HospitalInspections.org

Based on interview and record review the facility failed to honor a patient's request for discharge when a voluntarily admitted patient was held over 24 hour, after requesting to be discharged. (Patient #2)

Findings include:

Review of the facility provided Patient's Rights documents provided to all Patients reflected, "Voluntary Patients- Special Rights 1. You have the right to request discharge from the hospital. If you want to leave, you need to say in writing or tell a staff person. If you tell a staff person you wan [sic] to leave, the staff person must write it down.
2. You have the right to be discharged from the hospital within four hours of requesting discharge. There are only three reasons why you would not be allowed to go:
First, if you change your mind and want to stay at the hospital, you can sign a paper that says you do not wish to leave ...the staff member has to write it down for you ....
Third, you may be detained longer than four hours if your doctor has reason to believe that you might meet the criteria for court-ordered services or emergency detention ....4. Your doctor must note in your medical record and tell you about any plans to file an application for court-ordered treatment ...If the doctor finds that you are ready to be discharged, you should be discharged without further delay ...."

Review of Patient #2's Admission records dated 7/14/18 revealed a 27-year-old male admitted with voluntarily with symptoms of severe depression and an adjustment disorder with concurrent anxiety and depression.

Review of the Patient #2's Nurse's note dated 7/17/18 at 12:14 pm reflected, " ... Patient is name calling and wants to go AMA (Against Medical Advice). AMA paper given to him and Dr .... notified. He will be transferred to Unit #3. He was accompanied by several staff person [sic]. Dr. .... will see the patient or another MD will be assigned in the time frame for AMA protocol."

Review of the Psychiatric Progress note dated 7/17/18, time of examination 7:00 pm reflected, " ...Chief Complaint ('in patient's own words') 'I was wanting to leave AMA today because there was an argument ...' Reason for continued hospitalization: Medication Stabilization, Discharge May exacerbate Illness" was checked.

The medical records did not include Patient #2's withdrawal of the request to discharge or the physician's order to proceed to an emergency psychiatric hold.

Review of Patient #2's Physician's Discharge Summary dated 7/18/18 revealed " ...The patient had spoken about leaving against medical advice on admission to Unit Three from Unit Two. Patient felt he was disregard by nursing staff ... the patient had no significant reason for being held against his will .... Discharge was therefore affected on a straight basis without any reason for making a discharge against medical advice, as the patient had signed in voluntarily and proceeded to remain voluntarily, initially."

During an interview on the afternoon of 9/4/18, in the conference room, Staff #5, Interim Regulatory Monitor confirmed the findings.

Based on observation and interview the facility failed to provide care in a safe setting when two patients were moved into a room that was being blocked for repairs and multiple Wasp and Mud dauber nests were in a direct means of access and egress for patients and staff. (Unit 3)

Findings include:

An observation on the afternoon of 9/5/18 at 1300, on the facility's Unit 3, patient room 302 where two female patients were assigned, revealed a large puddle of water on the floor under the patient hand sink. Two bath towels had been placed on the floor; one towel was completely soaked through. Water had seeped into the baseboards and had buckled the walls. There was rust and a white slimy substance around the baseboards. There were areas of the wall where the baseboard had peeled and separated. There was a dark stain and cob webs on the corner wall, water was running out of the shower head; the nurse was unable to turn the faucet off. The fall behind the shower stall had separated and sheet rock was exposed.

During an interview on the afternoon of 9/5/18, in patient room #302, Staff #5, Environmental Services Director stated, "The room had initially been blocked for repairs, the facility had a fire on the unit and the patients had to be moved .... I wasn't aware they had placed patients in the room. We've been replacing the shower heads on the unit ... the pipes are leaking. I haven't gotten around to room 302 yet. It was the next on my list." When asked does the facility have a policy or procedure to ensure uninhabitable rooms are not utilized, Staff #5 stated, "No."

An observation on the afternoon of 9/5/18 revealed an approximately 5 inch round wasp nest and two, approximately two by five-inch, Mud dauber nests above the patient doorway exit. There was a bird's nest in the corner with copious amounts of bird droppings, in which the patients were at risk of walking through as they exited the door. Staff #5 had stated, "The birds will attack you if you mess with their nests."

On the afternoon of 9/5/18, Staff #6, Interim Regional Monitor stated, "The supervisors were aware the room was blocked." Staff #6 was not aware of a procedure to block off rooms.