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Based on review of documentation and interviews with facility staff, the facility failed to provide an appropriate and thorough medical screening examination within the capability of the hospital's emergency department to determine whether an emergency medical condition existed for 1 of 20 (Patient #1) patients reviewed that presented to the emergency department (ED). There was not complete medical screening exam of Patient #1's knee sufficient to determine the cause of the patient's condition.

Findings Include:

The complete medical record of Patient #1's ED visit on 10/17/2023 was reviewed. It was noted: Patient #1 was brought to the ED for right knee pain. Patient # 1 final diagnoses in ED Notes by staff # 7 MD-ED were: "Contusion of right knee, initial encounter effusion of right knee, fall from slip, trip, or stumble, initial encounter and pain due to trauma." Knee, right 3 Views (KNEE 3 VIEWS RT) x-ray "IMPRESSION: Moderate tricompartmental osteoarthritic changes. Small suprapatellar joint effusion." On 10/17/2023 at 9:47 PM it is documented that Patient # 1 was provided crutches and a knee immobilization. "Distal pulses intact. Crutches fit to patient; Crutch instructions given to patient; Patient demonstrated good use of crutches" on 10/17/23 [at] 2150. "pt given verbal immobilizer care instructions." on 10/17/23[at] 2150. Patient #1 was discharged to home with a prescription for Hydrocodone-acetaminophen 7.5-325 mg tablet, oral every six hours as needed for pain. Mobic 15 mg by mouth every day. Ondansetron ODT 4mg tablet, oral every 6 hours as needed for nausea or vomiting. Patient # 1 was given follow-up information to see her primary care physician in 2 days and if symptoms worsen return to the Emergency Room. It is then documented "There are no referrals from this visit."

There is no documentation to indicate that the ED physician assessed the patients knee for: swelling, skin instability, ligament and tendon assessment. The patient had a risk for loss of a limb and function of the right lower extremity.

A review of the Policy Medical Screening Examinations and Patient Transfers revealed the following: page 2 section 4.0 subsect 4.1.1a
"Persons coming to the Emergency Department and Labor and Delivery Department.
Any person who comes to Hospital Emergency Department (ED) and requests an examination or treatment for a medical condition shall receive an appropriate Medical Screening Examination by a physician or other Qualified Medical Person as defined in Section 5.0, within the Capability of the ED, including ancillary services routinely available to the ED to determine whether or not the person has an Emergency Medical Condition." ...
There is no documentation in the physical exam to indicate that the ED physician assessed the patients knee for: swelling, skin instability, ligament and tendon assessment.

An interview with the staff # 4, MD-Chief of Staff-ED on 12/18/2023 at approximately 11:15 AM revealed the following:
Surveyor: Who reads the radiology report?
Staff # 4: The Radiologist does.
Surveyor: Why was an MRI not done?
Staff # 4: An MRI is almost never done for a knee. The MRI remains open for life threatening emergencies and possibly hip fractures. This patient had no fracture, so no further testing was done.
Surveyor: Would you observe the knee during a knee assessment?
Staff # 4: Yes, and it is noted in the evaluation that no abnormalities were noted.
Surveyor: Would you consult with Ortho for a knee fracture?
Staff # 4 : No, that would not be usual. The patient might be admitted and keep the knee stable until the next day when surgery could be done.
Surveyor: Is it unusual for a patient with no fracture to be provided an immobilizer and crutches?
Staff # 4: No, If the patient has pain and pending an Ortho appointment, it would be standard.
Surveyor: How often are knee fractures missed?
Staff # 4: "I can't remember the last one."