HospitalInspections.org

Based on a review of the clinical record and facility documentation, the facility failed to inform the patient of the patient's rights in advance of furnishing care.

Findings were:

During the review of the clinical record for patient #1, a 5-page document titled "Consent for Treatment & Conditions of Admission" was noted. It contained different sections, each requiring patient #1's initials. One section, "Patient Rights and Responsibilities", stated:
"The undersigned affirms he/she has received a patient handbook which has listed both the patient rights and responsibilities, that these rights have been explained, and that they understand these rights and responsibilities. In addition, the undersigned agrees to all terms and conditions identified in the patient handbook." None of the sections (to include the section regarding patient rights) had been initialed by patient #1.
Vertically and along the right-hand side of the page was written "Pt [patient] unable to sign/EDO [emergency detention order]". This statement was dated/signed 2-21-19 at 1500 [3:00 pm] and signed by 2 individuals.

Facility policy 01.01.01 titled "Patient Rights" states, in part:
"Policy:
It is the responsibility of the River Crest Hospital to assure that patients are informed of their rights by the following procedure as established by the Texas Department of Mental Health and Mental Retardation.
Procedure:
1. Prior to admission, 'The Patient's Bill of Rights' must be given to all the patients 18 or older and/or a legal guardian, and if requested, a copy may be given to the family members, or significant others.
...
4. Each patient will be given a patient rights handbook along with their identification number regardless of mental status upon admission. If the patient is child/adolescent and the guardian is present, provide the guardian with a patient rights handbook and identification number as well. If guardian is not present, a patient identification number and rights will be provided via phone.
...
6. Oral communication of the Patient Rights will be documented on the admission form. This signed statement that the patient received an oral explanation of his/her rights is filed in the patient record.
7. When the individual receiving services is unable to or unwilling to sign the 'Patient's Bill of Rights' document which confirms that the rights have been orally communicated, a brief explanation of the reason should be entered onto the document along with the signature of the person who explained the rights and a third party witness.
...
Patient Rights and Responsibilities Information:
1. Patient Complaints - Information is provided regarding how to file complaints about a health care professional or facility if the patient has concerns about their care in this hospital."

The above was confirmed in an interview with the CEO and other administrative staff on the afternoon of 7-3-19.

Based on a review of the clinical record and facility documentation, the facility failed to protect the patient's right to receive care in a safe setting, as the patient was given medication to which she had previously stated she was allergic.

Findings were:

Allergies to the following medications were noted on the patient #1's intake assessment:
* Biaxin
* Effexor
* Seroquel
* Thorazine
* Zyprexa
During the patient's nursing admission assessment, patient #1 added an allergy to Haldol.

Patient #1 was prescribed the following psychoactive medications during her stay:
* Clonidine (detox protocol)
* Melatonin
* Depakote
* Vistaril
* Librium
* Ativan
* Zyprexa
* Benadryl
* Trazodone
* Thorazine
* Geodon
* Vraylar
* Lithium

Despite having stated an allergy to Thorazine and Zyprexa, both medications were ordered for patient #1 during her stay. Patient #1 received at least one dose of Zyprexa but refused the Thorazine, stating that she was allergic to the medication.

Facility policy 01.01.01 titled "Patient Rights" states, in part:
"Policy:
It is the responsibility of the River Crest Hospital to assure that patients are informed of their rights by the following procedure as established by the Texas Department of Mental Health and Mental Retardation.
Procedure:
1. Prior to admission, 'The Patient's Bill of Rights' must be given to all the patients 18 or older and/or a legal guardian, and if requested, a copy may be given to the family members, or significant others.
...
4. Each patient will be given a patient rights handbook along with their identification number regardless of mental status upon admission. If the patient is child/adolescent and the guardian is present, provide the guardian with a patient rights handbook and identification number as well. If guardian is not present, a patient identification number and rights will be provided via phone.
...
6. Oral communication of the Patient Rights will be documented on the admission form. This signed statement that the patient received an oral explanation of his/her rights is filed in the patient record.
7. When the individual receiving services is unable to or unwilling to sign the 'Patient's Bill of Rights' document which confirms that the rights have been orally communicated, a brief explanation of the reason should be entered onto the document along with the signature of the person who explained the rights and a third party witness.
...
Patients (or as appropriate a Surrogate) are entitled to:
...
* Receive care in a safe setting
...
Patient Rights and Responsibilities Information:
1. Patient Complaints - Information is provided regarding how to file complaints about a health care professional or facility if the patient has concerns about their care in this hospital."