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Based on observation, documentation and interviews, it was determined that the hospital failed to maintain the condition of the environment to ensure the safety and well-being of patients when the sewer main became blocked and overflowed into the Emergency Department (ED), Imaging and Breast Center patient areas.

Findings include:

The hospital did not meet the Condition of Participation of Physical Environment at 42 CFR 482.41.

Based on observation, documentation and interviews, the hospital failed to maintain the condition of the environment when the sewer main became blocked and overflowed causing physical damage to the building and sanitation concerns in the West Health Imaging/Breast Center patient areas. This has the potential to affect all patients that present to West Health ED, Imaging, and/or Breast Center.

Based on observation, documentation and interviews, the hospital failed to maintain the condition of the physical environment and protect the safety and well-being of all patients when the sewer became blocked and backed up into the West Health Imaging/Breast Center patient areas. This has the potential to affect all patients that present to West Health Emergency Department, Imaging, and/or Breast Center.

Findings include:
The hospital leases space at the West Health building location for an off-site Emergency Department (ED), Imaging Department and Breast Center, and the 2/4/16 incident occurred at this site. The incident caused damage to the Imaging Department and and the Breast Center patient areas. A disruption in patient services occurred as a result of the incident.

A timeline of events, dated 2/9/16, was provided to the investigator at the time of the site visit at the West Health building location on 2/11/16. The timeline stated a blockage in the sewer line (caused by paper towels) had previously occurred on 9/22/15. The plumbing company unclogged the pipe and cleaning and sanitizing occurred. Blockage was believed to be an isolated incident. Cleaning and pumping the sewer line was scheduled for every six months following the 9/22/15 incident.

In addition, the timeline addressed the sequence of events that occurred on 2/4/16 starting at 8:38 a.m. when sewer water was observed coming up from a drain in the MRI area. The building's on-site maintenance company and a plumbing company were contacted and service was requested. The housekeepers began to assist with clean-up. The hallway between the Emergency Department (ED) and the Imaging Department were closed for patient transport and transports were re-routed. The plumbers arrived at 10:00 a.m. and worked on the clog until 11:30 a.m. when the water began to flow properly. The smell was very "unpleasant' in the ED according to the timeline and a minimal amount of sewer water was noted in the ED hallway. At 12:00 p.m., the Breast Center was closed and patients were rescheduled, and staff were sent home. At 12:15 p.m. shoe covers were provided to Imaging technicians. At 3:00 p.m. a professional cleaning company arrived at the building. The timeline stated that between 2/5/16-2/9/16 the clean-up and restoration of the damaged areas occurred. On 2/9/16 sheetrock installation and mudding of the walls was completed. The prior (9/22/15) every six month sewer cleaning plan was upgraded to every month following the blockage re-occurrence and sewer cleaning on 2/4/16. The mechanical sewer cleaning was done again on 2/10/16 with additional debris, including an ace bandage, gauze dressings and tape being found in the sewer line.

A tour of the Emergency Department (ED), the Breast Center and the Imaging Department occurred on 2/11/16 and damage to the walls and floors was observed. Efforts to repair the areas were in progress at the time of the tour.

Another tour of the ED, Breast Center and Imaging Department occurred on 2/18/16, and three engineers from the Engineering Department at the MN Department of Health were present. They observed the damage, repair efforts and conducted an inspection in order to determine the exact cause of the sewer back-up and the corrective action needed to resolve the problem.

A summary of the 2/18/16 inspection by the Engineering Department of the MN Department of Health, completed by engineer (N), provided the following information: The ED man hole was plugged by sanitary napkins, towels diapers and various other items. The ED man hole had possibly settled due to the recent addition of the ED (three years ago) and heavy generators being mounted on the ground adjacent to the ED man hole. Sewage leaving the ED man hole is being obstructed due to the lower invert. This condition could have contributed to the recent blockage of the sewer main. It was determined that the restoration/repair of the affected areas was acceptable. The engineering inspection revealed that the remedies are: 1) Staff and other persons must be careful of what they put into the toilets and hoppers. 2) Invert elevations at the ED man hole must be corrected. The drainage piping has to be adjusted as far as necessary from the ED man hole to provide the minimum slope. If the minimum slope cannot be maintained, a lift station may be required to discharge sewage from the 1994 building into the ED man hole. Monthly pumping of the sewage is not an acceptable correction of this condition. Correction of the drainage piping at the ED man hole is required in order to maintain their license.