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Based on Record review and interview, the hospital failed to ensure compliance with the requirments of CFR 489.24 as evidenced by failing to provide stabilizing treatment to a patient that presented to the emergency department with a fractured arm for 1 (#2) of 20 (#1-#20) patients sampled (see findings C-2407).

Based on record review and interview, the hospital failed to ensure all patients who presented to the hospital's emergency department (ED) were provided stabilizing treatment for an emergency condition. This deficient practice is evidenced by failing to provide stabilizing treatment to a patient that presented to the emergency department with a fractured arm for 1 (#2) of 20 (#1-#20) patients sampled.

Findings:

Review of the Hospital's EMTALA policy revealed the following:
If an EMC is determined to exist, the individual will be provided necessary stabilizing treatment, within the capacity and capability of the facility, or an appropriate transfer as defined by and required by EMTALA.

Review of the hospital's emergency department log revealed Patient #2 arrived in the ED on 9/12/19 at 7:41 a.m. with the chief complaint of a fall.

Review of Patient #2's physician's notes revealed the history of the present illness was documented as follows: Patient fell at home, complains of pain at right elbow, right upper trapezius and head/neck.

Review of Patient #2's X-Ray results of her right elbow revealed a poorly visualized fracture in the proximal portion of the ulna. Significant size joint effusion in the right elbow. These results were documented as having been reviewed by S4MD on 9/12/19 at 7:45 a.m.

Review of Patient #2's medical record revealed she was discharged to home at 9:53 a.m. with the diagnosis of Fall, Contusion of Elbow and Contusion of Head, initial encounter. Further review revealed no stabilizing treatment was provided for her fractured right Ulna.

Review of Patient #2's emergency department record for a return visit on 9/23/19 revealed she arrived at the emergency department with the chief complaint of right arm pain. An x-ray of Patient #2's right arm revealed a poorly visualized healing fracture of the proximal portion of the Ulna. Patient #2 was treated with a sling and splint to her right elbow and referred to an orthopedic clinic.

In an interview on 10/10/19 at 1:00 p.m. with S2DON, she said they do not cast patients at the hospital. She said if a fracture is not bad they will splint it and tell the patients to see their orthopedist. She said if the fracture is bad, they will transfer to another hospital that will do casts. After review of Patient #2's medical record, she could not explain why she was not splinted the first time she was here on 9/12/19. She said she was working on 9/23/19 when Patient #2 returned. She said she was sent to the ED for a splint from her doctor's office after they reviewed her x-ray from her 9/12/19 visit to the ED. S2DON said something should have been done on Patient #2's first visit like a splint to her right arm.

In an interview on 10/10/19 at 1:35 p.m. with S4MD, he said he did not remember Patient #2. S4MD reviewed Patient #2's arm x-ray results from 9/12/19 and said Patient #2 should have had a splint and a sling and been referred to an orthopedist for follow up. He said a poorly visualized fracture would not require transfer to another hospital. After further review S4MD revealed he did not order a splint, sling or orthopedist visit for Patient #2 on 9/12/19. He said he is not sure why he did not splint her arm.