The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.
| MEMORIAL HERMANN HOSPITAL SYSTEM | 1635 NORTH LOOP WEST HOUSTON, TX 77008 | June 24, 2011 |
| VIOLATION: MEDICAL SCREENING EXAM | Tag No: A2406 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the Hospital failed to comply with CFR 489.24 requirements. The hospital failed to provide an appropriate medical screen (a pelvic fracture was missed upon exam). 1 of 25 emergency room patients were reviewed. (ID# 1) Findings include: Patient ID# 1 was seen in the emergency department at Memorial Hermann Southwest hospital on [DATE]. According to the emergency room record the patient fell from a tree and sustained acute fractures to the right humerus and left wrist. The patient was uninsured. The patient was discharged home to follow-up with an orthopedic surgeon three days later. The patient presented to another hospital and was also diagnosed with pelvis fracture in addition to the other fractures. Patient #1 (MDS) dated [DATE] at 3:51 p.m. and was treated by emergency room physician ID# 52. The demographic sheet listed the patient as " self pay. " The triage sheet stated chief complaint " fall from tree, approximately 10 feet, complaints of right shoulder pain and left hand pain." Radiology reports were as follows: Right Humerus: Fracture of the midshaft of the right humerus. Left wrist: Fracture of the styloid process of the distal left radius; Fracture of the carpal navicular bone; Fracture of the styloid process of the distal left ulna. The emergency room physician (ID# 52) record stated " Clinical Impression: Right humerus fracture, left carpal fracture, left distal radium fracture. Thumb spica splint left arm and sling right arm. Disposition: Home, Improved, Stable. " The patient was given a prescription for pain medication and discharged home to follow-up with an orthopedic surgeon three days later. Interview 6/23/11 at 3 p.m. with the patient ' s wife (ID# 91) revealed her husband does not speak English and she was the one that took him to the emergency room at Memorial Hermann Southwest Hospital. She stated that after discharge from the emergency room at Memorial Hermann Hospital her husband's condition progressively worsened. "His left hand was getting worse and he could not feel his fingers and he was constantly in pain. Also his right arm was continuing to swell." The patient's wife stated that her husband could not stand the pain any longer so she took him to the County Hospital on May 29th, 2011 (two days after being seen at Memorial Hermann Hospital). The wife stated they felt there was no reason to go back to Memorial Hermann Hospital since they did not do anything. She said he was admitted to the County Hospital for four days and had surgery. THE COUNTY HOSPITAL RECORD / admitted [DATE] and discharged [DATE] The emergency room record at the County Hospital (ID# 90) revealed the patient (MDS) dated [DATE] at 5:30 p.m. The Chief complaint stated " [AGE] year old male fell from a tree 3 days ago, initially seen (Memorial Hermann Southwest Hospital) and had x-rays but put only in right arm sling. Told that both arms were broken. Memorial Hermann told the patient to follow up with orthopedics but the patient was hurting too much. " The History and Physical dated 5/30/11 stated: " [AGE] year old male who presents with right upper extremity, left lower extremity, pelvis pain status post fall from tree about 2 floors 3 days ago. Presented to outside hospital, told he had fracture, and sent to an orthopedic surgeon. Patient notes no attempt at reduction or splinting at outside hospital was ever made. Patient was told had fracture injuries that would warrant treatment by an orthopedic surgeon and discharged to home without treatment. Patient notes the facility was Memorial Hermann Southwest. " The County Hospital's plan stated " Open reduction internal fixation right humerus, open reduction internal fixation left wrist scaphoid, radial styloid, perilunate dislocation. " An x-ray report on 5/30/11 at the County Hospital revealed that patient ID# 1's wrist was "minimally dislocated." The following are the radiology reports for patient ID# 1 at the County Hospital: 5/30/11: Left wrist and forearm series: -Acute minimally displaced fractures through the radial styloid process and ulnar styloid process. -Normal articulation of the radius and lunate with posterior dislocation of the remaining carpal bones posteriorly compatible with perilunate dislocation -Scaphoid is rotated and not well visualized. A scaphoid waist fracture cannot be excluded. 5/30/11: Right humerus and elbow series: -Acute comminuted fracture through the right humeral mid diaphysis The operative report for patient ID# 1 dated 6/1/11 stated the humerus fracture was debrided and reduced. "The 9-hole plate was placed. Four bone screws were placed on either side of the plate." The discharge summary dated 6/2/11 stated " Procedures: Status Post open reduction right humerus, open reduction internal fixation left scaphoid, open reduction percutaneous pinning of the left carpus, left sacral fracture, pelvis fracture. " Interview 6/23/11 at 1:25 p.m. with the Assistant Director of Radiology (ID# 54) at the initial hospital (Memorial Hermann Hospital Southwest) revealed that the radiologist misread the initial x-ray report of the left wrist for patient ID# 1 on 5/27/11 and failed to report the minimal displacement of the wrist fracture on the radiology report. Interview 6/24/11 at 11:15 a.m. with the orthopedic surgeon (ID# 56) that was on call 5/27/11 at Memorial Hermann Hospital revealed that he was called about patient ID# 1. The Doctor stated that he did not come to the emergency room to see the patient but reviewed his X-rays online. The Doctor stated that he felt he could manage the fractured wrist on an outpatient basis. The Orthopedic Surgeon did not have any recall about the acute fracture of the patient ' s humerus but acknowledged after reviewing the films today that the fracture probably required surgery to pin the fractured humerus. Record review of a policy at Memorial Hermann Hospital Southwest titled " Transfer Policy-Emergency Services and Patient Transfers " dated 7/21/10 stated " Patient ' s Rights and General Provisions: Medical Screening: The hospital recognizes the right of an individual to receive, within the capabilities of the Hospital ' s staff and facilities: An appropriate medical screening examination; Necessary stabilizing treatment; If necessary, an appropriate transfer to another facility. " Record review of the on-call schedules at Memorial Hermann hospital on [DATE] revealed that a surgical team was on call that date. Also, orthopedic surgeon ID# 56 was also on call and available 5/27/11. Record review of the hospital census for May 27, 2011 revealed the hospital was at 70% capacity with a total of 316 patients. The hospital is licensed for 625 beds. The Risk Manager, (ID# 51) acknowledged 6/24/11 at 10:30 a.m. the hospital had the capacity to admit patient ID# 1 on 5/27/11 if he required admission to a hospital. |
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| VIOLATION: APPROPRIATE TRANSFER | Tag No: A2409 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interview and record review the Hospital failed to comply with CFR 489.24 requirements. The hospital discharged a patient with an emergency medical condition (failed to stabilize a fractured arm). (Patient ID# 1) Findings include: Patient ID# 1 was seen in the emergency department at Memorial Hermann Southwest hospital on [DATE]. According to the emergency room record the patient fell from a tree and sustained acute fractures to the right humerus and left wrist. The patient was discharged home to follow-up with an orthopedic surgeon three days later. The patient's fractures were not appropriately stabilized before being discharged from the emergency room / hospital. Patient #1 (MDS) dated [DATE] at 3:51 p.m. and was treated by emergency room physician ID# 52. The triage sheet stated chief complaint " fall from tree, approximately 10 feet, complaints of right shoulder pain and left hand pain." Radiology reports were as follows: Right Humerus: Fracture of the midshaft of the right humerus. Left wrist: Fracture of the styloid process of the distal left radius; Fracture of the carpal navicular bone; Fracture of the styloid process of the distal left ulna. The emergency room physician documented on 5/27/11 at 6:03 p.m. that orthopedic surgeon ID# 56 agreed to see the patient in his office on 5/31/11 (three days later). The emergency room physician (ID# 52) record stated " Clinical Impression: Right humerus fracture, left carpal fracture, left distal radium fracture. Thumb spica splint left arm and sling right arm. Disposition: Home, Improved, Stable. " The patient was given a prescription for pain medication and discharged home to follow-up with an orthopedic surgeon three days later. THE COUNTY HOSPITAL RECORD / admitted [DATE] and discharged [DATE] The emergency room record at the County Hospital (ID# 90) revealed the patient (MDS) dated [DATE] at 5:30 p.m. The Chief complaint stated " [AGE] year old male fell from a tree 3 days ago, initially seen (Memorial Hermann Southwest Hospital) and had x-rays but put only in right arm sling. Told that both arms were broken. Memorial Hermann told the patient to follow up with orthopedics but the patient was hurting too much. " The History and Physical dated 5/30/11 stated: " [AGE] year old male who presents with right upper extremity, left lower extremity, pelvis pain status post fall from tree about 2 floors 3 days ago. Presented to outside hospital, told he had fracture, and sent to an orthopedic surgeon. Patient notes no attempt at reduction or splinting at outside hospital was ever made. Patient was told had fracture injuries that would warrant treatment by an orthopedic surgeon and discharged to home without treatment. Patient notes the facility was Memorial Hermann Southwest. " The County Hospital's plan stated " Open reduction internal fixation right humerus, open reduction internal fixation left wrist scaphoid, radial styloid, perilunate dislocation. " An x-ray report on 5/30/11 at the County Hospital revealed that patient ID# 1's wrist was "minimally dislocated." The following are the radiology reports for patient ID# 1 at the County Hospital: 5/30/11: Left wrist and forearm series: -Acute minimally displaced fractures through the radial styloid process and ulnar styloid process. -Normal articulation of the radius and lunate with posterior dislocation of the remaining carpal bones posteriorly compatible with perilunate dislocation -Scaphoid is rotated and not well visualized. A scaphoid waist fracture cannot be excluded. 5/30/11: Right humerus and elbow series: -Acute comminuted fracture through the right humeral mid diaphysis The operative report for patient ID# 1 dated 6/1/11 stated the humerus fracture was debrided and reduced. "The 9-hole plate was placed. Four bone screws were placed on either side of the plate." The discharge summary dated 6/2/11 stated " Procedures: Status Post open reduction right humerus, open reduction internal fixation left scaphoid, open reduction percutaneous pinning of the left carpus, left sacral fracture, pelvis fracture. " Interview 6/23/11 at 1:25 p.m. with the Assistant Director of Radiology (ID# 54) at the initial hospital (Memorial Hermann Hospital Southwest) revealed that the radiologist misread the initial x-ray report of the left wrist for patient ID# 1 on 5/27/11 and failed to report the minimal displacement of the wrist fracture on the radiology report. Interview 6/24/11 at 11:15 a.m. with the orthopedic surgeon (ID# 56) that was on call 5/27/11 at Memorial Hermann Hospital revealed that he was called about patient ID# 1. The Doctor stated that he did not come to the emergency room to see the patient but reviewed his X-rays online. The Doctor stated that he felt he could manage the fractured wrist on an outpatient basis. The Orthopedic Surgeon did not have any recall about the acute fracture of the patient ' s humerus but acknowledged after reviewing the films today that the fracture probably required surgery to pin the fractured humerus. Record review of a policy at Memorial Hermann Hospital Southwest titled " Transfer Policy-Emergency Services and Patient Transfers " dated 7/21/10 stated " Patient ' s Rights and General Provisions: Medical Screening: The hospital recognizes the right of an individual to receive, within the capabilities of the Hospital ' s staff and facilities: An appropriate medical screening examination; Necessary stabilizing treatment; If necessary, an appropriate transfer to another facility. " Record review of the on-call schedules at Memorial Hermann hospital on [DATE] revealed that a surgical team was on call that date. Also, orthopedic surgeon ID# 56 was also on call and available 5/27/11. Record review of the hospital census for May 27, 2011 revealed the hospital was at 70% capacity with a total of 316 patients. The hospital is licensed for 625 beds. The Risk Manager, (ID# 51) acknowledged 6/24/11 at 10:30 a.m. the hospital had the capacity to admit patient ID# 1 on 5/27/11 if he required admission to a hospital. |
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