HospitalInspections.org

The hospital failed 1 of 1 patient (Patient #1) the right to personal privacy, by raising the patients shirt over their head, exposing the chest and pulling pants and underclothing down and out searching for additional contraband.


Findings Include:

During Interview with hospital Patient #1, the hospital staff restrained me, because I was experiencing some triggers to self harm. The staff was given the contraband I had on my person, but was still 'excessive in their search of me, by raising my shirt up to my bra line, and pulling my pants and panties out and down. I just felt they were excessive. I have been looked at before outside of the hospital."

During Interview with hospital Staff #2, the hospital nurse on the unit was on the floor engaged with the patient., during all of this time. There was a restraint that occurred in order to receive a contraband item the patient had and was attempting to self-harm with (later identified as a comb). The restraint occurred after many attempts to de-escalate the patient and get Patient #1 to willingly give the item staff, but multiple staff restrained Patient #1 and then took Patient #1 to the assigned room to obtain the item.

During Interview with hospital Staff #6, reported Patient #1 was hiding one half inside the shirt and it was handed it to Staff #9, after that Patient #1 was questioned about having any other contraband on themself and Patient #1 denied it. Hospital techs were instructed by Staff #8, to restrain Patient #1. While in a physical restraint by four techs, the Patient #1's shirt was raised up and pulled out shaken by Staff #8 checking for contraband. The patient was then placed on the bed and Patient #1's pants were pulled up and down checking underclothing for additional contraband and nothing was found on person. The staff then removed the patient's mattress from bed frame, and the staff located the other half of the comb underneath the mattress on the bed frame.

During Interview with hospital Staff #7, reported Patient #1's escorted to assigned room and was asked multiple times to handover what was hiding. The patient continuously refused to provide the staff what was hiding. The patient did not have anything in hands at the time. The patient was asked to shake shirt out and refused. Staff #7 indicated that Staff #8 instructed the techs to restrain the Patient #1. While the patient was in a restraint on the bed with the four techs holding arms and legs one staff on each one. Staff #8 pulled the back of Patient #1's pants up along with underclothing and down somewhat, checking for additional contraband. When Patient #1 was standing the shirt was raised above head. There were male techs involved in hold the patient in place, and the patient's chest was exposed. There was no other contraband found. The patient had a broken comb and half was found underneath the mattress and the patient handed one half to staff. The patient reported throwing a lotion top holder down in the hallway. Staff #7 reported feelingt as if Staff #7 was excessive in the search of Patient #1. Staff #7 indicated that there were male staff present who responded to the code and participated in the restraint process. The incident took place in the patients room so there were no patients capable of observing the incident. However, the male staff were able to witness inappropriateness by Staff #8.

During Interview with hospital Staff #3 who accompanied Patient #1 to speak with the surveyor, returned to escort the patient back to the unit and then return to speak with the surveyor. Staff #3 indicated that Patient #1 was consistent in describing the story that was presented to the surveyor. Staff #3 stated that a past history of working with the Staff #7, Staff #8 in question in the past and indicated that they have never witnessed the staff be physically aggressive with patient's that it was to the point of being excessive. However, Staff #3 has worked with Staff #7 and this staff has a tendency to be verbally aggressive to staff and patient's alike. Staff #3 indicated that being in previous conversations with Patient #1 about this incident and her story is always consistent when she speaks about it.

During Interview with hospital Staff #9 it was reported that not witnessing the physical search of Patient #1. Staff #9 did respond to the code on the unit. When arriving on the unit it was witnessed Patient #1 standing with fist clinched. Staff #9 stated it was requested Patient #1 open hand and the patient refused. Staff #9 indicated after 3 request Patient #1' wrist were grabbed by Staff #9 and at that point Patient #1 gave Staff #9 the half of comb in hand. Staff #9 then left the unit with the comb. Staff #9 indicated being made aware the staff proceeded to restrain the patient and then search Patient #1 for any remaining contraband but did not witness it.

During Interview with hospital Staff #8, "I don't recall any information." The surveyor then presented the complaint describing the incident. The Staff #8 reflected that "Yes, I did whatever I wrote down in the Restraint sheet." Staff #8 was informed that the restraint was not very informative and it states; "Had half broken comb for self-harm ...pt. went to room and closed the door ...at the time on the unit it was Med-Pass time ...the environment was busy on the unit ...The last time medications were administered was 2015 and they were routine meds ...Verbal de-escalation and voluntary release of object." Staff #8 responded, "Yes, that's what I did." Staff #8 was asked if there was a physician's order to strip search Patient #1 or to just restrain the patient." Staff #8 started yelling, "I did whatever the paper said I did." Staff #8 was asked again, Did you pull the patients shirt up and pants and underclothing down and pull them out to see if there was any additional contraband there? Staff #8 yelled out again. "I did what was on the paper, I don't recall." Staff #8 was yelling through the phone, and the surveyor was making no more progress. The interview was terminated.

During Record Review The hospital Physician Orders dated on 12/20/2021 at 2030 reflected, Restraint to collect combs.
The hospital Physician Orders for Seclusion/Personal Restraint/Emergency Medications dated 12/20/2021 at 2030 reflected incident ended at 2033 12/2021. "Verbal De-escalation Intervention/Redirection provided. Patient was an imminent risk of self-injurious behavior. Danger to self or others is not sufficient must provide specifics ...Proper CPI used moved to the room. Any other measures deemed as no longer a danger to self or others. Ordering Physician is the Attending Physician."

During Record Review The hospital Progress Note dated 12/20/21 at 2025, "Tech notified nurse that pt. went into her room and closed door. Immediately this nurse went to room and opened the door, educated the pt. not to close the door and pt. responded 'No! I want the door closed.' This nurse noticed that the patient had an object in her hand. After several attempt to collect it. Pt. handed half broken comb to the nurse and immediately, Patient then put hand in underclothing, brought another half broken comb, attempting to use it to cut self, immediately, notified physician, restraint order received. Patient #1 was restrained from 2030 to 2033, half broken comb collected ...2040 Pt. calm, in the day room sitting."

Policy
The hospital policy on Neglect Abuse dated 07/17/2019 reflected, "Perimeter Healthcare promotes and requires professional, ethical and legal conduct of staff. The advocacy role of health care is maximized when addressing issues of conduct of staff. Perimeter Healthcare assesses the conditions of illegal, unethical and/or unprofessional conduct of staff. All health care services providers will immediately report to the appropriate supervisors, manager, or department head any suspected illegal, unethical and/or unprofessional conduct by another individual. Illegal, unethical and/or unprofessional conduct by any health care services providers are prohibited behaviors and will be grounds for disciplinary action and reporting to local and or state regulatory and/or legal authorities as mandated by statue, hospital policy and/or regulation(s). It is the responsibility of all staff members and health care professionals of Perimeter Healthcare to report concerns regarding illegal, unethical and/or unprofessional conduct to hospital administration."

The hospital Policy on Patient Rights dated 07/17/2019, reflected, "The rights, benefits, responsibilities, and privileges guaranteed by the constitutions and laws of the United States of Texas unless they have been restricted by specific provisions of law. The rights include, but are not limited to, the right to impartial access to and provision of treatment, regardless of race, nationality, religion, sex, ethnicity, sexual orientation, age, or disability; the right to petition for habeas corpus; the right to register and vote at elections, the right to acquire use, and dispose of property including contractual licenses, permits, privileges and benefits under law, the right to religious freedom and rights concerning domestic relations."

The hospital Policy on Nursing Services dated 07/17/2019 reflected, "It is the policy of the Perimeter Healthcare Nursing Services Department to provide the highest attain able quality of nursing care to all patients consistent with the mission, values, vision and goals."
The hospital Policy on Administration/Personnel dated 07/17/20219 reflected, "Perimeter Healthcare is dedicated to providing patient centered care and working to understand each individual's needs in order to supply excellent, differentiated treatment plans. We strive to employ passionate mental health professionals to ensure the highest level of care by providing hope and transforming lives ...Leadership Responsibility; The leaders of the Facility have defined responsibilities. These responsibilities are intended to further facilitate our ability to develop an environment that contributes to a quality system and patient safety ...Planning, formulation of specific goals, structure and functions to assure achievement of the Mission. The process includes information gathered from both internal and external customers. Management, the process of organizing, directing and coordinating the functions of the systems to achieve its goals ...Improvement, the process of regulating service activities to ensure achievement of goals through a continuous performance improvement process."


The hospital Policy on Emergency Behavioral Interventions: 'Use of Restraint/Seclusion dated 07/17/2019 reflected, "It is the policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others. In recognition that the patient has the right to be free of seclusion or restraint in any form that is not medically necessary; seclusion and restraint are to be used only in clinically appropriate and adequate justified situations when other less restrictive interventions have been determined ineffective or inappropriate."

The hospital failed 1 of 1 Patient (Patient #1) by the use of restraint or seclusion was not in accordance with the order of the physician or other licensed practitioner who is responsible for the care of the patient and authorized to order restraint or seclusion by the hospital policy in accordance with State law.


Findings Include:

During Interview with hospital Patient #1, the hospital staff restrained me, because I was experiencing some triggers to self harm. The staff was given the contraband I had on my person, but was still 'excessive in their search of me, by raising my shirt up to my bra line, and pulling my pants and panties out and down. I just felt they were excessive. I have been looked at before outside of the hospital."

During Interview with hospital Staff #2, the hospital nurse on the unit was on the floor engaged with the patient., during all of this time. There was a restraint that occurred in order to receive a contraband item the patient had and was attempting to self-harm with (later identified as a comb). The restraint occurred after many attempts to de-escalate the patient and get Patient #1 to willingly give the item staff, but multiple staff restrained Patient #1 and then took Patient #1 to the assigned room to obtain the item.

During Interview with hospital Staff #6, reported Patient #1 was hiding one half inside the shirt and it was handed it to Staff #9, after that Patient #1 was questioned about having any other contraband on themself and Patient #1 denied it. Hospital techs were instructed by Staff #8, to restrain Patient #1. While in a physical restraint by four techs, the Patient #1's shirt was raised up and pulled out shaken by Staff #8 checking for contraband. The patient was then placed on the bed and Patient #1's pants were pulled up and down checking underclothing for additional contraband and nothing was found on person. The staff then removed the patient's mattress from bed frame, and the staff located the other half of the comb underneath the mattress on the bed frame.

During Interview with hospital Staff #7, reported Patient #1's escorted to assigned room and was asked multiple times to handover what was hiding. The patient continuously refused to provide the staff what was hiding. The patient did not have anything in hands at the time. The patient was asked to shake shirt out and refused. Staff #7 indicated that Staff #8 instructed the techs to restrain the Patient #1. While the patient was in a restraint on the bed with the four techs holding arms and legs one staff on each one. Staff #8 pulled the back of Patient #1's pants up along with underclothing and down somewhat, checking for additional contraband. When Patient #1 was standing the shirt was raised above head. There were male techs involved in hold the patient in place, and the patient's chest was exposed. There was no other contraband found. The patient had a broken comb and half was found underneath the mattress and the patient handed one half to staff. The patient reported throwing a lotion top holder down in the hallway. Staff #7 reported feelingt as if Staff #7 was excessive in the search of Patient #1. Staff #7 indicated that there were male staff present who responded to the code and participated in the restraint process. The incident took place in the patients room so there were no patients capable of observing the incident. However, the male staff were able to witness inappropriateness by Staff #8.

During Interview with hospital Staff #3 who accompanied Patient #1 to speak with the surveyor, returned to escort the patient back to the unit and then return to speak with the surveyor. Staff #3 indicated that Patient #1 was consistent in describing the story that was presented to the surveyor. Staff #3 stated that a past history of working with the Staff #7, Staff #8 in question in the past and indicated that they have never witnessed the staff be physically aggressive with patient's that it was to the point of being excessive. However, Staff #3 has worked with Staff #7 and this staff has a tendency to be verbally aggressive to staff and patient's alike. Staff #3 indicated that being in previous conversations with Patient #1 about this incident and her story is always consistent when she speaks about it.

During Interview with hospital Staff #9 it was reported that not witnessing the physical search of Patient #1. Staff #9 did respond to the code on the unit. When arriving on the unit it was witnessed Patient #1 standing with fist clinched. Staff #9 stated it was requested Patient #1 open hand and the patient refused. Staff #9 indicated after 3 request Patient #1' wrist were grabbed by Staff #9 and at that point Patient #1 gave Staff #9 the half of comb in hand. Staff #9 then left the unit with the comb. Staff #9 indicated being made aware the staff proceeded to restrain the patient and then search Patient #1 for any remaining contraband but did not witness it.

During Interview with hospital Staff #8, "I don't recall any information." The surveyor then presented the complaint describing the incident. The Staff #8 reflected that "Yes, I did whatever I wrote down in the Restraint sheet." Staff #8 was informed that the restraint was not very informative and it states; "Had half broken comb for self-harm ...pt. went to room and closed the door ...at the time on the unit it was Med-Pass time ...the environment was busy on the unit ...The last time medications were administered was 2015 and they were routine meds ...Verbal de-escalation and voluntary release of object." Staff #8 responded, "Yes, that's what I did." Staff #8 was asked if there was a physician's order to strip search Patient #1 or to just restrain the patient." Staff #8 started yelling, "I did whatever the paper said I did." Staff #8 was asked again, Did you pull the patients shirt up and pants and underclothing down and pull them out to see if there was any additional contraband there? Staff #8 yelled out again. "I did what was on the paper, I don't recall." Staff #8 was yelling through the phone, and the surveyor was making no more progress. The interview was terminated.

During Record Review The hospital Physician Orders dated on 12/20/2021 at 2030 reflected, Restraint to collect combs.
The hospital Physician Orders for Seclusion/Personal Restraint/Emergency Medications dated 12/20/2021 at 2030 reflected incident ended at 2033 12/2021. "Verbal De-escalation Intervention/Redirection provided. Patient was an imminent risk of self-injurious behavior. Danger to self or others is not sufficient must provide specifics ...Proper CPI used moved to the room. Any other measures deemed as no longer a danger to self or others. Ordering Physician is the Attending Physician."

During Record Review The hospital Progress Note dated 12/20/21 at 2025, "Tech notified nurse that pt. went into her room and closed door. Immediately this nurse went to room and opened the door, educated the pt. not to close the door and pt. responded 'No! I want the door closed.' This nurse noticed that the patient had an object in her hand. After several attempt to collect it. Pt. handed half broken comb to the nurse and immediately, Patient then put hand in underclothing, brought another half broken comb, attempting to use it to cut self, immediately, notified physician, restraint order received. Patient #1 was restrained from 2030 to 2033, half broken comb collected ...2040 Pt. calm, in the day room sitting."

Policy
The hospital policy on Neglect Abuse dated 07/17/2019 reflected, "Perimeter Healthcare promotes and requires professional, ethical and legal conduct of staff. The advocacy role of health care is maximized when addressing issues of conduct of staff. Perimeter Healthcare assesses the conditions of illegal, unethical and/or unprofessional conduct of staff. All health care services providers will immediately report to the appropriate supervisors, manager, or department head any suspected illegal, unethical and/or unprofessional conduct by another individual. Illegal, unethical and/or unprofessional conduct by any health care services providers are prohibited behaviors and will be grounds for disciplinary action and reporting to local and or state regulatory and/or legal authorities as mandated by statue, hospital policy and/or regulation(s). It is the responsibility of all staff members and health care professionals of Perimeter Healthcare to report concerns regarding illegal, unethical and/or unprofessional conduct to hospital administration."

The hospital Policy on Patient Rights dated 07/17/2019, reflected, "The rights, benefits, responsibilities, and privileges guaranteed by the constitutions and laws of the United States of Texas unless they have been restricted by specific provisions of law. The rights include, but are not limited to, the right to impartial access to and provision of treatment, regardless of race, nationality, religion, sex, ethnicity, sexual orientation, age, or disability; the right to petition for habeas corpus; the right to register and vote at elections, the right to acquire use, and dispose of property including contractual licenses, permits, privileges and benefits under law, the right to religious freedom and rights concerning domestic relations."

The hospital Policy on Nursing Services dated 07/17/2019 reflected, "It is the policy of the Perimeter Healthcare Nursing Services Department to provide the highest attain able quality of nursing care to all patients consistent with the mission, values, vision and goals."
The hospital Policy on Administration/Personnel dated 07/17/20219 reflected, "Perimeter Healthcare is dedicated to providing patient centered care and working to understand each individual's needs in order to supply excellent, differentiated treatment plans. We strive to employ passionate mental health professionals to ensure the highest level of care by providing hope and transforming lives ...Leadership Responsibility; The leaders of the Facility have defined responsibilities. These responsibilities are intended to further facilitate our ability to develop an environment that contributes to a quality system and patient safety ...Planning, formulation of specific goals, structure and functions to assure achievement of the Mission. The process includes information gathered from both internal and external customers. Management, the process of organizing, directing and coordinating the functions of the systems to achieve its goals ...Improvement, the process of regulating service activities to ensure achievement of goals through a continuous performance improvement process."


The hospital Policy on Emergency Behavioral Interventions: 'Use of Restraint/Seclusion dated 07/17/2019 reflected, "It is the policy of Perimeter Healthcare to create an environment that protects the patient's health and safety and preserves his or her dignity, rights and well-being. All patients have the right to be free from restraint or seclusion, of any form, imposed as means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patient, a staff member, or others. In recognition that the patient has the right to be free of seclusion or restraint in any form that is not medically necessary; seclusion and restraint are to be used only in clinically appropriate and adequate justified situations when other less restrictive interventions have been determined ineffective or inappropriate."