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Based on record review, and interview, the facility failed to conduct a complete medical examination, to determine whether an emergency medical condition exits for (1) one (Patient #1) out of (21) twenty-one medical records reviewed of patients having arrived at the facility's emergency department seeking treatment. The facility failed to assess Patient #1's left shoulder resulting in a 3-day delay of a diagnosis of a fractured clavicle, this delay placed Patient #1 in continued pain, at risk of worsening symptoms and permanent deformity.

Findings include:

Review of the Christus Hospital Physician's notes dated 10/25/24 reflected, "Physical Exam
Musculoskeletal: No edema in the lower extremities bilaterally, no stigmata of DVT (signs/symptoms of deep vein thrombosis)
Medical Decision-Making Differential diagnosis:
Seizure, intracranial hemorrhage, cervical spine fracture.

This is a patient with a seizure disorder who takes valproic acid and clonazepam when he has a Seizure. Today had a seizure which was witnessed. He fell and hit his head. He had a small amount of bleeding over the right left eyebrow. No significant laceration. CT (computed tomography) the brain ordered which was unremarkable. CT of the cervical spine from interpretation shows no evidence of acute fracture."

Review of the Clinic Physician's notes dated 10/27/24 reflected, "Chief complaint of Left trauma/injury. Pt (patient) has developmental delay. Pt is with mother. Pt had a seizure and fell Weds. Pt went to the ER and had a CT of the neck and head. Mother states no one look at his shoulder and he is having problems putting on his shirt.
Physical Exam Musculoskeletal: Motor Strength and Tone: abnormal motor strength; left arm and shoulder. Joints, Bones, and Muscles: limited ROM (Range of Motion); left shoulder, deformity of left distal clavicle with mild tenting, no redness or significant pressure to skin... FINDINGS: Bones are diffusely demineralized. There is displaced mildly comminuted distal clavicular fracture with greater than one full shaft elevation of the major proximal fragment in relation to the major distal fragment. AC joint appears intact. Coracoclavicular interval
may be widened. Left-sided implanted electronic device and leads are in place. *** IMPRESSION ***: Distal clavicular fracture."

During a telephone interview 12/18/23 at 12:10 pm, Patient #1's mother stated in part, "My husband and I were called by the facility, Patient #1 had a seizure and had fallen, he and was taken to the emergency room. We went to the emergency room; Patient #1 was already being treated by the emergency room. Patient #1 is non-verbal I took him home for a few days, when I took him back to the residential home the staff noticed the bruising to his upper shoulder and arm pit. He also winced when they put his shirt on. I told them he needed to get an x-ray. I took him to the clinic; they took x-rays and said he had a non-union break of his left clavicle. He kept a sling on that arm for 6-weeks."

During an interview on 12/18/23 at 11:00 am in an admin office, Staff #3, Emergency room director stated in part, "We don't automatically take x-rays for all falls, it would depend on the mechanism of the fall and the injuries, each case is different. Usually, the patients from the group homes will come by ambulance, we use the information provided by the ambulance to help determine the course of treatment. We will call the group home to get additional information if needed."