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Based on interview and record review, the facility failed to ensure that 2 of 3 Involuntarily committed patients (#8 and #5) were held in compliance with facility policy and State Law, resulting in patients being held on a locked psychiatric unit without consent or proper certification by persons authorized to detain the patient. Findings include:

Hospital Unit Policy:

Policy 7080-088, titled "Admission to (Unit name)," dated 5/11/11, states: "Patients admitted to (unit name) will be treated with dignity and respect and in a method that adheres to the Michigan Mental Health Code and other applicable laws and regulations.

Under "Involuntary Legal Status" the policy states:
2. Involuntary legal status...is defined in the Michigan Mental Health code beginning with section 330.1423.
5. A Physician or a fully Licensed Clinical Psychologist shall certify in writing on a "clinical Certificate" form (often called the 'first certification' that the individual who has been petitioned is a person requiring psychiatric treatment.
6. The petition and the first certification shall be completed accurately and in full prior to the time the patient enters the locked doors of (unit name).

Michigan Mental Health Code:

MCL 330.1425 Execution of physician's or psychologist's clinical certificate.
A physician's or a licensed psychologist's clinical certificate required for hospitalization of an individual under section 423 shall have been executed after personal examination of the individual named in the clinical certificate, and within 72 hours before the time the clinical certificate is filed with the hospital.

MCL 330.1429 Examination; detention period.
(1) A hospital designated under section 422 shall receive and detain an individual presented for examination under section 427 or 428 for not more than 24 hours. During that time the individual shall be examined by a physician or a licensed psychologist. If the examining physician or psychologist executes a clinical certificate, the individual may be hospitalized under section 423.

MCL 330.1434 Petition; filing; contents; clinical certificates.
(1) Any individual 18 years of age or over may file with the court a petition that asserts that an individual is a person requiring treatment as defined in section 401.
(3) The petition shall be accompanied by the clinical certificate of a physician or a licensed psychologist, unless after reasonable effort the petitioner could not secure an examination. If a clinical certificate does not accompany the petition, an affidavit setting forth the reasons an examination could not be secured shall be filed.

Record Review and Interview:

1. From May 2-3 review of patient #8's clinical record revealed that patient #8 was Involuntarily committed to the inpatient psychiatric unit without documentation that a Clinical Certificate was completed by a Physician or Licensed Psychologist, as required by State Law on 2/7/12.

2. The first Certificate was completed by a Nurse Practitioner (NP#1). NP #1 signed that he personally examined the patient on 2/7/12 at 1400 hours as the "Examiner." NP #1 completed the whole Certificate, including the Examiner section, stating that he read the following statement to the patient: "I am authorized by law to examine you for the purpose of advising the court if you have a mental condition which needs treatment and whether such treatment should take place in a hospital or in some other place. I am also here to determine if you should be hospitalized or remain hospitalized before a court hearing is held."

3. The first Certificate contained a signature by a Physician (#2), dated 2/7/12 at 1504 hours, indicating that he/she examined the Clinical Certificate, completed by Nurse Practitioner #2, who completed the form as the Examiner. Physician #2's signed statement did not certify a personal examination or the patient and all narrative portions of the Clinical Certificate were hand-written by NP #1, with no comments by Physician #2.

4. The second Clinical Certificate in patient #8's record was properly completed by a Psychiatrist, Physician #1, on 2/8/12.

5. The "Notice of Hospitalization and Certificate of Service" form for patient # 8, filed with County Probate Court, listed the Clinical Certificate completed by Nurse Practitioner #1 as the Examiner, as completed by a licensed psychologist/physician/psychiatrist.

6. On 5/2/12 at approximately 1400 hours patient # 5's clinical record was reviewed. Patient #5 was hospitalized on the inpatient psychiatric unit at the time of the review. One of two Clinical Certificates was incomplete. The section of the form verifying personal examination of the patient and naming the Examiner who read the patient a required statement was left blank. The unnamed Examiner indicated doing an 20 minute examination on 4/26/12, starting at 2113 hours. The handwriting on the form did not appear to match the Physician's signature. Physician #3 signed-off on examining the Clinical Certificate on 4/26/12 at 2145 hours.

7. On 5/2/12 and 5/3/12 the above findings were verified with the Director of Behavioral Health. On 5/3/12 at 1200 hours the above findings were verifed by the Medical Quality Director.

Based on record review and interview, the facility failed to ensure that 1 of 6 current inpatients on the psychiatric unit (patient #6) received 15-minute safety checks per unit policy resulting in increased risk of injury. Finding include:

On 5/2/12 at approximately 1410 hours, review of patient #6's clinical record revealed that facility staff failed to document 15-minute checks on 4/27/12 at 0700 and 0715 hours and on 4/28/12 at 0715 hours. The Director of Behavioral Health was unable to find documentation in the clinical record in progress notes or elsewhere to explain these omissions. On 5/3/12 at approximately 1530 hours the Director of Behavioral Health stated that it is psychiatric unit policy to do 15-minute safety checks on all patients. The Director stated that the unit policy on 15-minute checks is being revised and was not made available for review prior to exit.

Based on record review and interview, the facility failed to fully investigate 1 of 1 patient's complaints (#10) of staff abuse resulting in the potential for patient abuse occurring without the facility responding to protect patients. Findings include:

On 5/3/12 from 1000-1400 hours patient #10's clinical record and 3 written complaints made in March 2012 were reviewed. On 3/19/12 patient #10 filed complaints with the Office of Recipient Rights alleging staff physical and verbal abuse and neglect. Review of investigative findings revealed that there was no detailed patient interview, asking the patient what was allegedly said and done by staff and who may have witnessed the alleged abuse. The only interviews conducted were with staff who were on duty at the time of the allegations. There was no documented attempt to interview patients who were near the area where the alleged abuse occurred. The RRO had no explanation for why no patients were interviewed. These findings were verified by the Recipient Rights Officer on 5/3/12 at 0900 hours.