HospitalInspections.org

Based on medical record (MR) review, document review, and interview, in one (1) of five (5) medical records reviewed, the facility failed to implement its policies and procedures on sexual assault to ensure patients received appropriate management and intervention (Patient #1).

This failure may have placed patients at risk for harm.

Findings:

Review of the medical record for Patient #1 identified a 34-year old male patient who presented to the Emergency Department (ED) on 04/09/19 at 10:40 am with Acute Psychosis, and was admitted to inpatient psychiatric unit on 4/10/19. On 04/11/19 at 12:52 pm, Staff D, Social Worker documented that the patient reported he was raped on 4/9/19 prior to the ED visit. The patient refused sexual offense examination, evidence collection and prophylactic treatment.
A note by Victim Services Representative on 04/12/19 at 04:58 pm, indicated the patient is now requesting to have sexual offence examination and evidence collection performed.

On 04/12/19 at 4:45 pm, a Social Worker documented that there is no Sexual Assault Response Team (SART) liaison available and that a Medical Staff from the ED can complete the rape kit. On 04/12/2019 at 5:56 pm, Staff B (MD PGY2) documented that she contacted ED and she was told that there is no SART examiner until 04/14/19. On 04/13/2019 at 2:59 am, Staff C, MD (PGY 3) documented that patient requested a rape kit and was told that no one is available until 04/15/19. On 04/14/2019 at 9:33 am, Staff B (MD, PGY 2) noted that the patient reported he sustained an injury to his upper thigh when he was raped.

The patient was discharged on 04/17/19. A Nurse Practitioner documented on the discharge summary that as per Staff A, clinical coordinator, it has been more than 94 hours since the occurrence of the assault and therefore, SART examination was not recommended.

Review of the hospital wide policy and procedure titled "Social Work Policy: Sexual Offense," effective 5/18 states the following: "Treatment of sexual offense should be considered a medical emergency. Management of traumatic injuries takes precedence ... A SAFE trained person who is a member of the sexual Assault Response Team (SART) will be called for survivors 13 years of age and above ... The examiner performs sexual offense examination; collects evidential materials and specimens using the sexual offense evidence kit; provides prophylactic treatment and documents all actions taken, including a follow-up treatment plan ...If assault took place more than ninety-six hours prior to the examination, the use of sexual assault evidence collection kit is generally not necessary, but may be used based upon physician's determination. Evidence of photographs of bruises, lacerations, bite marks, impressions must be collected and documented. The Drug Facilitated Sexual Kit will be used in conjunction with the evidence kit ... If the patient or parent/legal guardian refuses to give consent for any portion of the above, the portion may not be carried out ...The patient must sign a release directing the hospital not to collect and keep privileged evidence if they chose not to participate in an evidentiary exam."

Review of a separate document titled "Triage Guidelines for Sexual Assault Patients" that was not dated, notes "If there are no SAFE trained personnel available, an ED physician should do the case."

There was no documented evidence as per policy that the patient signed a refusal of treatment form when he declined all interventions, including evidence collection on 4/11/19.

There was no documented evidence that the patient was promptly assessed by either the SAFE trained personnel or an ED physician when he requested for an examination and evidence collection on 4/12/19.

As per interview with Staff B (MD, PGY 2) on 05/24/2019 at 02:00 pm, she called the Medical Emergency Department regarding rape kit evidence collection and was told the SART provider went home. She did not examine the patient's upper thigh injury because she was waiting for a SART examiner to perform the sexual offense examination.

During interview with Staff D, RN, SART Coordinator on 05/28/2019 at 12:00 pm, she explained that they do not have adequate number of SAFE trained personnel to complete the 24/7 monthly schedule for SAFE coverage. however, in the absence of a SAFE personnel, "Any advanced care provider can do the rape kit, they come with written instructions." The collection of evidence using the rape kit is within an ED physician's scope of practice.

These finding were brought to the attention of Staff I, Chief Quality Officer on 5/28/19 at 3:00 PM.