented. If there is a change in the patient’s condition they are reassessed, and the physician should be notified. B. Based on document review and interview, it was determined that for 1 of 4 (Pt.#1) clinical records reviewed for patients that required immediate labs, the hospital failed to ensure that a registered nurse completed physician’s orders, as required. Findings include: 1. The hospital’s policy titled, “Emergency Department (Scope of Care) Nursing Practice” (revised 10/5/24) was reviewed and required, “ ... 2. Initiate appropriate pre-established protocol when patient conditions warrant upon arrival to treatment area ... 3. Establish intravenous access and maintain as ordered by ED physician ... 4. RN will notify and collaborate with physician and ancillary departments for interventions based on ... patient care assessments.” 2. The clinical record for Pt.#1 was reviewed on 04/11/25. Pt.#1 presented to the Emergency Department (ED) on 12/19/24 at 2:18 PM, with a chief complaint of fatigue and dizziness. The clinical record included the following: -Physician Order, dated 12/19/24 at 5:41 PM, “Venous Arterial Gas (once) Immediate.” -Venous Blood Gas Results, dated 12/19/24 at 8:23 PM, “PH Venous 7.30 low (reference range 7.32-7.43/used to measure acidity or basicity); PC02 52.2 high (41.0-51.0/partial pressure of carbon dioxide-measures amount of C02 in blood); P02 Venous 25.3 L (30.0 - 40.0/partial pressure of oxygen-measures amount of 02 in blood); 02CT 9.1 L (15.0-22.0/oxygen content-amount of 02 in blood); 02 Sat Venous 38.8 (94.0 - 99.0).” The lab results indicated that the specimen was collected by the RN (E #11) at 8:08 PM (2 hours and 27 minutes) after the order was placed. 3. An interview was conducted with an Advanced Practice Nurse (E#1) on 04/11/25 at 1:40 PM. E#1 stated that labs that are ordered as “Immediate” should be drawn right away.”

“COMPLIANCE WITH 489.24 CFR(s): 489.20(l) [The provider agrees,] in the case of a hospital as defined in §489.24(b), to comply with §489.24. This Standard is not met as evidenced by: 37971 Based on document review, and interview, it was determined that the hospital failed to ensure compliance with 42 CFR 489.24. Findings include: 1. The hospital failed to conduct an appropriate medical screening as evidenced by delayed clinical intervention. See cited (A-2406). 2. The hospital failed to appropriately stabilize the patients’ emergency medical condition. See cited (A-2407). The Immediate Jeopardy (IJ) began on 3/2/2024, due to the hospital’s failure to appropriately conduct a medical screening examination for 1 of 4 patients (Pt. #1) and stabilization treatment for 1 of 4 patients (Pt. #9) that presented to the Emergency Department (ED) with an ectopic pregnancy. Subsequently, this failure led to the patients deterioration and life-threatening condition. The IJ was announced on 5/3/2024 at 4:30 PM during a meeting with the hospital’s the Chief Executive Officer, the Risk Manager Specialist, the Director of Quality, Director of Imaging/Oncology, the Manager of Pharmacy Services, the Director of Human Resources, the Chief Medical Officer, the Patient Experience Coordinator, the VP Mission Integration, the Chief Nursing Officer, the Manager of Educational Services, the Director of Surgery Services, the VP Marketing and Public Relations, the Director of Patient Quality Services, the VP Strategy and Business Development, the Quality Manager, the Corporate VP of Quality, the ED Medical Director, the Medical Director of Laboratory Services, the VP Administrative Services, and the Director of Services Excellence and Business Initiative. The IJ was not removed by survey exit date of 5/3/2024.”

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 37971 Based on document review, and interview, it was determined that for 1 of 4 (Pt. #1) clinical record reviewed for ectopic pregnancies, the hospital failed to conduct an appropriate medical screening, as evidenced by delayed clinical interventions. Subsequently, this led to a ruptured ectopic pregnancy (fertilized egg grows outside of uterus) and hemodynamic instability (unstable blood pressure). Findings include: 1. The hospital’s Medical Staff Bylaws (dated 04/20/2022) was reviewed and indicated, “ ...13. Emergency Medical Condition (as described in the Emergency Medical Treatment and Active Labor Act ...) is a condition manifesting symptom ...which, in the absence of immediate medical attention, is likely to cause serious dysfunction ...serious jeopardy to the health of the individual ...17. Medical Screening Examination ...required to reach, with reasonable confidence, the point at which it can be determined whether an emergency medical condition does or does not exist ... ...Emergency Department within the Hospital’s capabilities to determine or diagnose whether the patient has an emergency medical condition ...” 2. The hospital’s policy titled, “Turnaround Time” (dated 01/10/2020) was reviewed and indicated, “ ...1. STAT (immediately) orders will be drawn within 30 minutes of the order time. 2. STAT Testing performed on the site will, under normal circumstances, be reported within 60 minutes of specimen receipt in the laboratory ...” 3. The hospital’s “Laboratory Reproductive Analyzer for BetaHCG (pregnancy blood test)” was reviewed and indicated, “ ...total BetaHCG result approximate time to first result - 18 minutes. 4. On 4/30/2024, the clinical record of Pt. #1 was reviewed. Pt. #1 presented to the Emergency Department (ED) on 03/02/2024 at 5:29 AM, with a chief complaint of left lower quadrant pain. Pt. #1’s clinical record included: -The Emergency Room (ER) Registered Nurse (E #2) note dated 03/02/2024 at 6:49 AM, included, “ ...Vital signs: pulse: 73 [normal 60 -100]; respirations: 21 [ normal 16-18]; Blood pressure (BP): 109/77 [normal 120/8 -140/90] oxygen saturation: 99%. -The ER Resident Physician orders dated 6:50 AM, included, an HCG Quantitative (pregnancy blood test). -The HCG quantitative report dated 03/02/2024 at 8:57 AM included, “Collected: 03/02/2024 at 6:56 AM ...Final Result: HCG Quant: 7, 471 [<5=Negative; 5-25=Indeterminate; >25 = Positive] ...” The result was made available 119 minutes after specimen collected. -The ER Resident Physician order dated 03/02/2024 at 9:00 AM, included, “Ultrasound Pregnancy < [less then]14 weeks and pregnancy transvaginal STAT.” -At 9:54 AM, the Ultrasound Technician (E #13) took Pt. #1 via wheelchair to radiology for a transvaginal ultrasound. The exam started at 10:49 AM and ended 10:56 AM Imaging preliminary result at 11:18 AM ...” -The US Pregnancy <14 Weeks and transvaginal report dated 03/02/2024 at 11:25 AM, included, “ ...Findings: A left adnexal ectopic pregnancy is seen with active fetal heart tones at 110 BPM [beats per minute] ...gestational age 6 weeks 2 days trace free fluid in the cul-de-sac ...Radiology Resident Physician spoke with ER Physician [MD #1] at 11:15 AM ...electronically signed by Radiology Medical Director [MD #2] at 11:25 AM.” From the time the STAT ultrasound was order to being read by the radiologist was 2 hours and 25 minutes. -The ER Resident Physician order dated 03/02/2024 at 11:19 AM, included, “Consultation to OB/Gyn (Obstetrics/Gynecology)...” -The ER Registered Nurse (E #3) note dated 03/02/2024 at 12:00 PM, included, “...[Name of On-call OB/Physician /MD #3] at bedside.” -The ER Registered Nurse (E #3) note dated 03/02/2024 from 9:12 AM to 2:32 PM, indicated that the patient was complaining of pain to the left side of the abdomen 10 out of 10 (worse pain) crying and actively vomiting. The ER notes indicated that Pt. #1 had become diaphoretic and hypotensive, at 2:19 PM BP: 79/57; and 2:32 PM BP: 72/41. -Pt. #1 was taken to surgery at 2:32 PM. The Operating Case Tracking Event Report, included, “[Pt. #1] in Operating Room: 2:34 PM, Procedure Start: 3:09 PM ...Procedure finish: 4:32 PM ...out of room: 4:38 PM.” -Pt. #1’s ER clinical record did not include the on-call OB Physician (MD #3) consultation note or assessment of Pt. #1 in ED. In addition, the clinical record did not include that MD #3 was made of change in condition: hypotensive and diaphoretic. 5. On 4/30/2024 at approximately 1:00 PM, the ER Nursing Director (E #8) was interviewed. E #8 stated that the (Pt. #1) should have been taken to the OR (operating room/surgery) within 2 hours. E #8 stated that the ultrasound showed it was ectopic pregnancy at around 11:30 AM, that is an emergent case, then the on-call team would be in the OR within an hour and 30 -minutes to set-up, so (Pt. #1) should have been in the OR table by 1:30 PM. 6. On 5/1/2024 at approximately 8:45 AM, E #3 was interviewed. E #3 stated she does not recall MD #3 conducted a pelvic exam or assessment. 7. On 5/1/2024 at approximately 10:04 AM, the On-Call OB Physician (MD #3) was interviewed. MD #3 acknowledged that an ectopic pregnancy is an emergency. MD #3 stated the ectopic pregnancy should have been in the OR in 60 minutes. MD #3 stated that MD #3’s resident saw Pt. #1 and didn’t know why there was no documentation. MD #3 stated after consultation they have 24 hours to create a note. 8. On 5/1/2024 at approximately 11:35 AM, the Laboratory Director II (E #11) was interviewed. E #11 stated that the beta quantitative HCG report should have been reported within an hour, when the specimen was collected at 6:56 AM, the results should have ready within 7:57 AM. E #11 stated that the analyzer only takes approximately 18 minutes for the results. E #11 stated that she (E #11) was not sure why the results were delayed. 9. On 05/01/2024 at approximately 2:45 PM, the On-call Anesthesiologist (MD #5) was interviewed. MD #5 stated Pt. #1’s clinical presentation in the ER was a typical ruptured ectopic pregnancy. MD #5 stated ruptured ectopic pregnancy is highly emergent, and that he (MD #5) was not sure if they (ED Physician and staff) realized when it was ruptured. 10. On 5/02/2024 at approximately 8:52 AM, the Chief Medical Officer (MD #4) was interviewed. MD #4 stated that ectopic pregnancy is an emergency. MD #4 stated that the laboratory report for blood HCG quantitative study and the STAT ultrasound scanning could have been quicker. MD #4 stated it is not reasonable for any STAT ultrasound order to read time to be take more than 2 hours. MD #4 stated that he (MD #4) was appalled, that there was no documentation of the On-call OB consultant of any type of assessment, orders, pelvic exam, or to check if (Pt. #1) was bleeding or blood loss, and analyze what life threatening situation the (Pt. #1) was going through, to decide how soon the (Pt. #1) be taken to the surgery to stabilize her (Pt. #1) condition.”

“STABILIZING TREATMENT CFR(s): 489.24(d)(1-3) (1) General. Subject to the provisions of paragraph (d)(2) of this section, if any individual (whether or not eligible for Medicare benefits) comes to a hospital and the hospital determines that the individual has an emergency medical condition, the hospital must provide either- (i) within the capabilities of the staff and facilities available at the hospital, for further medical examination and treatment as required to stabilize the medical condition. (ii) For for transfer of the individual to another medical facility in accordance with paragraph (e) of this section. (2) Exception: Application to inpatients. (i) If a hospital has screened an individual under paragraph (a) of this section and found the individual to have an emergency medical condition, and admits that individual as an inpatient in good faith in order to stabilize the emergency medical condition, the hospital has satisfied its special responsibilities under this section with respect to that individual (ii) This section is not applicable to an inpatient who was admitted for elective (nonemergency) diagnosis or treatment. (iii) A hospital is required by the conditions of participation for hospitals under Part 482 of this chapter to provide care to its inpatients in accordance with those conditions of participation. (3) Refusal to consent to treatment. A hospital meets the requirements of paragraph (d)(1)(i) of this section with respect to an individual if the hospital offers the individual the further medical examination and treatment described in that paragraph and informs the individual (or a person acting on the individual’s behalf) of the risks and benefits to the individual of the examination and treatment, but the individual (or a person acting on the individual’s behalf) does not consent to the examination or treatment. The medical record must contain a description of the examination, treatment, or both if applicable, that was refused by or on behalf of the individual. The hospital must take all reasonable steps to secure the individual’s written informed refusal (or that of the person acting on his or her behalf). The written document should indicate that the person has been informed of the risks and benefits of the examination or treatment, or both. This Standard is not met as evidenced by: 37971 Based on document review and interview, it was determined that for 1 of 4 (Pt. #9) patients clinical records reviewed with ectopic pregnancies, the hospital failed to appropriately stabilize the patient’s emergency medical condition. Subsequently, this failure led to the patient’s deterioration and life-threatening condition. Findings include: 1. On 04/30/2024, the hospital’s Medical Staff Bylaws (dated 04/20/2022), was reviewed and indicated, “ ...13. Emergency Medical Condition (as described in the Emergency Medical Treatment and Active Labor Act) ...Emergency Department within the Hospital’s capabilities to determine or diagnose whether the patient has an emergency medical condition ...emergency physician, on-call physician, obstetrician/gynecologist ...Section 4. ER Call Responsibilities: (2) The Emergency Department physician, in consultation with the on-call physician, shall determine...Section 7. Stabilizing and Treatment beyond the Capability of the Emergency Department: ...A patient is considered to be stabilized when the treating physician has determined, with reasonable clinical confidence, that the patient’s emergency medical condition has been resolved ...(b) An Emergency Department physician shall be responsible for the care of all patients ...until the patient’s attending physician, or an on-call physician, assumes that responsibility ...(f) Consults must be completed within 24 hours of being notified ...(h) An emergency case shall take precedence over an elective surgical case ...” 2. On 04/30/2024, the hospital’s policy titled, “Scheduling Cases in OR (operating room/surgery) and Endo Procedure” (dated 10/2023) was reviewed and indicated, “...An emergent case is an immediate threat to life ...must be started without delay ...The physician must declare the case an emergency...the physician scheduling the emergency case must communicate directly ...an on-call team is available for ...emergency cases ...weekends ...the physician will notify the House Supervisor when the on-call team is needed ...” 3. On 05/01/24, the clinical record for Pt. #9 was reviewed. Pt. #9 arrived at the ED on 03/03/24 via EMS (emergency medical services) from an urgent center with a chief complaint of abdominal pain. The ED timeline included the following: -At 3:15 PM, Triage Started: Chief Complaint: (Pt. #9) reports to emergency room from urgent center due to abdominal pain with slight nausea. Vital Signs: Temperature 98.5, Pulse 105 (reference range 60-100), Respirations 18, BP (blood pressure) 141/96 (reference range systolic BP 90-140; diastolic BP 60-90). ESI (emergency severity index) Level - 3 (urgent). Pain 0-10 at 10/worst pain ever. -At 4:45 PM, HCG, qualitative resulted: Positive (reference range/negative) ...HCG, Quantitative value 1486 (range in pregnant women 217 to 8245 = 5-6 weeks) ...” -At 5:26 PM, the STAT ultrasound preliminary results completed (2 hours from time of order) “... area adjacent to the right ovary may represent free fluid with internal debris versus ovarian mass ... Recommend attention and follow-up.” -At 6:27 PM, Physician Note (entered by MD #6) “Discussed with the on-call OB (MD #7/via phone), states that (MD #7) would like the quantitative HCG and CBC (complete blood count) before (OB Physician/MD #7) is able to give recommendations. (The above results were available at time of this call). -At 7:30 PM, Pulse 88, BP 63/49. -At 7:45 PM, Pulse 97, BP 78/41. -At 7:53 PM, Provider Note (MD #6), “Called to the bedside (Pt. #9) had episode of hypotension (low blood pressure) and tachycardia (rapid heart beat more than 100 beats per minute) ... diaphoretic (perspiring profusely) as well. (Pt. #9) was put in Trendelenburg (head decline below the feet) and a second IV (intravenous line) was started ... two units of blood were ordered. -At 7:59 PM, Tranexamic acid (used to control bleeding) administered. - At 8:07 PM, Discussed (Pt. #9’s) case with the OB physician (MD #7) (1 hours and 40 minutes from initial call for OB consult) ... will come to assess (Pt. #9) updated on the episode of hypotension. At 8:34 PM, (OB Physician) evaluating the patient.” -At 9:21 PM, (Pt. #9) escorted to the OR (operating room) for Ectopic Procedure (approximately 3 hours from time of ultrasound results). Pt. #9 was taken to the OR approximately 3 hours after the time of Ultrasound and HCG results were available and indicated an ectopic pregnancy. 4. On 05/02/2024 at approximately 8:52 AM, the Chief Medical Officer (MD #4) was interviewed. MD #4 stated that once Pt. #9 ectopic pregnancy was confirmed and the consulting physician notified the arrangements should have been made to schedule for surgical procedure within an hour, before an ectopic pregnancy ruptures to prevent complications.”