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All verbal or written complaints regarding abuse, neglect, patient harm, or
hospital compliance with CMS requirements are considered grievances for the purposes of these requirements.

Based on record review and interview, the facility failed to identify allegations of neglect and investigate as a grievance in 3 of 3 patients (ID#s 1, 2 and 19).

Findings included:


Neglect defined by CMS (Centers for Medicare and Medicaid) Services: a form of abuse and is defined as the failure to provide goods and services necessary to avoid physical harm, mental anguish, or mental illness.


Record review of facility policy titled," Patient Grievance" dated 6/13/2023, showed the following information:

I. POLICY/ GENERAL STATEMENT
Houston Methodist is committed to creating an open environment of communication in which patients, patients' legally authorized representatives (LARs)/companions, family members, and visitors feel comfortable relaying comments regarding care received and services delivered.

II. DEFINITIONS

Grievance-a patient grievance is a written or verbal complaint (when the verbal complaint about patient care is not resolved at the time of the complaint by staff present) by a patient or the LAR/companion regarding the patient's care, discrimination, abuse or neglect issues related to the hospitals compliance with the Centers for Medicare and Medicaid Services (CMS) Hospital Conditions of Participation ...

If a verbal patient care complaint cannot be resolved at the time of the complaint by staff present, is postponed for later resolution, is referred to other staff for later resolution, requires investigation and/or requires further actions for resolution, then the complaint is considered a grievance.

A written complaint is always considered a grievance whether from an inpatient, outpatient, released/discharged patient or his/her LAR/companion regarding care provided, abuse or neglect or with the hospital's compliance with the Conditions of Participation.

All verbal or written complaints regarding discrimination, abuse, neglect, patient harm or hospital compliance with CMS requirements, are to be considered a grievance.

Record review of Patient ID #2's medical record showed the following:

Case Management Progress Note dated 1/26/2024:
Patient reported that he felt as though the HMH was being abusive for a number of reasons including but not limited to: PCA not putting ointment on his wound, he had not had pain medication today, attending has not come to see him in 5 days ...

Medical record for patient ID# 2 showed no evidence of investigation to claims made by patient 1/26/2024.

Record review of patient complaint/ grievance logs showed no entries for patient ID #2.


Review of complaint information documented on complaint log for patient ID# 19 showed the following:

Received via patient letter 10/21/23, patient (ID# 19) reported that during his surgery 10/12/23 he stopped receiving anesthesia because his IV fell out. Referred to contracted anesthesia group, MD spoke with patient on 10/26/23 to discuss and answer questions. Patient appreciation of follow-up call to address concerns.
No facility investigation was documented (i.e. review of intra-operative record, IV restarts, review of patient vital signs)


Interview with patient liaison staff ID H on 2/6/24 at 11:20 am, he stated that allegation of abuse and neglect are recorded and tracked on the grievance log. He went on to say that complaint are issues that are handled in real time and that they are not logged; only issues that is likely to escalate into a grievance are logged.


23032


Patient ID# 1

Review of complaint intake TX00486403 showed allegations that Patient ID #1 developed a hospital-acquired pressure ulcer and multiple infections during her hospital admission.

Record review of patient complaint/ grievance logs showed no entries for Patient ID #1.

During an interview on 2/06/2024 at 12:20 PM with Staff ID-F, nursing director, she stated a family member of Patient ID # 1 left a voice mail and asked to speak to her about care issues. The daughter was upset that her mother had a urinary tract infection (UTI) and felt that we had contributed to that. Also, she had concerns about one nurse's actions when she was setting up pressure bags for an arterial line. The nurse manager of the unit, Staff ID- G asked to return the call, as she had developed a "rapport with the daughter." Staff ID- G was unavailable to interview or contact at the time of survey; she was on leave. The Nursing director said she knew the nurse manager spoke with the daughter. Unsure of the outcome of the call; unknown if there was any documentation by Staff-G of the call.

During an interview with patient liaison, Staff ID H on 2/6/24 at 10:25 AM, he stated he received a call to speak with the daughter of Patient # 1 . He spoke with her outside the room in CVICU. He said all he could recall was she was upset about the infections. The daughter had already spoken with the nurse manager, Staff ID-G. The patient liaison asked her if she wanted to file a formal complaint, she said no. He gave her his card and said to call him if things did not get resolved. The patient liaison said there was no documentation of the concerns expresssed or the interaction

During a telephone interview on 02/07/2024 at 12:30 PM with Staff ID-X, MD she stated that she had spoken with the daughter of Patient ID # 1 after the patient came under her care in CVICU. The daughter expressed concerns that her mother had developed a pressure ulcer while in the hospital and also a UTI that contributed to Patient # 1's sepsis. MD said she tried to help her understand her mother's deteriorating condition and the treatment plan of care.

Based on interview and record review, the facility failed to report a patient allegation of abuse to the appropriate authorities and/or regulatory agency per facility policy (Patient ID# 2)

Findings included:


Record review of facility policy titled: "Reporting Suspected Abuse, Neglect, or Exploitation of Victims of Family Violence," dated 08/31/2023 showed the following:

I. General Statement

Texas law requires medical professionals, including physicians, nurses, physician assistants, and emergency medical technicians to provide specific information to patients suspected of having sustained, which includes abuse, neglect, and exploitation.

The purpose of this procedure:
1. To guide THMH's (Houston Methodist Hospital) 1st 2/5 with state and federal laws to report abuse comment, exploitation family violence and or their family members. Reporting is required whether the abuse is alleged, suspected, or observed.
2. To ensure all patients who are victims or suspected victims of abuse, neglect, family violence, or exploitation are identified, assessed, offered counseling, education, treatment, and protection ...

Under the Texas law, for reporting abuse, neglect, or exploitation any individual who observes or has a reason to suspect abuse, neglect, or exploitation of children, the disabled, or the elderly, is required to report the allegation to the Texas Department of family and Protective Services (DFPS).

Within THMH, Case Management Department, SW Case Manager staff are available 7 days per week on a consultative basis from 8am to 5:00pm, and after business hours until midnight.

To report Abuse or Neglect of children, the elderly, or people with disabilities, call ...

Alleged or suspected abuse, neglect, or exploitation of disabled and elderly patients requires reporting under Federal and Texas Law.




Record review of Patient ID #2's medical record showed the following:

Case Management Progress Note dated 1/26/2024-

SW (social work) received call from pager operator regarding patient refusing to discharge. SW contacted pat's RN and informed her SW would meet with patient at the bedside. Met with patient at bedside ... Pt. stated that HMH (Houston Methodist Hospital) was "trying to discharge me to a place that abused me and I am scared." Patient reported that he felt as though the HMH was being abusive for a number of reasons including but not limited to: PCA not putting ointment on his wound, he had not had pain medication today, attending has not come to see him in 5 days ...
SW attempted to discuss solutions for a discharge plan, patient would only discuss how HMH was "refusing a safe discharge." ...
Patient stated that he has requested MHM be investigated and provided telephone number for investigator with Health and Human Services. Patient contacted HHS while SW was at bedside, voicemail was left requesting her to call SW.


Interview with Case Manager ID M on 2/6/24 at 11:20 am, she stated that patient ID#2 filed two (2) discharge appeals. While the second appeal was in progress the facility received notification that there was a current investigation regarding allegation of abuse for patient ID#2 at the facility the was to be discharged to. She stated that her management team was made aware. After the second appeal was denied and based on conversation with supervisors, we were not sure if allegations were substantiated and had to discharge him back to the facility. It was not reported to DFPS because the patient said that he had reported the facility.

Interview with Case Management Manager ID N on 2/6/2024 at 11:45 am, she stated that patient ID#2 alleged abuse after his discharge appeals had been denied. He told the staff that he had reported this to HHS. She stated that the facility did not make a report of the alleged abuse because the patients stated that he already did. She went on to say that they called the facility to discuss the allegation and they stated that there was no abuse. The social worker was in contact with the investigation but was not given findings of the investigation, or guidance. The patient's condition did not support abuse and he was discharged to the facility.

Record review of incident/ variance logs showed no documentation of alleged/ reported abuse for patient ID # 2.

Record review of patient complaint/ grievance logs showed no alleged/ reported abuse for patient ID #2.

Based on record review and interview, the facility failed to implement an effective and safe discharge planning process that resulted in modification of the discharge plan after allegation of abuse for 1 of 1 patient (Patient #2).

Findings included:


Record review of facility policy titled: "Discharge Planning," dated 09/19/2023 showed the following information:

POLICY AND GENERAL STATEMENT
Discharge planning is the formalized process through which a program of continuing and follow up care is planned and carried out for all patients. It is an interdisciplinary process designed to achieve, within projected time frames, stated goals that lead to the timely release of patients either to their homes or facilities or programs with a lower level of care. Discharge planning is undertaken to ensure that patients remain in a health care organization only for as long as medically necessary.

Definitions:
A. Discharge Plan: documented evidence that through initial and ongoing psychosocial and physical assessment, each patient's post-hospital needs are identified, and an action plan to meet those needs is developed and implemented.

Procedure:
E. The discharge plan is reassessed and modified as patient's condition/ or support system changes to determine any change in, or addition to identified discharge needs during care coordination rounds and team collaboration.

III. Responsibilities of Health Care Providers
3. Case Management and Social Work Department
C. Regularly reassess treatment plan and discharge plan to anticipate and initiate planning for alternate levels of care when inpatient care is no longer indicated.
E. Assist patient and family in finding options for appropriate post hospital care including post-acute care data on quality measures and resource use measures applicable to patient needs, goals of care and treatment preference per system PCP S029 patient freedom of choice.
H. Documents in electronic medical record any education or list of providers provided to the patient and/or family.

Record review of facility policy titled "Patient Freedom of Choice," dated 12/08/2022 showed the following information:

GENERAL STATEMENT
Patients requiring health care items or services following discharge from a Houston Methodist Hospital must have the freedom to choose the supplier or provider for the necessary item or service. Medicare beneficiaries are guaranteed this right under federal law. All patients, regardless of payment or payment source, must have their freedom of choice respected. This procedure also addresses those situations when patients request assistance from the hospital and making a choice.

I. PROCEDURE
A. Patient Choice: The discharging employee must inform the patient that the patient has the freedom to choose among providers or suppliers for post-hospital items or services. A patient must be provided with information on quality and resource use measures data that is relevant to his or her goals of care and treatment preferences in order to assist with his or her choice of post-hospital items or services provider or supplier.

1. If a patient's discharge planning evaluation determines that the patient will need the services of a HHA (home health agency), SNF (skilled nursing facility), IRF (inpatient rehabilitation facility), or LTACH (long term acute care hospital), the discharging employee provides the patient with the applicable list maintained by each Houston Methodist Hospital in accordance with federal law. The discharging employee may tell the patient his physician's recommendation (if any), which are my the patient's insurance or health plan.

3. Documentation: the discharging employee will document the patient's choice in the medical record.

B. Patient's Refusal to Choose
1. If a patient refuses to choose or asks the discharging employee to choose, the discharging employee may make the selection and, then, get the patient's agreement with the post-hospital item or service selection.
3. Documentation: the discharging employee shall document in the medical record that the patient asked the hospital to select the provider.




Record review of Patient ID #2's medical record showed the following:

Case Management Progress Note dated 1/26/2024-

SW (social work) received call from pager operator regarding patient refusing to discharge. SW contacted pat's RN and informed her SW would meet with patient at the bedside. Met with patient at bedside ... Pt. stated that HMH (Houston Methodist Hospital) was "trying to discharge me to a place that abused me and I am scared." Patient reported that he felt as though the HMH was being abusive for a number of reasons including but not limited to: PCA not putting ointment on his wound, he had not had pain medication today, attending has not come to see him in 5 days ...
SW attempted to discuss solutions for a discharge plan, patient would only discuss how HMH was "refusing a safe discharge." ...
Patient stated that he has requested MHM be investigated and provided telephone number for investigator with Health and Human Services. Patient contacted HHS while SW was at bedside, voicemail was left requesting her to call SW.


Interview with Case Manager ID M on 2/6/24 at 11:20 am, she stated that patient ID#2 filed two (2) discharge appeals. While the second appeal was in progress the facility received notification that there was a current investigation regarding allegation of abuse for patient ID#2 at the facility the was to be discharged to. She stated that her management team was made aware. After the second appeal was denied and based on conversation with supervisors, we were not sure if allegations were substantiated and had to discharge him back to the facility.

Interview with Case Management Manager ID N on 2/6/2024 at 11:45 am, she stated that patient ID#2 alleged abuse after his discharge appeals had been denied. He told the staff that he had reported this to HHS. She stated that the facility did not make a report of the alleged abuse because the patients stated that he already did. She went on to say that they called the facility to discuss the allegation and they stated that there was no abuse. The social worker was in contact with the investigation but was not given findings of the investigation, or guidance. The patient's condition did not support abuse and he was discharged to the facility.

The medical record for patient ID# 2 showed no documentation of alternate post-hospital care choices provided or reviewed with patient ID#2 after he made allegation of abuse at planned post-acute facility and he was discharged back to that facility.