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Based on observation, interview and record review, the facility failed to ensure patients were provided privacy during nursing treatments, during discussions of clinical care issues, and personal hygiene activities (A143); failed to maintain an environment that protected the patient's health and safety (A144); and failed to protect patient's clinical records from public view (A147).

The cumulative effect of these systemic practices resulted in the failure of the facility to deliver statutorily mandated care to its patients.

Based on observation, patient interview and staff interview, the facility failed to ensure 33 patients admitted to the hospital or receiving care and services in the emergency department were provided personal privacy.

Emergency Department:
On 9/1/11 at 11:45AM, 17 patients were observed on gurneys, positioned around the nursing station in the emergency department (ED) and in corridors adjacent to the emergency department for continuation of medical treatment. Two patient's stated during interviews they were moved from triage rooms in the emergency department into the corridor for continuation of medical treatment because the hospital had no available rooms. The corridors were observed serving as public and staff access to other departments of the hospital and access to emergency exits.

A female patient stated during interview on 9/1/11 at 11:45AM, that if she needed to use the toilet room, she just slipped out of the end of the gurney, and walked across the corridor leading from the emergency department to radiology to the general bathroom. The patient was also observable from the ambulance entrance of the ED.

A male patient and his sister stated during interview on 9/1/11 at 12:15PM, that he had been moved from a triage room at approximately 10:00PM the night before and placed in the hallway for ongoing medical treatment. Nursing staff were observed taking the patient's vital signs, administering medications and talking with the patient about their medical condition in this area with no patient privacy provided. The patient stated there were no rooms available and the family stated, "this is totally unacceptable." The patient indicated that due to the noise level and the lights he was not able to sleep during the night.

Staff interview with the Chief Medical Officer on 9/1/11 during the facility tour and Chief Financial Officer at 3:30PM, revealed the facility took the following steps to address the over census status of the hospital beginning on 8/31/11. Facility staff indicated they called "Code Triage" and an Internal Disaster for a period of 6 hours ending at midnight. They further stated that for 16 hours they actively transferred all patients that were willing to be transferred to other Catholic Healthcare West hospitals, and were still in code Triage status during the interview.

Facility staff stated that Clark County Emergency Management Systems did not allow the hospital to go on divert status for "Internal Disasters" related to over capacity. Additionally, facility staff indicated they were not permitted to turn away an ambulance, due to federal EMTALA requirements. The facility reported having 27 emergency room bays, this included a specific room for trauma level services, a room with two beds for cardiac care services, and an emergency room bed designated for eyes.

The trauma room, two cardiac beds and the area for eyes were the only emergency room bays that were observed unoccupied during the tour from 11:45AM to 1:00PM on 9/1/11.

Seventeen patients were moved from the ED bays into the hallways of the ED. Two of the 17 were interviewed, one patient stated there were no available hospitals rooms, so they spent the night on a gurney placed in the hallway of the ED. One of these two patients indicated they were being discharged to home that afternoon, the other patient indicated they were waiting to go to surgery at 4:00PM on 9/1/11. Additionally, eighteen patients were admitted to public areas and other converted rooms within the hospital. The hospital had 41 patients over licensed bed capacity of 219 beds.

Hospital staff stated during the interview that ambulance services were notified that the facility was over capacity on 8/31/11 and 9/1/11. An ambulance was observed waiting with a patient in the ambulance entrance/admit area during the tour of the ED on 9/1/11. The Chief Financial Officer stated during interview that incoming patients were not told of the facility overcapacity status because such statements could be construed as dissuading, or turning away a patient thereby violating EMTALA requirements.

Onsite visits to two other Catholic Healthcare West hospitals on 9/1/11 revealed one hospital with approximately 20 open and available ED rooms, and one hospital that was over capacity.

Interview with a Paramedic from the Henderson Fire Department on 9/1/11 at 7:30PM, revealed they transport to the patient's hospital of choice, unless the patient meets the criteria for transport to a specialized unit located only at a particular hospital or a trauma center.

Medical Record Review: Review of medical record revealed that Patient #4 was admitted to the hallway of the ED department at 7:00PM on 6/11/11.

Hospital Floors 1 through 4:
On 9/1/11, a tour of hospital floors one to four, between 1:00PM and 3:00PM, revealed 16 patients admitted to hospital beds that were placed in public waiting areas, a rehabilitation gym that was cleared of exercise equipment, and other rooms that were not designed, constructed or licensed as in-patient hospital rooms.

1st floor: Patient beds numbered 131 to 135 were positioned in a room that was submitted in the original license application and architectural documents as a rehabilitation therapy gym. A commode was placed in this area for patient toileting use. There was a medication pump placed near the commode. There were no nurse call lights for each patient bed, there were no reading lights for patient use. There were no wardrobes or storage space for personal effects. Also observed was dirty linen placed on top of the soiled linen container, rather than inside the container.

1 West: Patient beds numbered 127, 128, 129 and 130 were placed in a public area at the end of a public corridor in a public waiting area. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects. Patient stated, "I'm not in a room, I'm with a bunch of other people with curtains around us."

2nd floor: Patient bed #22051 observed at end of corridor. There was no reading light, individual nurse call light, access to a toilet room without entering the general corridor, or a wardrobe, storage space for personal effects.

3rd floor medical/surgical oncology: Two patients admitted to hospital beds placed in the public area at the end of the corridor. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects.

3rd floor West: Three patients admitted to hospital beds placed in the pubic area at the end of the corridor. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects.

4th floor East: Two patients admitted to hospital beds placed in the public area at the end of the corridor. Two beds separated by a hanging curtain that measured 20.5 inches from the floor exposing the commodes for patient use for toileting rooms. The legs of the commode were visible from the public corridor. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects.

The 216 licensed patient rooms in the hospital were designed as private rooms and met the state construction standards for the nursing unit locations. The patient beds that were placed in the corridor had curtains hung on tracks around the beds, however the patient's personal privacy was not protected from conversations between the patient and healthcare providers, or from casual observation from the corridor or during transfer from the bed to a private toileting room.

4th floor West: The public area at the end of the corridor was in use as a waiting area, as submitted with the original license application and architectural documents.

Based on observation, patient interview and staff interview, the facility failed to ensure 17 patients in the emergency department and 16 patients on floors one through four in the hospital were provided care and services in a safe setting:

Findings include:

Emergency Department:

On 9/1/11 at 11:45AM, 17 patients were observed on gurneys, positioned around the nursing station, in corridors adjacent to the emergency department, and in front of smoke barrier doors. Staff stated during the tour of the emergency department (ED) that patients were initially treated in the emergency room bays and then admitted to a gurney and placed into the corridor for continuation of medical treatment when there were no available hospital beds, or when there were no transfer options available. The corridors were observed serving as public and staff access to other departments of the hospital and access to emergency exits.

A male patient and his sister stated during interview on 9/1/11 at 12:15PM, that he had been moved from a triage room at approximately 10:00pm the night before and placed in the hallway for ongoing medical treatment. Nursing staff were observed taking the patient's vital signs, administering medications and talking with the patient about their medical condition in this area with no privacy provided. The patient stated there were no rooms available and the family member stated, "this is totally unacceptable." The patient indicated that due to the noise level and the lights he was not able to sleep during the night.

Patient movement to and from triage areas to hospital departments such as magnetic resonance imaging (MRI) was limited due to the number of gurneys placed in the corridor. Patients lying on gurneys were observed being moved around in the corridor to allow passage of other patients in gurneys.

Observation on 9/1/11 at 11:45AM, revealed an electrical cord from an intravenous (IV) pump, that transfused fluids in one male patient positioned in the corridor next to the nursing station. The electrical cord ran from the pump under the glass partition at the nursing station to an outlet under the nursing station counter.

There were no medical gas outlets, electrical receptacles, minimum floor area per bed, storage space, counter space, or examination lights for the 17 beds placed in the corridor around the nursing station and in corridors leading to other departments of the hospital.

Medical Record Review: Review of medical record for Patient #4 revealed the patient was admitted to the hallway of the ED department at 7:00PM on 6/11/11.

Hospital floors 1 through 4:
On 9/1/11, a tour of hospital floors one to four, between 1:00PM and 3:00PM, revealed 16 patients were admitted to hospital beds that were placed in public waiting areas, a rehabilitation gym that was cleared of exercise equipment, and other rooms that were not designed, constructed or licensed as in-patient hospital rooms.

1st floor: Patient beds numbered 131 to 135 were positioned in a room that was submitted in the original license application and architectural documents as a rehabilitation therapy gym. A commode was placed in this area for patient toileting use. There was a medication pump placed close to the commode. There were no nurse call lights for each patient bed, there were no reading lights for patient use. There were no wardrobes or storage space for personal effects. Also observed was dirty linen placed on top of the soiled linen container, rather than inside the container.

1 West: Patient beds numbered 127, 128, 129 and 130 were placed in a public area at the end of a public corridor in a public waiting area. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects. Patient stated, "I'm not in a room, I'm with a bunch of other people with curtains around us."

2nd floor: Patient bed #22051 observed at end of corridor. There was no reading light, individual nurse call light, access to a toilet room without entering the general corridor, or a wardrobe, storage space for personal effects.

3rd floor medical/surgical oncology: Two patients admitted to hospital beds placed in the public area at the end of the corridor. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects.

3rd floor West: Three patients admitted to hospital beds placed in the pubic area at the end of the corridor. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects.

4th floor East: Two patients admitted to hospital beds placed in the public area at the end of the corridor. Two beds separated by a hanging curtain that measured 20.5 inches from the floor exposing the commodes for patient use for toileting rooms. The legs of the commode were visible from the public corridor. There were no reading lights, individual nurse call lights, access to a toilet room without entering the general corridor, or wardrobes, storage space for personal effects.

4th floor West: The public area at the end of the corridor was in use as a waiting area, as submitted with the original license application and architectural documents.

These areas in the hospital and the emgerency department that were being used for patient care and services were not designed or constructed to contain all required elements of a triage room in the emergency department or an inpatient hospital room as required by state construction guidelines adopted by regulation contained in the A.I.A. Guidelines for Design and Construction of Hospital and Health Care Facilities, 2006 edition.

Complaint #NV00029072 and #NV00029249

Based on observation the facility did not maintain the confidentiality of patient medical records for 3 of 17 patients.

Findings include:

On 9/1/11, at 11:45AM, 17 patients were observed on gurneys, positioned around the nursing station and in corridors adjacent to the emergency department.

Observed two individual patient medical records placed on the end of the patient's gurneys and not at the nursing station.

Observed one patient electronic medical record on a screen at an unattended station open to viewing by any person walking past.