HospitalInspections.org

Based on record review and interview, the hospital failed to thoroughly investigate and report potential neglect to LDH-HSS (Louisiana Department of Health - Health Standards Section) or a local law enforcement agency within 24 hours of receipt of the allegation for 1 (#1) of 1 sampled patients reviewed for abuse/neglect.
Findings:

Review of the State law R.S. 40:2009.20 revealed "Any person who is engaged in the practice of medicine, social service, facility administration, psychological services or any RN, LPN, nurses' aide, personal care attendant, respite worker, physician's assistant, physical therapist, or any other healthcare giver having knowledge that a consumer's physical or mental health or welfare has been or may be further adversely affected by abuse, neglect, or exploitation shall, within 24 hours, submit a report to the department or inform the unit or local law enforcement agency of such abuse or neglect." Further review revealed "Neglect" was defined as the failure to provide the proper or necessary medical care, nutrition, or other care necessary for a consumer's well-being.

Review of the hospital policy titled, "Abuse/Neglect of Patient", provided by S1CNO revealed in part that whenever suspected patient abuse and/or neglect is reported, the CEO shall report the situation to State and local authorities who have jurisdiction over such matters. The incident shall be investigated by the CEO who shall interview witness, including charged employee, and obtained signed statements when appropriate.

Further review of the above policy revealed no reference to the requirement to report allegations, suspected, or potential occurrences of abuse/neglect to LDH.

Review of the hospital incident report dated 04/16/19 and completed by S3IOP Director revealed that S2Transportation was transporting Patient #1 and Patient #2 to the IOP when it was involved in a motor vehicle accident. The report revealed that S2Transportation hit another vehicle. Patient #1 sustained a bloody nose and both patients were transferred to the local hospital per ambulance for evaluation.

Review of the police report (dated 04/16/19) attached to the incident report revealed that S2Transportation stated he was not paying attention and hit a vehicle that was stopped causing that vehicle to hit another vehicle that was also stopped.

On 05/20/19 at 2:00 p.m., a phone interview was conducted with S3IOP Director. She confirmed that S2Transportation was involved in a wreck in the hospital van while transporting Patients #1 (wheelchair bound) and #2 to the IOP on 04/16/19. S3IOP Director stated that both patients were transferred to the local hospital for evaluation, but Patient #1 was admitted and later transferred to a higher level of care due to multiple facial fractures after hitting his head on the seat in front of him.

When S3IOP Director was asked if she had conducted an investigation of the incident, she stated yes. When asked if she had documentation of her investigation, she stated that she had the police report and S2Transportation's drug test results that were performed after the wreck. When asked if she had any other documented evidence of a thorough investigation, including interviews, she stated no. When asked if she had reported this incident of potential neglect to LDH-HSS, she stated no.

On 05/20/19 at 3:20 p.m., interview with S1CNO revealed that she was aware of the incident involving S2Transportation on 04/16/19. She further stated that S3IOP Director was responsible for the investigation. S1CNO confirmed that a thorough investigation had not been documented regarding the wreck on 04/16/19 and that the potential neglect should have been reported to LDH-HSS.