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Based on interview and record review the facility failed to protect patients' rights, placing all patients at risk for loss of their rights. Findings include:

The facility failed to acknowledge and recognize the notarized birth plan and declination of specified medication. See tag A-0131.

Based on interview and record review the facility failed to acknowledge and recognize the notarized birth plan and declination of specific medications of a patient resulting in the potential for the violation of patient rights for all patients being treated at the facility. Findings include:

A review of facility's complaint and grievance log for the past six months September 2013 to March 10, 2014 occurred on March 13, 2014 at approximately 1300. The focus of the review was for occurrences in relation to patient rights. During the review of the log, a complaint for the complainant patient was identified. The complaint was received on January 2, 2014. The complaint detailed the patient was denied discharge without the infant receiving a Vitamin K shot and was held in the room by security. The complaint also stated the parents were threatened with Child Protective Services being called if they (patient #1) chose to leave with the infant without receiving the Vitamin K.

Review of the complainant's chart was conducted on March 13, 2014 at approximately 1500. Contained in patient #1 chart was a notarized birth plan stating that Vitamin K would not be administered to patient #2. Present in patient #2 chart was the newborn vitamin K injection refusal, parental refusal for newborn screening, immunization waiver form, refusal for prophylactic treatment of newborn eye infection (Ophthalmia Neonatorum). All documents were signed by patient #1.

Staff K physician notes dated December 31, 2013 at 0709 stated "Plan: Routine Newborn Care: Mom and Dad are refusing most testing and care (including Vitamin K, routine metabolic newborn screen, circumcision, Hep B.[hepatitis B vaccine], birth plan on baby's chart for more details)." The notes further stated "counseling provided on importance of Vitamin K - parents asked to reconsider". The note also details that no primary care physician had been assigned as the infant was refused as a patient by the pediatrician's office they had chosen prior to admission.

Nursing notes of Nurse #1 dated December 31, 2013 at 1601 stated, "Dad demanding that baby be released this evening and wants to talk to a Dr.(staff K) today. Staff K physician,(infants pediatrician) states that she will not sign a discharge for baby unless dad provided her with a PCP (primary care physician), waivers must be signed for Hep B, Vitamin K. Told parents I would let parents know."

Nursing notes of Nurse #1 dated December 31, 2013 at 1640 stated, "Called [facility A] legal counsel at advice of house director. Explained situation to him regarding baby, that parents have refused Vit. K., eye prophylaxis, circumcision, and all vaccinations. Explained that Dr. [staff K] will not sign discharge papers for baby until the parents provide a primary care physician. Explained that parents are asking to talk with someone and will not have nurse as a go-between. He stated that parents have right to refuse those treatments but that if Dr. (staff K) will not put discharge orders in for baby for medical reasons and parents want to take baby home against her advice then it becomes a protective service order. Legal counsel (staff J) was given floor number of [xxx-xxxx] and he stated he would call back. Will continue to monitor."

Nursing notes of Nurse #1 dated December 31, 2013 at 1653 state "Dad at nurses station stating that he has called police and he will be taking his son home. States nurse has until 1507 to do any other tests on baby. He will be taking baby home at that point." At 1701 nursing notes further stated, "Legal counsel (staff J) called back. Stated need to talk to parents and relay that Dr. will not release baby at this time, that Dr. stated she would come in tomorrow morning to talk with parents. If parents try to take baby from hospital against medical orders than this becomes a social work/child protective services order. Explained to him that my goal is to de-escalate that situation. Stated I would go and talk to parents and inform them of this. He gave his number of [XXX-XXX-XXXX] if need arises to talk with him again. Will continue to monitor."

Nursing notes of Nurse #1 dated December 31, 2013 at 1710 stated, "security in to room with nurse to explain that Dr. (staff K) states she will not put a discharge in for baby today. Dad states that he is taking baby home this evening and that nurse need to perform 24 hour tests that parents have agreed to. Security explained to day that baby cannot be taken home without discharge order. Dad states he has called police and he will be taking baby home. Nurse explained that she cannot discharge baby without a discharge order from doctor but that test could be done now. Invited parents to nursery with baby and nurse, security left. CCHD (Critical Congenital Heart Defects testing) done 98/97 - pass. TCB (transcutaneous bilirubinometry testing) completed 5.0 and 5.9 on sternum, blood draw not necessary. Weight taken 3.080 kilograms (kg.) Bands were checked on both parents before coming to nursery. Mom left nursery after CCHD was completed. Dad stayed for weight and took baby back to room. House Director (staff I) in nursery and at nurses' desk when dad took baby out to room. Nurse (staff G) and House Director (staff I) went to talk with parents. Dad states he would be willing for Vitamin K to be given now if they can then leave as soon as it was given. House Director (staff I) talked with parent regarding Dr. (staff K) stating that a PCP (primary care physician) is also needed. Mom gave her Dr. XXXX and House Director (staff I) attempting to call. Will continue to monitor."

The final nursing note of Nurse #1 (staff G) dated December 31, 2013 at 1926 stated, "discharge teaching has been given to parents. Vitamin K was given, baby to be seen by Dr. XXXX- telephone number XXX-XXXX. Parents signed all discharge papers and were very attentive during discharge teaching. No distress noted in baby throughout evening. Awaiting signed prescription for baby to discharge. Will continue to monitor."

On Friday March 14, 2014 at approximately 0825 staff K was interviewed. When asked why the baby was not initially discharged staff K stated, "I rounded on the baby and discussed the need for a primary care physician for the baby. I also educated the parents on the importance of Vitamin K. According to the American Academy of Pediatricians it is pertinent for a baby to be seen by a primary care physician in two to three days of discharge from the hospital." When asked if the baby had not been discharged based on the refusal of the parents to accept the Vitamin K shot she stated, "no".

On Friday March 14, 2014 at approximately 0900 staff G and staff H were interviewed. Staff G was asked what her understanding for the delay in discharging the baby. Staff G stated she was told that the baby could not be discharge without a PCP (primary care physician) being assigned and the Vitamin K shot being administered. She was then asked if security was called to the room because of any threatening behaviors exhibited by the baby's father. She stated, "no". Staff H was then asked if there were any concerns with the child being released to an unsafe environment and she stated, "no".

On Friday March 14, 2014 at approximately 0930 staff I was interviewed. Staff I was asked what her understanding of the baby not being discharged that evening. Staff I stated she was told that the baby could not be discharged without a primary care physician being assigned and the Vitamin K shot being administered. Staff I was then asked if she was aware that declinations had been signed for the administration of Vitamin K shot. Staff I stated,"yes".