HospitalInspections.org

Based on review of the event log, medical record review, and interviews, the facility failed to provide the information needed to make an informed decision and request or refuse treatment of facial blemishes before receiving general anesthesia for 1 (Patient #11) of 11 sampled patients.

The findings include:

During the review, on 8/26/11 at 10:30 a.m., of the facility event log for July and August 2011 the following documentation was found:
"7/15/11 PT. (patient) noted erythemia (redness of the skin) of bilateral cheekbone and forehead postoperatively after the surgical drapes were removed and able to visualize patient. The patient was transported to PACU (post anesthesia care unit) when further erythema noted areas and bruising noted on the cheek bones and forehead. The Nurse Anesthetist admitted to me that he was squeezing the patient's blemishes while the patient was under general anesthesia. This incident was reported to PACU nurse and the OR's (Operating Room) Supervisor."

The incident report was filled out by the Registered Nurse circulating in the operating room during the patient's surgery.

The incident was discussed with the facility Risk Manager on this date at 11:30 a.m. She stated, "Everyone was shocked and could not believe this had occurred. The incident was referred to the Anesthesia Department for follow up. Not reported to any regulating or licensing agency."

Review on 8/26/11 at 12:15 of sampled Patient #11's medical record found the following information:
The patient was admitted to the hospital on 7/14/11 at 11:37 with cellulitis (bacterial infection of the deepest layer of skin)/ and abscess (pocket of pus) of trunk. She was taken to the operating room on 7/15/11 and received an incision and drainage of the groin area abscess. The patient was alert and coherent and discharged home with home health on 07/17/11.

The Anesthesiologist in charge of the Anesthetist on the day of the incident wrote a progress note on Patient #11's medical record on 7/19/11 documenting the following information:
"7/19/11 1000- On the afternoon of Friday 7/15, I was made aware of concerns regarding ecchymosis on the cheeks of the patient. I promptly visited the pt. in her room to evaluate the ecchymosis. The patient and her husband were concerned that there appeared to be "bruising" on her face after returning from her surgery. I discussed with the patient and her husband the possible etiology (cause) of the ecchymosis. I obtained verbal consent from the patient to take a photograph to aid in obtaining the diagnosis. After discussing the case with the PACU staff, OR personnel, and nurse anesthetist, I returned to see the patient on Saturday 7/16 at approx. 3 p.m. The patient and I discussed her hospitalization and management. We further discussed her facial ecchymosis, which had since improved. I left the patient my contact information. The patient seemed satisfied with our discussions."

A speaker phone interview, in the presence of the Risk Manager, Director of Progressive Care, and 2 surveyors, at 1:15 p.m., on 08/26/11, with the Anesthesiologist in charge of the anesthetist on the day of the incident included the following information:
"I heard about it a few hours after eaves dropping. It was the most shocking thing I ever heard. I visited the patient the afternoon of the same day because the patient and her husband were upset about the bruising on her face. I looked at the bruising and took a picture. I was shocked; the bruising was very impressive on her face. I talked to the nurses and found out what happened. I took (name of CRNA)) aside spoke to him on how inappropriate, out of scope of practice, assault, horrible and unconsented, poor decision making, a serious breach of ethical behavior, profoundly stupid this was. CRNA said he was concerned they might become infected, and that it was not malicious. Saturday I went back to the hospital and talked with the patient and told her I found out how the bruising occurred. I told the patient that the CRNA popped the pimples. I also explained that it was inappropriate and out of scope of practice. The patient said it was okay and no big deal. I told her it was inappropriate and the CRNA was reprimanded. The patient was satisfied.

I met with the Chief of Anesthesia and President of the anesthesia group. Decided on in- services for all CRNA's; it was taken very seriously. The CRNA's contract was reviewed and he received a reprimand. It was decided to suspend him for one week without pay. Legal was kept involved. We did not report the incident to any regulating or licensing agency maybe the hospital did."

Interview with the Manger of Credentialing Services held at 1:40 p.m., on 8/26/11. The CRNA's creditionaling file was reviewed. The Manager states "no information will be forwarded to the credentialing file until CRNA reapplies and is up for reappointment in November 2012."

During the review on 8/26/11 at 2:00 p.m., of the facility Policy and Procedure #711 titled Patient Rights and Responsibilities on page 9 under #11 Consent found the following documented:
"In accordance with LMHS (Lee Memorial Hospital policy and procedure S03 05 442 Informed Consent, the patient has the right to reasonable informed consent under the Florida Medical Consent Law, which provides that in treating, examining, or operating on a patient:
a. The action of the responsible practitioner in obtaining the consent of the patient or another authorized to give consent is in accordance with an acceptable standard of medical practice among members of the medical profession with similar training and experiencing the same or similar medical community."

Interview on 8/26/11 at 2:45 p.m., held with the operating room RN reporting the incident revealed: "I glanced at the patient when preparing to take her to PACU; her face did not look right. I didn't know what happened to her face. The CRNA approached me and told me he was picking on her black heads. I spoke to the Anesthesiologist. The CRNA felt bad and showed regret."

Interview on 8/26/11 at 3:00 p.m., with scrub technician assisting in case who stated "I did the case, everything great; the drop (sheet blocking the patient's upper body and head from the operating area) was up. I was called by (name of RN) to look at the red marks on the patient's face asked if I noticed patient's face referring to the number of blackheads on face I said yes, did not notice red marks before. Patient had very obvious black heads on her face. Asked what happened; was told CRNA popping black heads."

Risk Manager stated on 8/26/11 at 3:30 p.m., Anesthesiologist informed her that CRNA started a 3 week vacation on 08/8/11; he was given an additional week starting on 8/29/11 without pay as a suspension for the incident.

Surveyor was unable to contact CRNA by phone for an interview; informed by Risk Manager he was unavailable as he is in Puerto Rico and would not return until 9/05/11.

A speaker phone interview, in the presence of the Risk Manager, Director of Progressive Care, and 2 surveyors, on 08/26/11 at 3:40 p.m., was held with the Medical Director of the Anesthesiology Department: "After discussion with Group and Labor Attorney, decision was made to counsel CRNA. When talking with (name of CRNA) found a child like innocents, a clean face and lack of malice; would never do anything like this. Told him it was a serious thing, had no consent asked what were you thinking. (name of CRNA) is well liked and has had no problems previously. Letter of reprimand documenting counseling can be obtained from my office manager."