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Based on interview and document review, the hospital failed to ensure an allegation of potential employee-to-patient physical abuse was reported timely to outside agencies, in accordance with established policies and procedures, for 1 of 1 patients (P3) reviewed who was a minor child (i.e., less than 18 years old) and alleged they were slapped in the face by a nurse.

Findings include:

P3's Reason for Visit note, printed 6/21/23, identified P3 was less than 18 years of age and presented to the Mercy campus emergency department (ED) with a chief complaint listed, "Mental Health Issue." A corresponding Mental Health Crisis Clinician Consult Note, dated 10/14/22, identified P3 presented to the ED via EMS after physically attacking a school official including, "[P3] is impulsive, and attached the school Principal today."

P3's ED Nursing Note, dated 10/14/22 at 8:49 p.m., identified registered nurse (RN)-A recorded, "[P3] was screaming and appeared to becoming physically aggressive with security staff ... Green Alert was called ... [P3] began clawing and scratching this RN in the hand ... appeared to be ready to bite. [P3] head was positioned securely away from this RN's hand ... [P3] was restrained."

A corresponding Case Report, dated 10/14/22, was completed by the security response team which identified P3 was screaming and yelling at staff. P3 started to pull and kick on locked doors in attempt to open them. P3 was eventually escorted back into their room and a RN provided oral medication to P3; however, the behavior remained and P3 escalated their actions to making clenched fists postures. The report outlined, "During the intervention techniques, [P3] was able to claw [RN-A] and [other RN] right hands as well as spit on the right side of my face causing the spit to get into my right eye. A spit hood was placed ..." The report concluded with dictation outlining both RN's wished to not file occupation health or police reports on the injuries sustained.

However, a subsequent note, dated 10/15/22 at 6:03 a.m., identified another "Code Green" was called due to P3's behavior. The note included, "Patient screaming that she was assaulted by staff last night and 'you did nothing about it." Further, an additional Mental Health Reassessment Note, dated 10/15/22, identified P3's current mental health symptoms along with dictation, " ... indicated upset with how police/security treated her and hurt her (hit her in face). She did not go into other details." In addition, a Psychiatric Follow Up note, dated 10/16/22, identified P3 was seen in the ED for care due to no inpatient psychiatric bed availability. The note outlined P3 was smiling and open, however, added, "She however persists in maintaining that she had been assaulted on the night of her arrival to ED and states that it is making her 'worse' to be in ED."

On 6/21/23 at 12:04 p.m., security officer (SO)-A was interviewed. SO-A explained they, along with other security personnel, had responded to a "code green" incident involving P3 on 10/15/22, where P3 was combative with staff. During this response, SO-A stated they "vaguely remember" P3 accused RN-A of "assaulting her" during a previous Code Green (on 10/14/22) situation. SO-A explained RN-A had entered the room during the 10/15/22 response, and P3 accused RN-A of assault adding P3 didn't say RN-A by name, however, motioned "that nurse" which was "towards [them]." SO-A added, "She [P3] did say that." SO-A stated they were unable to recall if they reported the accusation to their supervisor or other management personnel after the situation had de-escalated; rather RN-A stated they would make sure the incident was charted appropriately. Further, SO-A stated there was "not really" an established process or procedure for security to report such accusation; however, SO-A expressed if they saw something concerning then they would report it to their supervisor or a nursing supervisor and see "how to proceed."

P3's medical record was reviewed and lacked evidence the allegation of potential physical abuse or assault was reported to any outside agencies (i.e., common entry point, child protective services), nor was any evidence provided during the abbreviated survey demonstrating such reporting had been completed, despite repeated medical record notes outlining such an allegation, and hospital employees having directly heard such an allegation.

On 6/21/23 at 12:45 p.m., the risk management manager (RMM) was interviewed. RMM explained their department was primarily responsible to triage and review incidents to help determine reporting needs and "where do we think we should go with this." Then, if education needs are present, then the situation gets handed off the "quality team" for further action. RMM recalled P3 had accused they were "slapped by a nurse who had moved her [P3] head to the side," and pulled up the internal "patient event" report for review with the surveyor. The initial internal report was started on 10/15/22, and RMM explained they had reviewed the report from the 10/14/22 incident themselves, and they dictated an investigation would be needed into the allegation of the RN who "slapped her [P3] in the face." This was recorded in the comments section of the report. As a result, the unit manager was tasked to follow-up with the accused RN who explained they had simply moved the patient's head but denied slapping them. RMM stated they re-visited and reviewed the report on 10/18/22, and then determined the allegation was not reportable to the outside agencies as the RN and security report "stories are [were] consistent" and P3 sustained no physical injuries from the incident. However, RMM explained they had made this decision without interviewing anyone else present for the incident, either the patient or hospital employees, and reiterated the decision to not report was made almost entirely from the security report and RN-A denying physical abuse or assault had happened adding security reports were typically taken "at face value." RMM stated, in hindsight, they may have not recognized or "appreciate" the age of P3 when the incident happened (i.e., minor) which potentially required different actions or reporting per their policies; however, again expressed the consistency in the reporting of the security report and RN-A's interview with the unit manager made them feel the situation was not abusive in nature. RMM acknowledged the provided policies on maltreatment of minors outlined reporting to outside agencies should have most likely occurred given the accusation adding, "That's a fair discussion point."

On 6/21/23 at 1:39 p.m., a return telephone call was received from RN-A, and they were interviewed. RN-A recalled P3 was in the ED on the Mercy campus after they had assaulted their school principle. P3 had behaviors which escalated on 10/14/22 and a "green alert" was called in response, which included a security team response. RN-A recalled P3 was "completely out of control" and they determined restraints needed to be applied. During that process, P3 began attempting to bite at peoples, including RN-A, hands and spit at them. RN-A stated they used their forearm and hand to turn and "brush away" P3's face away from others as a result. RN-A denied slapping P3 but acknowledged P3 did scream aloud, "You just hit me." RN-A stated they denied the allegation immediately to P3 and expressed they rather just "moved your head" due to the biting attempts. RN-A stated they did not recall any further contact with P3 during the hospitalization adding, "I did not touch her again."

A provided Maltreatment of Minors policy, dated March 2021, identified the policy applied to Mercy Hospital (both campuses) and to all staff and employees. The policy outlined all mandated reporters were responsible to report suspected or known instances of child maltreatment to the local welfare agency, police department or county sheriff. These reports should be made as soon as possible but no longer than 24 hours after the reporter becomes aware of the suspected or known incident of maltreatment. The policy outlined various sections on the proper post-incident evaluation and reporting processes; along with a section labeled, "Maltreatment Within Allina Facility or Involving Allina Staff," which directed, "If the known or suspected maltreatment occurred within an Allina facility or by an Allina employee ... within an Allina facility, a Patient Safety Visitor Report is required in addition to the mandatory agency report."