HospitalInspections.org

Based on policy review, medical record review, and physician interviews, the hospital failed to comply with 42 CFR §489.20 and §489.24.

The findings included:

The hospital's Dedicated Emergency Department (DED) failed to provide, within the capabilities of the staff and facilities, further medical examination and treatment as required to stabilize a patient with an emergency medical condition for one (1) of 25 patients reviewed who arrived to the DED seeking emergency care. (Patient #13)

~ Cross refer to Stabilizing Treatment - 489.24(d)(1-3) - Tag C2407

Based on policy review, medical record review and staff and physician interviews, the hospital failed to provide within the capabilities of the staff and facilities available further medical examination and treatment as required to stabilize a patient with an emergency medical condition for one (1) of 25 patients reviewed. (Patient #13)

The findings included:

Review of the EMTALA (Emergency Medical Treatment and Labor Act) policy, effective 08/2023 revealed "...If an emergency medical condition is found to exist, the Hospital will....provide (a) stabilizing treatment within the capabilities of the Hospital and its staff (including on-call physicians and diagnostic services)... ."

DED [Dedicated Emergency Department] medical record review, on 06/04/2024, revealed Patient #13, an 8-year-old male who arrived to the DED on 02/23/2024 at 1608 with a complaint of right wrist/hand pain. Review of the Triage Note at 1618 revealed "Tenderness noted to right hand and wrist. No swelling noted. Redness noted to the post. of right hand and wrist. Mother states - pt [patient] fell on stairs at home."

The MSE [medical screening examination] was initiated at 1617 by Physician's Assistant [PA] #2 and indicated " ...Chief complaint: Right hand pain. History of Present Illness HPI details: 8-year-old male child was outside playing flipping and struck his right hand now with diffuse hand pain and discomfort with small area of abrasion no obvious deformity closed injury right-hand-dominant just happened prior to arrival alert orient x3 [person, place, time].... Physical Examination ... mild diffuse tender to palpate right hand, active full range motion of all digits hand wrist and elbow and shoulder closed injury no obvious deformity [space] ... Results Diagnostic Interpretation: x-ray show no fracture dislocation, ... Impression: right hand contusion. ...Disposition Patient condition: stable.... ED Disposition: Home;"

Radiology results were reviewed by the Radiologist [MD #3] at 1652 and revealed "Review of the "HAND; MINIMUM OF THREE VIEWS RIGHT ...Views: AP and oblique views of the right hand.... FINDINGS: Suboptimal evaluation without a true lateral view. BONES: No fracture or focal lesion ...IMPRESSION ...no evidence of acute osseous process ..."

Interview on 06/05/2024 at 1037 with DED PA (Physician Assistant) #2 revealed he did not remember Patient #13. Interview revealed " ...for this patient I added an ace wrap and advised to see the PCP (Primary Care Physician) in 5-7 days. ... anytime you're close to the growth plate you should be looked at again. The sub-optimal view would not have changed the treatment plan. The radiologist would call if he had any changes, and I would have called the patient back by phone to update them if needed. I always go back in to speak with the patient and give the findings myself, go over discharge instructions also ..." The interview revealed that if the x-ray findings were indicated, a copy of the x-ray would be sent with the patient for follow-up.

In summary, DED record review failed to show the provider correctly interpreted the physical examination which, even with a negative x-ray, pointed to a diagnosis of Salter-Harris type 1 fracture due to pain and tenderness over an open growth plate area. There was no evidence of an immobilizing splint or referral/ recommendation to see a pediatric orthopedist within one week. The hospital provider failed to provide stabilizing treatment to Patient #13.