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Based on review of medical records it was determined that the hospital failed to seek either patient #1's consent, or certify patient #1's incapacity for decision-making prior to inserting a peripherally inserted central catheter (PICC) line with a consent signed by daughter #2 as evidenced by:

Patient #1 is a 63-year-old female admitted to the hospital from a nursing home for respiratory distress and a saturation of 78%. Patient #1 has no advance directive, nor had she designated a healthcare decision-maker. She has two daughters who have shared surrogate decision-making when patient #1 has not been oriented. Daughter #1 is noted as the emergency contact.

Patient #1's history includes chronic obstructive pulmonary disease, cerebrovascular accident, pulmonary hypertension, seizure disorder, diabetes mellitus, coronary artery disease, and anxiety disorder with psychomotor agitation. Patient #1 has had a coronary artery bypass graft, a percutaneous endoscopic gastrostomy tube placement and tracheostomy tube placement. On presentation, she was noted to have swelling to her bilateral arms. Patient #1 was ventilator dependent and admitted with a diagnosis of Pneumonia vs. Pulmonary edema.

On 2/20/2010 at 2345, a nursing note states "Pt. (patient) alert and able to make needs known (pt. can mouth words)." On each subsequent day of 2/21, 2/22, 2/23, 2/24, and 2/25, patient #1 is noted to be alert and oriented.

While being treated for pneumonia, patient #1 required a PICC line for continuing antibiotic therapy due to poor access otherwise. An order for PICC line dated 2/23/2010, in addition to a signed consent from daughter #2 appears in the record. There was no documented evidence of why patient #1's consent was not sought as opposed to her daughter's.

On 2/24/2010 at approximately 12 noon, a certified infusion RN performed the procedure. Interview with the infusion RN revealed that she announces the procedure to each patient. The infusion nurse remembered that patient #1 offered her left arm for the procedure; however, the procedure was done in the right arm without apparent complication.

On 2/25 at 11:15 am, consent for blood products is signed by patient #1. It is unknown why hospital staff sought patient #1's consent for blood products but not for the PICC line.

The hospital failed to honor patient #1's right to consent when they did not inform her of the need for a PICC line with the risks and benefits, and then obtain her consent as opposed to obtaining consent from her daughter.