Interviews and record review of nursing notes revealed that on 5/19/2021 during the PM shift, staff noticed swelling on R1’s left hand and applied a cold compress to reduce swelling. Nursing staff continued to monitor R1’s condition and documented that on 5/20/2021, R1’s left elbow appeared swollen and red. Interviews and record review claimed that R1 appeared uncomfortable as R1 would pull their arm closer to their chest when the elbow was touched. R1’s primary care physician was notified of R1’s condition and on 5/21/2021, R1’s physician ordered a chest x-ray, left arm x-ray, left arm ultrasound, blood work, and a urinalysis. An x-ray technician arrived at approximately 6:00 p.m. on 5/22/2021 and took an x-ray of the left arm and chest. The results arrived at approximately 8:00 p.m. on 5/22/2021 and the results were sent to R1’s physician. R1’s physician instructed staff to send R1 to the emergency room for further treatment, as the left arm x-ray showed a fracture. R1 was sent to the emergency room on 5/22/2021 at 9:26 p.m. R1 was admitted with the initial diagnosis of sepsis, fracture of the left humerus, urinary tract infection, bowel obstruction and chronic seizure disorder. While in the hospital, additional tests were performed and R1 was found with multiple hepatic metastases (cancerous tumors in the liver) and R1 was diagnosed with stage 4 colon cancer. R1 was discharged back to the facility on 5/27/2021 on hospice care. On 6/6/2021, R1 passed away at the facility.

Staff claimed that R1 had a known behavior where R1 frequently held their left arm close to their chest, and denied claims that R1 was improperly handled or transferred. Staff supported claims that two staff assisted with transfers and repositioning at all times.

Records confirmed that R1 had a diagnosis of osteoporosis. According to Mayo Clinic, osteoporosis 'causes bones to become weak and brittle – so brittle that a fall or even mild stresses such as bending, or coughing can cause a fracture’. Staff reiterated that whereas R1 pulled their arm close to their body, staff negated claims that they improperly transferred R1 or mishandled R1 while being repositioned. During the hospital stay, hospital records indicated that the imaging of the left arm revealed ‘diffuse osteopenia’, which is an indication of brittle bones and a loss of bone density. Upon being discharged from the hospital, R1’s final diagnosis was Age-related osteoporosis with current pathological fracture, left humerus, initial encounter for fracture. According to National Library of Medicine, a pathological fracture is “…a bone fracture which occurs without adequate trauma and is caused by a preexistent pathological bone lesion. Causes include resorption of bone mass (osteoporosis), reduction of bone quality (osteomalacia, osteonecrosis), insufficient bone production (osteogenesis imperfecta, fibrous dysplasia) or local bone destruction due to tumorous growths.”

In summary, staff denied claims that R1 suffered an injury due to an improper transfer or being improperly repositioned. Interviews with collateral agency representatives revealed that individuals with osteoporosis may have episodes of spontaneously fracturing themselves due to brittle bones. Prior to hospitalization, staff were aware that due to R1’s condition, R1 was at a high risk of sustaining fractures while in care. As such, interviews revealed that staff followed specific directives when providing care to R1. Based on the information provided, there is insufficient evidence to support the claim that due to neglect or physical abuse, R1 sustained a fracture while in care. This allegation is deemed Unsubstantiated at this time.