HospitalInspections.org

Based on observation, document review and interview, the facility failed to ensure: (1) the use of appropriate restraints, specifically the use of handcuffs as restraints, (2) restraints are used in accordance with the order of the physician or licensed independent practitioner, and (3) hospital police officers who apply, monitor, and / or assist in the application of restraints are trained in the application of first aid and are certified in the use of cardiopulmonary resuscitation (CPR).

These failures place patients at risk for potential harm.


Findings include:

See Tag A 154
See Tag A 168
See Tag A 175
See Tag A 206

Based on document review and interview, in 1 (one) of 3 (three) medical records (MR)reviewed, the facility failed to ensure that patients were not subjected to the use of handcuffs as restraints by hospital police officers. (Patient #1).

Findings include:
Review of New York City Health and Hospitals Corporation - Hospital Police Crime and Incident, noted an incident reported on 9/10/2016 at 1928 (7:28 PM). The occurrence time was documented as 9/10/2016 at 1643 (4:43 PM). The reporting staff documented that he along with four other officers and a Behavioral Health staff (BHA), escorted Patient #1 from the psych ER to adult emergency (AED). The "Central did advise that said patient was a flight risk. Upon arrival in AED, patient caused public inconvenience, annoyance and alarm, engaging BHA pushing his body and arms to snatching his property away with intent to elope, showing no compliance or reasoning. At this time officers used necessary minimum amount of force to subdue said patient placing him under arrest for disorderly conduct at 1643 (4:43 PM), criminal summons # 432258933-9. "

Review of MR for Patient #1 noted: 40 year old un-domiciled male patient, with history of hypertension (HTN) and unknown psychiatric history, went to the facility's Adult Medical Emergency Department (AED) by EMS on 9/10/16 at 11:54 AM, with complaint of chest pain. The patient left the AED and went to the CPEP (Comprehensive Psychiatric Emergency Program) on 9/10/16 at 1414 (2:14 PM) but he was transferred from the CPEP back to the AED for medical clearance.

The patient arrived in the AED and he was triaged on 9/10/16 1704 (5:04 PM). The nurse noted that the patient was agitated, aggressive, fighting staff. An order for restraint was dated 9/10/16 at 1736 (5:36 PM), "type: soft extremity 4 points (wrist/ankle). Indication: agitation putting patient at risk for dislodging medical interventions or causing harm to themselves; patient's response combative."
On 9/10/16 at 1747 (5: 47 PM) , the nurse noted "patient placed in trauma room 1 for take down after patient got into physical fight with staff from CPEP at triage area and several hospital police officers had to hand-cuff him." The nurse noted " 5 mg of Haldol (antipsychotic drug) and 4 mg of Ativan (management of anxiety) administered by MD order and 2 points restraints to each arms and one point to each wrists ."
On 9/10/16 1813 (6:18) PM, the nurse noted that the patient's left hand had been handcuffed with metal handcuffs by hospital police at 6 PM.
On 9/10/16 at 2022 ( 8:22 PM), the nurse noted "received patient on restraints both lower extremity and on right hand, handcuffed is on the left hand."

Staff A was interviewed on 11/8/16 at 12:05 PM. This staff stated that officers do handcuff patients. Staff stated if hospital police arrest a patient or if the patient attempted to elope, these are examples when patients may be handcuffed. This staff also stated that a patient given a ticket for disorderly conduct is not under arrest and is not under hospital police custody.

The facility policy and procedure titled "Seclusion and Restraint Behavioral Health, " last revised 2/16 stated: The use of lockable restraints (hand cuffs, ankle to restraints) is prohibited.

Based on medical record (MR) review, document review, and interview, in 2 (two ) of 3 (three) medical records reviewed, the facility did not ensure that patients are restrained in accordance with the order of a physician or other licensed independent practitioner. (Patient #2 & #3).


Findings include:
Review of the medical record for Patient #2 noted: 32 year old arrived at the facility's emergency department (ED) by EMS and NYPD with right arm hand cuff on 9/12/16 at 1311 (1:11 PM). The patient had a medical evaluation on 9/12/16 at 1350 (1:50 PM). The MD noted that the patient continued to be aggressive in the trauma bay and required medication and patient was placed in restraints. The orders for restraints was noted on 9/12/16 1338 (1:38 PM) for the emergency management of unanticipated outbursts of aggressive, destructive or violent behavior that poses an imminent danger to the patient or others. Type of restraints, 4 points (wrists/ankles); monitor patient every 15 mins.
There was no documentation in the medical record that the order to monitor patient every 15 mins. was implemented.


Review of New York City Health and Hospitals Corporation: Hospital Police Crime and Incident Report, dated 10/21/2016 2247 (10:47 PM) noted an incident for Patient #3. The officer wrote: Patient #3 "was subdued with necessary minimal force assisted by staff and EMS. Patient was then placed in 4pt restraint and medicated as per MD"

Review of MR for Patient #3 noted: this 22 year old patient with psychiatric problems was transported to the facility's ED by ambulance on 10/21/16 as EDP ( emotional disturbed person). The nurse noted that the patient was on 1:1 hold. The MD noted that patient arrived to ED, tried to elope and hospital police responded. Patient was placed in trauma bay 2 where he needed to be restrained and medicated for psychotic behavior, 1:1 sitter at bedside.
The order for restraint and 1:1 monitoring was not documented in the medical record.

The findings were discussed during interview with Staff D, Nursing Director on 11/8/16 at approximately 1:15 PM.

Based on medical record (MR) review, document review and interview, in 2 (two ) of 3 (three) medical records reviewed, the facility did not ensure that patients who are restrained are monitored in accordance with the order of a physician or other licensed independent practitioner. (Patient #2 & #3).


Findings include:
Review of the medical record for Patient #2 noted: 32 year old arrived at the facility's emergency department (ED) on 9/12/16 at 1311 (1:11 PM) and was evaluated by the physician on 9/12/16 at 1350 (1:50 PM). The MD noted that the patient continued to be aggressive and an order for restraints was noted on 9/12/16 1338 (1:38 PM) for the emergency management of unanticipated outbursts of aggressive, destructive or violent behavior that poses an imminent danger to the patient or others. Type of restraints, 4 points (wrists/ankles); monitor patient every 15 mins.
There was no documentation in the medical record that the order to monitor patient every 15 mins. was implemented.


Review of MR for Patient #3 noted: this 22 year old patient with psychiatric problems was transported to the facility's ED by ambulance on 10/21/16 as EDP (emotional disturbed person). The nurse noted that the patient was on 1:1 hold. The MD noted that patient arrived to ED, tried to elope and hospital police responded. Patient was placed in trauma bay 2 where he needed to be restrained and medicated for psychotic behavior, 1:1 sitter at bedside.

The order for restraint and 1:1 monitoring was not documented in the medical record.


The findings were discussed during interview with Staff D, Nursing Director on 11/8/16 at approximately 1:15 PM.

Based on observation, interview and document review, it was determined that the facility failed to ensure that hospital police staff who assist in take downs, application and monitoring of patients in restraints, are trained in the use of first aid techniques and cardiopulmonary resuscitation.

Findings include:

The personnel files for Hospital Police Staff G and Staff H, lacked evidence of training in the use of first aid and cardiopulmonary resuscitation.


During interview on 11/8/16 at 12:37 PM, Staff B stated that hospital police assist clinical staff with restraints but they do not restraint patients. Staff B admitted that hospital police officers manually hold patients down while clinical staff apply the restraint.

During interview of Staff E on 11/9/16, it was acknowledged that there is a lack of mandatory first aid training and certification in cardiopulmonary resuscitation for Staff G and Staff H. At interview, an additional four (4) Hospital Police officers were identified as not being trained in CPR (Staff I, Staff J, Staff K and Staff L).