Christus Jasper Memorial Hospital

“MEDICAL SCREENING EXAM CFR(s): 489.24(a) & 489.24(c) (a) Applicability of provisions of this section. (1) In the case of a hospital that has an emergency department, if an individual (whether or not eligible for Medicare benefits and regardless of ability to pay) “comes to the emergency department”, as defined in paragraph (b) of this section, the hospital must- (i) Provide an appropriate medical screening examination within the capability of the hospital’s emergency department, including ancillary services routinely available to the emergency department, to determine whether or not an emergency medical condition exists. The examination must be conducted by an individual(s) who is determined qualified by hospital bylaws or rules and regulations and who meets the requirements of §482.55 of this chapter concerning emergency services personnel and direction; and (ii) If an emergency medical condition is determined to exist, provide any necessary stabilizing treatment, as defined in paragraph (d) of this section, or an appropriate transfer as defined in paragraph (e) of this section. If the hospital admits the individual as an inpatient for further treatment, the hospital’s obligation under this section ends, as specified in paragraph (d)(2) of this section. (2)(i) When a waiver has been issued in accordance with section 1135 of the Act that includes a waiver under section 1135(b)(3) of the Act, sanctions under this section for an inappropriate transfer or for the direction or relocation of an individual to receive medical screening at an alternate location do not apply to a hospital with a dedicated emergency department if the following conditions are met: (A) The transfer is necessitated by the circumstances of the declared emergency in the emergency area during the emergency period. (B) The direction or relocation of an individual to receive medical screening at an alternate location is pursuant to an appropriate State emergency preparedness plan or, in the case of a public health emergency that involves a pandemic infectious disease, pursuant to a State pandemic preparedness plan. (C) The hospital does not discriminate on the basis of an individual’s source of payment or ability to pay. (D) The hospital is located in an emergency area during an emergency period, as those terms are defined in section 1135(g)(1) of the Act. (E) There has been a determination that a waiver of sanctions is necessary. (ii) A waiver of these sanctions is limited to a 72-hour period beginning upon the implementation of a hospital disaster protocol, except that, if a public health emergency involves a pandemic infectious disease (such as pandemic influenza), the waiver will continue in effect until the termination of the applicable declaration of a public health emergency, as provided under section 1135(e)(1)(B) of the Act. (c) Use of dedicated emergency department for nonemergency services. If an individual comes to a hospital’s dedicated emergency department and a request is made on his or her behalf for examination or treatment for a medical condition, but the nature of the request makes it clear that the medical condition is not of an emergency nature, the hospital is required only to perform such screening as would be appropriate for any individual presenting in that manner, to determine that the individual does not have an emergency medical condition. This Standard is not met as evidenced by: 29191 Based on record review and interview, the facility’s emergency department physician failed to complete a medical screening exam for Patient #1’s condition before being discharged home. This deficient practice had the likelihood to cause persistent pain, altered gait, long-term disability. There was a likelihood of “Compartment syndrome” (a condition where increased pressure within a muscle compartment (surrounded by fascia) restricts blood flow, leading to tissue damage) which could have occurred due to the calcaneus fracture. Findings include: A review of the triage record revealed that Registered Nurse #25 documented the following: “patient in wheelchair to room, patient alert and oriented x 4, neighbor in waiting room. Patient reports he was stepping down the ladder of his deer stand this evening and slipped on the ladder rolled the right ankle and patient crawled to the 4-wheeler.” Temp 98.7 Pulse 78 respiratory rate 18 Blood Pressure 140/91 Oxygen 98% on room air. Patient event history: 1957 (7:57 PM) Reception 1957 (7:57 PM) Patient registered 2035 (8:35 PM) Triage 2036 (8:36 PM) Patient in room 2035 (8:35 PM) Provider disposition 0003 (12:03 AM) Patient discharged Patient #1 was seen by the Nurse Practitioner #10 and Physician #11. Nurse Practitioner #10 signed off at 10:00 PM and Physician #11 took over the care of Patient #1. A review of the medical record for Patient #1 revealed the following: “History/Physical Document Date and Time Nov 2, 2024, at 21:10 (9:10 PM) Time Seen by Provider: 20:00 General: Chief Complaint: Extremity injury Complaint Description 45-year-old male presents with complaint of pain and swelling to his right ankle after he twisted his ankle while coming off the ladder of his deer stand just prior to arrival today. Vital signs: 11/2/2024 2035 (8:35 PM) Temp 98.7 Pulse 78 respiratory rate 18, Blood pressure 140/91 oxygen 98% on room air Procedures Splinting/Fracture/Dislocation Time: 22:02 (10:02 PM) Splint: Crutches, Short-leg Applied by: Nurse Exam Post Splint Application: Neuro intact, Vascular intact, Alignment good Post Procedure Status: Patient tolerated procedure well. Time: 22:02 (10:02 PM) Interval Plan Left lower extremity is warm and well-perfuse without neuromuscular deficit Medical Decision Making Comment: Chief complaint: 45-year-old male presents with complaint of pain and swelling to his right ankle after he twisted his ankle while coming off the ladder of his deer stand just prior to arrival today. Problems: Differential diagnoses include but not limited to: Fracture, dislocation, contusion, sprain, strain External Notes Reviewed: Nurses notes and vitals reviewed History Obtained others: History obtained from the patient. Tests and Images ordered and reviewed by me: X-ray right ankle is pending ED course: hydrocarbon 10/325 mg, Oran 4 mg P.O., Toradol 60 mg IM given in ER, posterior short leg splint and crutches with good improvement. Clinical impression/disposition/follow-up: Right ankle Sprain pending radiologist report. Patient is stable for discharge home with outpatient treatment and follow-up Discussions regarding hospitalization, escalation of care, or emergency surgery: Not applicable Discussions regarding de-escalation of care: I discussed all test results and treatment plan with patient. I instructed patient to follow-up with Orthopedic specialist within 72 hours. I discussed reasons to return to emergency room. Patient is comfortable, no distress. Hemodynamically stable. Right lower extremity is warm and well-perfused without neurovascular deficit.” Further review of the medical record revealed no assessment for a spinal injury due to the height of the fall from the deer stand (8 feet). The foot was not examined for injury. Patient #1 complained of pain in the ankle and radiating down to the foot. Foot injuries account for 15-25% of ankle injuries due to the type of fall injury that occurred with an 8-foot fall. The physicians documentation referred to the nurse’s triage note. A review of the X-rays indicated there were no foot or spinal X-rays or scans ordered. An interview with Physician #11 on 12/10/2025 at 2:00 PM acknowledged the calcaneus fracture had been missed by the radiologist.”

“THERAPEUTIC DIETS CFR(s): 482.28(b), (b)(1) §482.28(b) Menus must meet the needs of patients. (1) Individual patient nutritional needs must be met in accordance with recognized dietary practices. This Standard is not met as evidenced by: 29191 Based on observation, record review, and interview, the facility staff failed to ensure practices and processes were in place to prevent expired prepared sandwiches from being available for patient consumption. Findings include: During a tour of the emergency department medication room on 1/8/2024 observed in the nutrition refrigerator were sandwiches not dated or expired date. 4 -sandwiches were not dated as to when prepared 4- sandwiches were dated 1/3/2024 4- sandwiches were dated 1/4/2024 An interview with Staff #12 (dietary) on 1/8/2024 at 11:00 AM was asked how long the prepared sandwiches are available to patients once prepared. Staff #12 stated, “The sandwiches are good for 72 hours from the prepared day.” Staff #12 acknowledged that all the sandwiches were expired and should have been pulled and not available for patient consumption. A review of the dietary guidelines titled, “DATING & LABELING OF FOOD IN PRODUCTION” revealed the following: “All foods opened, prepared, and used in the unit must be dated and labeled. Date marks are important for all TCS foods because while the growth of bacteria in refrigerated foods is largely controlled by temperature, it is not stopped altogether. * TCS foods requiring a date mark shall be labeled with the common name, preparation date, discard date, and associate initials. * RTE, TCS food that is prepared onsite and held refrigerated for more than 24 hours must be used within 4 days including the day of production.” An interview with Staff #8 on 1/8/2024 at 11:30 AM acknowledged that the sandwiches were not dated and beyond the consumption date for patients. Staff #8 confirmed there was no process for staff members to check the sandwich dates and destroy if beyond the 4 days including the day of production.””