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Based on interview, record review, and policy review, it was determined the facility failed to protect the rights of three (3) of ten (10) patients who presented to the Emergency Department (ED) for treatment (Patients #1, #2, and #3). Review of the medical record for Patients #1, #2, and #3 revealed the patients had a legal guardian. However, there was no documented evidence that the facility obtained consent from the guardians to treat the patients and/or provided the guardians with information required to make an informed decision regarding the patients' care.

The findings include:

Review of a facility policy titled "Patient Rights and Organization Plan for Provision of Care/Treatment," revealed the ED would ensure patient representatives/guardians were provided with information necessary to understand and make decisions regarding the health care needs of the patients. This included exchange of patient care and clinical information when patients were admitted, referred, transferred, or discharged.

1. Review of Patient #1's medical record revealed the patient was transferred to the ED on 02/21/19 from a local skilled nursing facility. There was no documented evidence that the legal guardian was notified of the visit or that the patient was being discharged to another family member and not to the skilled nursing facility. The facility discharged Patient #1 to a family member (patient's grandson), who was not the patient's legal guardian.

Interview with the Skilled Nursing Facility's Social Worker on 03/05/19 at 2:00 PM revealed the nursing facility was not aware Patient #1 had been discharged from the hospital until the patient's grandson called and asked if the patient could spend the night with him.

Interview on 03/05/19 at 3:20 PM with Registered Nurse (RN) #2 revealed she was assigned to provide nursing care for Patient #1 on 02/21/19. RN #2 stated Patient #1 was alert and oriented and family was present when the patient was discharged. The RN stated the family was willing to transport the patient at the time of discharge and she "thought" the family member was going to transport the patient back to the local nursing facility. RN #2 stated Patient #1 was interacting with the family member and gave no indication of concern. Further interview with the RN revealed she gave no explanation why Patient #1's legal guardian was not notified of the patient's visit to the ED on 02/21/19.

On 03/05/19 at 1:30 PM an interview was conducted with RN #1, who was the Charge Nurse on 02/21/19. RN #1 stated RN #2 was a new nurse and should have notified Patient #1's legal guardian of the visit.

2. Review of Patient #2's medical record revealed the patient was treated and released from the ED on 11/03/18. Further review of the patient's medical record revealed the patient had a legal guardian. However, there was no documented evidence that the facility contacted the guardian to obtain consent to treat the patient nor provided information to the guardian to make informed decisions regarding the patient's care. Further review revealed Emergency Medical Services (EMS) signed the patient's discharge instructions.

3. Review of Patient #3's medical record revealed the patient was transferred to the ED from a local nursing facility on 11/07/18 by ambulance. Further review revealed the facility treated Patient #3 in the ED and discharged the patient back to the local nursing facility. However, there was no documented evidence that the facility contacted the guardian to obtain consent to treat the patient nor provided information to the guardian to make informed decisions regarding the patient's care. Further review revealed Emergency Medical Services (EMS) signed the patient's discharge instructions.

Interview with the ED physician on 03/05/19 at 4:00 PM revealed the physician only contacted the family/guardian of patients when they were critical or decisions were required to be made for their health care. The ED physician recalled providing care for Patient #1, but was not aware of any issues related to the patient's discharge. The ED physician stated nursing staff normally conducted discharge planning, transfer arrangements, and notification of guardians.

Interview with the Registration Clerk on 03/05/19 at 1:15 PM revealed guardianship information was collected at the time of registration. The Registration Clerk stated it was the registration clerk's duty to gather the information for the nurse to notify the legal guardian.

An interview with the Director of Nursing (DON) on 03/05/19 at 5:00 PM revealed staff had been trained to notify patients' legal guardians. According to the DON, they depended on the local nursing facility to notify the family/guardians that patients were being transferred to the ED, and ED staff did not contact patients' families/guardians until discharge.