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Based on observation, interview and document review, the hospital failed to ensure a patient's right to be free of use of force when handcuffs, a law enforcement restraint, were used by hospital staff on 1 of 10 patients (P1) reviewed for patient's rights. P1 attempted to elope from the hospital, and following behavioral outbursts, P1 was restrained by hospital security officers with the use of law enforcement restraints. P1 did not have an order for restraints.

As a result of these failures, this deficient practices resulted in a condition level deficiency for P1. The hospital was found out of compliance with the Condition of Participation Patient Rights at 42 CFR 482.13.

Based on observation, interview and document review, the hospital failed to ensure a patient's right to be free of use of force when handcuffs, a law enforcement restraint, were used by hospital staff on 1 of 10 patients (P1) reviewed for patient's rights. P1 attempted to elope from the hospital, and following behavioral outbursts and restrained by hospital security officers with law enforcement restraints.

Finding include:

P1's electronic medical record (EMR) was admitted to the emergency department (ED) on 8/12/23 at 10:32 p.m. for treatment of an intentional overdose of over-the-counter benzodiazepines.

P1's EMR indicated diagnoses which included major depressive disorder, anxiety, and two previously documented suicide attempts.

On 8/12/23 at 10:50 p.m., an ED note indicated P1 was placed on a 72 hour hold for her safety, and a 1:1 direct observation was initiated.

On 8/13/23 at 4:00 p.m., Close Observation notes indicated P1 exhibited behaviors of hitting, punching, yelling, and screaming. The notes indicated P1 was verbally re-directed, and potentially harmful equipment was removed from her room.

On 8/13/23 at 4:02 p.m., a hospital Case Report indicated P1 had attempted to elope from the facility while receiving care in the ED. The case report indicated P1 was verbally and physically assaultive with security officer (SO)-A, requiring assistance to the ground. The case report indicated a second security officer, SO-B, arrived and assisted SO-A in bringing P1 back inside the ED. The case report indicated these security officers were utilizing a two-person escort hold to guide P1 back inside the building, when SO-A removed his hands from P1 to manually unlock a door back into the ED. P1 used her free arm to strike SO-A on the back of the head, and SO-B brought P1 to the ground. SO-B applied handcuffs to P1 at the request of SO-A, and P1 was assisted from the ground and then escorted back to her room. The case report indicated handcuffs were removed by SO-B when medical staff in P1's room directed him to do so.

On 8/13/23 at 4:04 p.m. ED Notes indicated P1 had attempted to elope from the hospital while on her 1:1 and was intercepted by hospital security officers in the parking lot. The ED note indicated security escorted her back to her room and seen by the provider, all items were removed, and P1 remained on 1:1 supervision.

A local police department case report dated 8/13/23, indicated a law enforcement (LE) officer arrived in the ED at 6:50 p.m. The case file indicated SO-A was interviewed regarding his injuries from the assault, and would be pursing criminal charges against P1.

On 8/29/23 at 12:53 p.m., a video review of multiple ED cameras with the Security Manager (SM)-A revealed the following: On 8/13/23 at 3:45, P1 exited her ED room and walked with registered nurse (RN)-A to the bathroom down the hall. P1 exited the bathroom a short time later and walked with RN-A down the hall, past her room and towards the ED exit. RN-A notified other staff via her Vocera (a wearable healthcare communication radio device) of P1's intent to exit the building. P1 exited the ED care area and moved past the security desk, where SO-A was seated, and out a side door of the hospital. RN-A and security officer (SO)-A continued to follow P1 off-camera. At 3:53 p.m., P1 returned to frame being escorted by SO-A and SO-B in a two-man escort hold. SO-A, who was controlling P1's right arm at the time, discontinued the escort hold to step in front of P1 to unlock the previously used hospital side door. P1 then struck SO-A with her uncontrolled arm in the back of the head, and was brought to the ground by SO-B. SO-A recovered and assisted SO-B with maintaining control of P1 as SO-B applied handcuffs. RN-B came to the unlocked door to supervise this interaction and observe as P1 was brought to her feet and escorted back inside the building. P1 was escorted back to her assigned room by security staff and RN-B, at which time they begin emptying all supplies from her room and closed the door. The door reopened shortly afterwards as staff brought supplies out and P1 was no longer handcuffed.

During an interview on 8/30/23 at 9:55 a.m., RN-B stated she did not know the exact time handcuffs were applied or removed from P1. RN-B stated she directed SO-B to remove the handcuffs from P1 almost as soon as they returned to her ED room. RN-B stated handcuffs were considered a restraint.

During an interview on 8/30/23 at 10:24 a.m., RN-A stated she did observe handcuffs being applied to P1 by SO-B, but did not see them being removed. RN-A stated handcuffs were a restraint. RN-A stated she had not received training on handcuff usage from the hospital.

During an interview on 8/30/23 at 10:40 a.m., SO-B stated he applied the handcuffs to P1 at the instruction of SO-A while they had full control of her on the ground. SO-B stated once they had escorted P1 to her assigned ED room and the door was secured, healthcare staff instructed him to remove the handcuffs. SO-B stated he does not know when his supervisor was notified of the usage of handcuffs. SO-B stated LE must be called every time hand cuffs were used by security officers. SO-B stated he did not contact LE and this was the responsibility of the primary responding officer of the incident, who would have been SO-A.

During an interview on 8/29/23 at 11:14 a.m., SM-A stated she became aware handcuffs were used on P1 on 8/14/23 when she reviewed the incident. SM-A stated she was made aware of the incident via text from the security officer lead, SO-C, on the evening of 8/13/23. SM-A stated security staff were supposed to notify law enforcement with the usage of handcuffs on a patient or visitor. SM-A stated security officers can only remove the handcuffs at the instruction of medical staff or law enforcement. SM-A stated security officers were trained to use handcuffs on patients or visitors if necessary, and received this training prior to having patient contact.

During an interview on 8/30/23 at 11:54 a.m., SO-A stated did not remember most of what happened after he was struck by P1. SO-A stated he only began to remember what happened when he was being seen in the ED as a patient for the concussion he sustained. SO-A stated he spoke with an LE officer while in an ED treatment room. SO-A stated he did not contact LE, and did not know who did.

During an interview on 8/30/23 at 12:30 p.m., P1's medical provider (P)-A stated she was made aware P1 attempted to elope and was brought back to her ED room by security staff. P-A stated she went to see P1 immediately upon her return to her room. P-A stated she was not aware P1 had been placed in handcuffs. P-A stated she did not know how long the handcuffs were applied for. PA stated she does not feel handcuffs were an appropriate restraint, and would not use them to restrain a patient. P-A stated she did not write an order for the application a restraint for P1 during her care at the hospital.

During an interview on 8/30/23 at 2:09 p.m., SO-C stated he was the security lead on the evening of 8/13/23 and was made aware handcuffs were used at the time of the incident. SO-C stated he notified administration and the security supervisor of the usage of handcuffs immediately. SO-C stated he did not contact LE after the usage of handcuffs on P1. SO-C stated he was unaware who contacted LE. SO-C stated security staff was supposed to notify the county sheriff's office via a non-emergency line each time handcuffs were used on a patient. SO-C stated he did not know if it was the responsibility of the security lead or the primary responding officer to contact LE after the use of handcuffs on a patient. SO-C stated he did not contact LE and did not know who did.

During an interview on 8/30/23 at 2:40 p.m., the chief nursing officer (CNO) stated staff were to notify a provider whenever restraints were used on patients, and to get an order as soon as reasonably possible. CNO stated handcuffs are a type of restraint.

The facility policy Handcuffs dated 8/25/21, directed security staff may only use handcuffs on a subject as a detainment method until law enforcement arrive. The policy directed handcuffs are a law enforcement intervention and not a healthcare intervention, and therefore cannot be used on a patient as a restraint.

The facility policy Restraint of Seclusion dated 10/27/22, directed a restraint was any physical or mechanical device that reduces the ability of a patient to move their body freely. The policy directed therapeutic holds that restrict a patient's movement are also considered a restraint. The policy further directed a physician order must be written every time a restraint is used, and must include the restraint type, the rationale for restraining a patient, and the criteria for release from the restraint. The policy directed in emergency application situations, orders for restraint use must be obtained during the incident or immediately following the application of the restraint.