HospitalInspections.org

Based on interview, document review and policy review the Hospital failed to protect and promote patient's rights when they failed to ensure a patient was free from all forms of abuse.

The cumulative effect of the Hospital's failure to ensure patients are free from all forms of abuse places all patients at risk for receiving care from untrained, abusive staff resulting in physical and emotional harm or injury.

Findings Include:

The hospital failed to ensure that a patient was free from abuse for one of three patients reviewed (Patient 1), by failing to ensure that the patient was not subject to intimidation and mental anguish from an emergency department physician. (Refer to A0145)

Based on record review, document and policy review, and staff interview, the hospital failed to ensure that a patient was free from abuse for one of three patients reviewed (Patient 1) by failing to ensure that the patient was not subject to intimidation and mental anguish from an emergency department (ED) physician (Staff M).

Failure of the hospital to ensure patients are free from abuse has the potential for patients to experience physical and emotional suffering, trauma, pain, depression, harm and fear of relationships and treatments.

Findings Include:

1. Review of the hospital's policy titled, "Abuse and Neglect," dated 04/18/19, showed all health care professionals who have reason to suspect that a child or dependent adult has been abused ...are mandated to report that suspicion ...any action taken shall be clearly noted in the medical record and include a conspicuous designation such as "suspected abuse" ...document all activities on patient's behalf fully and completely in medical record.

Review of the hospital's policy titled, "Patient Rights and Responsibilities," dated 01/14/20, showed a hospital must protect and promote each patient's rights ...as part of their mission to recognize and support patient rights.

Review of the hospital's policy titled, "Workplace Violence Prevention," dated 02/06/19, showed workplace violence a threat or act of violent behavior against another person ...that results in or has a high likelihood of resulting in injury, death or psychological harm ...may involve patients ...physicians ...examples include bullying, intimidation or use of physical force ...associates be mindful and use their best de-escalation/safety management skills as preventative/preparatory behaviors ...to reduce risk of not communicating the potential for aggression is established.

Review of Patient 1's discharged medical record on 03/02/2021 showed a 26-year-old female, who presented to the ED via police escort with staff from a clinic crisis center on 02/18/21 at 12:29 PM with a complaint of delusional with psychosis (unable to tell what is real and imagined.) Patient 1 also had diagnosis of Schizoaffective disorder (a combination of schizophrenia (a breakdown in relation to thoughts, behaviors, emotions, and actions) and a mood disorder) and bipolar disorder (mood swings).

Review of ED physician notes dated 02/18/21 at 1:55 PM, showed Staff M, ED Physician documented the history and review of systems was limited due to her psychiatric state and uncooperative behavior, and her psychiatric state showed threatening posture, verbally aggressive, explosive temperament, not redirectable flat affect and uncooperative with interview.

Review of a hospital investigation showed Staff DD, Case Manager, from a community mental health clinic, contacted the hospital on 02/22/21 to file a complaint stating that after assessing Patient 1, Staff M, ED Physician began taunting her by laughing at her and getting in her face ...Staff M approached Patient 1 and stood within a foot from her telling her that she would not be making the rules and instead it would be him who made the rules ...the patient escalated asking Staff M to get away from her before he exited the room laughing ...Staff M returned ...listened to the patient, approached her, and stopping within a foot of her laughed at her and told her she was funny. The patient got up, he (Staff M) put his hands on her by pushing her and told her she was going to sleep, all the while still making fun of her delusions and laughing ...the patient repeatedly asked the provider to get out of her face but he refused to do so ...causing the patient to escalate and become more agitated.

During a telephone interview on 03/02/21 at 9:31 AM, Staff DD, Case Manager, from a crisis clinic stated that Patient 1 was put into Room 20 (one of the ED behavior/safe rooms), the physician (Staff M) stood in the doorway, while she was still handcuffed, and assessed the patient. The physician pushed the patient and laughed saying he was going to put her to sleep, and then walked away.

Review of the hospital's investigation notes, no date or time noted, included Staff M's, ED Physician written statement that showed he walked back to the ED to find and evaluate the patient ...when I approached the patient to ask what was going on ...I was immediately met with hostility and told to "not get any closer" and "to get out of her face" ...I was more than a foot from the patient ...and the patient said something to the effect of her being in charge and not having to answer my questions along with repeated forceful directions for me to get out of her face ...I informed the patient that she in fact she was not in charge ...I informed her of my role as the physician and that we would talk once she had a room ...once the patient was roomed ...the agitated patient walked into my personal space lunging forward ...I stepped backwards towards the door while simultaneously extending my arm with an out held hand ...my fingertips barely touched the patient's shoulder, my palm never making contact as I backed out of the room ...the patient began to scream "Don't touch me" at the top of her lungs ...this was a defensive maneuver ...with a locked and extended arm ...I do remember telling the nurse at this point that the patient "was going to go to sleep" ...I'll admit such language carries a certain level of unprofessionalism even if it is common place ...meds were ordered ...my shift was ending ...if I laughed or smiled, it was likely at attempts to diffuse the situation or poorly timed inappropriate laughter based on some of the wild delusional things that were being said.

During an interview on 03/02/21 at 3:04 PM, Staff M, ED Physician stated that he first observed the patient with security in a sitting area, she was pacing back and forth, and she had very animated gestures. He stated that he went over to her, she met him with hostility telling him to get out of her face, and she had power from God. Staff M stated that every time he walked down the hallway by the patient in the sitting area, she made outrageous behavior and comments to him. Staff M stated that during his assessment the patient again, told him to get out of her face, she leaned towards him, so he extended his arm, and three fingers on his right hand touching her shoulder just to put distance between them. He shared the patient screamed bloody murder "Do not touch me." Staff M stated that he did laugh at the patient, but he was trying to defuse the conversation, he did not mean for it to be taken as malicious or degrading.

During an interview on 03/02/21 at 10:39 AM, Staff F, ED Charge Nurse stated that Staff M, ED Physician reacted verbally to some of the things Patient 1 said. Staff F could not remember any specific words that were exchanged at that encounter. Staff F stated that Staff M's tool box for deescalating a patient is not great. Staff F remembered besides Staff M being verbal back to the patient, his body language and tone of voice were not calming and at one point the patient said something like you cannot tell me what to do and Staff M told the patient he was in charge. When asked if Staff M ever touched Patient 1, Staff F stated that she did not witness anything.

During an interview on 03/02/21 at 12:49 PM, Staff K, ED RN stated that she remembers Patient 1 as irritable, inpatient, authoritative, threatening and demanding. Staff K stated that generally Staff M, ED Physician does not do well with psychiatric patients and he tends to get annoyed easily, walks away from them and can be very short with them.

2. Review of the ED physicians' group contract dated 06/15/15 showed practitioners ...participate in educational programs conducted by the Hospital and the medical staff to train Hospital personnel and to help ensure the department's and hospital's compliance with accreditation requirements ... practitioners ...shall perform medical services in a careful, prudent and professionally competent manner ...evaluate the professional abilities of the practitioner ...each physician providing services under this agreement shall become and remain a member in good standing of the medical staff of the hospital.

During an interview on 03/02/21 at 3:04 PM, Staff M, ED Physician, stated that he was a member of this ED physicians' group and he had not received training concerning abuse, neglect and exploitation from this group or the hospital and the only training he had received concerning care of psychiatric patients was during his residency.

During an interview on 03/03/21 at 1:17 PM, Staff A, President and Staff B, Quality and Patient Safely Director stated that the number of staff completing Management of Aggressive Behavior (MOAB - skills and techniques to reduce and manage violent and aggressive behavior) training has been drastically reduced due to COVID-19. Staff B stated that staff from the behavioral units, ED and intensive care units (ICUs) are usually the first ones assigned for training, and Staff M, ED Physician had not completed the training. Staff A, President and Staff B, Quality and Patient Safely Director stated that follow up for Staff M, ED Physician after the allegation of abuse and harassment was passed on to Staff X, Medical Director for the contracted ED physician group. Staff A and Staff B stated that they were not aware of any actions taken by Staff X regarding the allegation of abuse towards Staff M.

During a telephone interview on 03/03/21 at 3:30 PM, Staff X, Medical Director for the contracted ED physician group stated that his job is to oversee ED physicians, if there is a physician issue he would be notified, and he would proceed as needed. When asked if there had been any follow-up for Staff M since he became aware of the allegation of abuse and harassment towards Patient 1, Staff X stated that he had a discussion with him, since this was the first allegation and there had not been a pattern of any issues.

Review of the hospital's ED physician schedule showed Staff M, ED Physician was not scheduled to work at the above-named hospital between the date of the allegation of abuse and harassment on 02/22/21 until 03/04/21. Even though the hospital was not aware of any actions taken by the contracted ED Physician group regarding the allegation of abuse, Staff M, ED Physician worked on 03/04/21.

During a telephone interview on 03/03/21 at 3:15 PM, Staff W, Contracted ED physician group Practice Administrator, verified Staff M, ED Physician had not been assigned any extra education in the last two months.