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Based on policy review, video review, medical record review, document review, and interview, in 1 of 20 medical records reviewed, it was determined the hospital failed to keep Patient #2 free from abuse.

Reference:
482.13(c)(3) - The patient has the right to be free from all forms of abuse or harassment.

Based on policy review, video review, medical record review, document review, and interview, in 1 of 20 medical records reviewed, it was determined the hospital failed to keep Patient #2 free from abuse.

Findings include:

Review of the policy "Triage of Psychiatric Patients from the Emergency Department to the CPEP/Comprehensive Psychiatric Emergency Program," last reviewed 05/2022, revealed patients will be medically evaluated in the medical emergency department. After the medical evaluation and treatment, the medical emergency department will determine the proper disposition of the patient. The medical emergency department triage nurse will contact the charge nurse in the CPEP for report. The patient will be accompanied to the CPEP by either emergency department staff or the CPEP staff. Crisis services, law enforcement, and ambulance personnel may also accompany the patient as needed.

Review of the policy "2023 Code of Conduct," revealed inappropriate conduct may include sub-quality care, patient abuse, harassment, fraud and abuse and other illegal activities problems and issues, especially those that have compliance implications. All patients have the right to be free from restraints and seclusion of any kind that is not medically necessary or is used as a means of coercion, discipline, convenience, or retaliation by staff. Ensure that patients shall be free from abuse or neglect. All employees have a duty to report any instances or suspected instances of such behavior.

Review the policy "Use of Force," last reviewed 02/2024, revealed hospital public safety officers use only the force necessary to effectively bring an incident under control while protecting the lives of the officer and others. The use of force must be objectively reasonable based upon the totality of the circumstances. The officer must only use that force they reasonably believe to be necessary to effectively bring an incident under control or take a person into custody. The use of weapons by hospita1public safety officers as a means of subduing a patient to place that individual in restraint or seclusion is not authorized. Hospital public safety officers shall utilize the following tools: officer presence; verbal commands; control tactics (places hands on the suspect and advises him/her that they are in violation of hospital policy and/or New York State laws and subject to possible arrest); manual compliance (employ pressure point control or mechanical compliance including wrist locks, arm bar or other 'come along' techniques). Prohibited uses of force shall not be used for the following reasons: against persons who are handcuffed or restrained unless it is used to prevent injury, escape, or otherwise overcome active or passive resistance posed by the subject.

Review on 10/28/24 of the medical record for Patient #2 revealed on 09/11/24 at 09:25 PM revealed Patient #2 was taken into police custody due to making multiple threats to kill their mother, burn the house down, and kill themselves. At 09:31 PM, Patient #2 arrived at the emergency department for a mental health evaluation with police in handcuffs and wearing a spit hood. At 09:46 PM, Patient #2 was triaged, refusing to answer questions. At 09:46 PM, a medical screening examination was documented indicating Patient #2 was agitated on exam requiring four-point restraints and a spit hood. Patient #2 was medically stable for transfer to the CPEP. At 09:48 PM, Patient #2 was transferred to the CPEP and arrived at 09:56 PM.

Review on 10/29/24 of the surveillance video "ED-Back of Trauma Toward Ambulant ENT," revealed video footage, dated 09/11/24, of the emergency department near the trauma room located on the ground floor revealed the following:
-At 00:02, Patient #2 was sitting in a chair with a spit hood on and in handcuffs. There were multiple police officers and hospital public safety officers standing around Patient #2. Patient #2 attempted to kick Staff (M), Hospital Public Safety Officer.
-At 00:04, Staff (M), Hospital Public Safety Officer placed their right knee on top of Patient #2's legs.
-At 00:20, Patient #2 was attempting to kick Staff (M), Hospital Public Safety Officer who placed their right knee and left hand on top of Patient #2's legs.
-At 00:22, Staff (M), Hospital Public Safety Officer, released their right knee and left hand from Patient #2's legs.
-At 01:02, Patient #2 was sitting still in the chair. Staff (M), Hospital Public Safety Officer, pushed Patient #2's head into the wall with both hands.

Review on 10/29/24 of the surveillance video "ED-Triage Ambulance Area," revealed an "overhead" view of video footage, dated 09/11/24, of the emergency department triage ambulance area located on the ground floor revealed the following:
-At 00:03, Staff (M), Hospital Public Safety Officer pushed Patient #2 ' s head into the wall with both hands forcefully.
-At 00:06, Patient #2 attempted to kick Staff (M), Hospital Public Safety Officer who placed their right knee on top of Patient #2's legs and their right hand on Patient #2's shoulder.
-At 00:24, Staff (M), Hospital Public Safety Officer released their right knee and right hand off Patient #2's body.
-At 00:58, Patient #2 removed the spit hood and kicked it away.
-At 01:00, a police officer picked up the spit hood.
-At 01:06, Staff (M), Hospital Public Safety Officer pushed Patient #2's head forcefully back into the wall. The police officer reapplied the spit hood.
-At 01:25, Staff (T), Registered Nurse was standing in front of Patient #2 and began talking to them. A police officer had their right hand on the back of Patient #2's neck, holding it.

Review on 10/29/24 of the surveillance video "ED-Triage E-F EMS Overflow," revealed video footage, dated 09/11/24, of the emergency department triage/emergency medical staff overflow area located on the ground floor revealed the following:
-At 02:01, Patient #2 was visualized "flying" backwards into a chair in exam room E. An unidentified hospital public safety officer is seen on top of Patient #2.
-From 02:03 to 02:10, an unidentified hospital public safety officer and Staff (M), Hospital Public Safety Officer were on top of Patient #2 while Patient #2 was thrashing in exam room E.
-At 02:32, Staff (M), Hospital Public Safety Officer was still on top of Patient #2 in the chair in exam room E.
-At 03:33, Staff (M), Hospital Public Safety Officer, two unidentified hospital public safety officers, and Staff (NN), Registered Nurse attempted to place Patient #2 on the gurney.
-At 03:35, Staff (M), Hospital Public Safety Officer, two unidentified hospital public safety officers, one police officer, and Staff (NN), Registered Nurse continued to try to secure Patient #2 on the gurney. Patient #2 was thrashing and sitting up.
-At 03:36, Staff (M), Hospital Public Safety Officer, pushed Patient #2's upper body and head down onto the stretcher with force and then held the left shoulder down with their left hand. Two police officers and two unidentified hospital public safety officers were holding down Patient #2's limbs (to apply restraints).
-At 03:39, Staff (M), Hospital Public Safety Officer was holding Patient #2's head down into the gurney with both hands. Staff (M), Hospital Public Safety Officer had their right hand on Patient #2's head and their left hand on top of Patient #2's right hand.
-At 03:45, Staff (RR), Patient Care Technician and Staff (LL), Patient Care Technician attempted to place both ankle restraints on Patient #2 while they were on the gurney. Staff (M), Hospital Public Safety Officer was holding Patient #2's head down into the gurney with both hands.
-At 04:20, Staff (OO), Physician Assistant, was at the side of the gurney. Staff (M), Hospital Public Safety Officer was holding Patient #2's head down into the gurney with both hands.
-At 04:39, Staff (M), Hospital Public Safety Officer, released Patient #2's head.
-At 08:48, Staff (M), Hospital Public Safety Officer handed the handcuffs to a police officer.
-At 10:34, all the four-point restraints were successfully applied. All staff, policy, and hospital public safety officers removed their hands from Patient #2. Patient #2 sat up and started thrashing around on the gurney.
-At 11:17, Staff (LL), Patient Care Technician, pushed the gurney into exam room E. Patient #2 continued to thrash around. Multiple community police officers and hospital public safety officers including Staff (M), Hospital Public Safety Officer entered exam room E.

Review on 10/29/24 of the surveillance video "ED-Toward Employee Entrance," revealed video footage dated 09/11/24 of the emergency department employee entrance revealed the following:
-At 11:37, Patient #2 was seen on a gurney thrashing around with four-point restraints applied and spit hood over their head.
-At 11:41, Patient #2 was thrashing around on the gurney. Staff (O), Hospital Public Safety Officer pushed Patient #2's head into the gurney with both hands. At 11:46 Staff (O), Hospital Public Safety Officer was holding Patient #2 ' s head down into the stretcher with their left hand at Patient #2 ' s jaw line. There were four other unidentified hospital public safety officers around the gurney. Staff (LL), Patient Care Technician and an unidentified hospital public safety officer were looking at Patient #2's left arm restraint.
-At 11:50, Staff (LL), Patient Care Technician and an unidentified hospital public safety officer were still looking at Patient #2's left arm restraint. Patient #2 lifted their arm up off the gurney. At this time there were also three community police officers visualized. Staff (LL) was attempting to readjust Patient #2 ' s left arm restraint until 13:14 and the entire time Staff (O), Hospital Public Safety Officer was holding Patient #2 ' s head down on the gurney with their left hand at Patient #2's left jaw line.
-At 13:17, Staff (LL), Patient Care Technician began pushing the gurney that Patient #2 was laying on. Staff (O), Hospital Public Safety Officer continued to hold Patient #2 ' s head down onto the gurney with their left hand at Patient #2's jaw line.
-At 13:21, Patient #2 and the gurney they were on were out of the video.

Review on 10/29/24 of the surveillance video "ED-OR Patient Transport Elevator," revealed video footage dated 09/11/24 of the emergency department elevators located on the ground floor revealed the following:
-At 11:49, Patient #2 was calm in four-point restraints, with a spit hood applied, waiting for the elevator. An unidentified hospital public safety officer and Staff (LL), Patient Care Technician were looking at the restraint on Patient #2's left arm.
-At 13:25, Staff (O), Hospital Public Safety Officer was holding the left side of Patient #2's head at the jaw area into the gurney. Staff (LL), Patient Care Technician, four police officers and five hospital public safety officers were standing around Patient #2 on the gurney. Patient #2 was calm at this time and the spit hood was on.
-At 13:28, Staff (LL), Patient Care Technician pushed Patient #2 into the elevator on the gurney. Staff (O), Hospital Public Safety Officer was still holding Patient #2's head at the jawline. Patient #2 was calm and still had the spit hood on. Two other hospital public safety officers entered the elevator.

Review on 10/29/24 of the surveillance video "ED-FL1 Patient Elevators, " revealed video footage dated 09/11/24 of the emergency department patient elevators located on the ground revealed the following:
-At 13:48, Staff (LL), Patient Care Technician, Staff (O), Hospital Public Safety Officer, and two unidentified hospital public safety officers start to exit the elevator. Staff (LL), Patient Care Technician pulled the gurney with Patient #2, out of the elevator.
-At 13:50, Patient #2 was on the gurney in four-point restraints with a spit hood on, completely out of the elevator. Staff (O), Hospital Public Safety Officer was holding the left side of Patient #2 ' s head at the jawline. Patient #2 was calm and still had the spit hood on.
-At 13:52 Staff (O), Hospital Public Safety Officer released Patient #2's head and placed their left hand on Patient #2 ' s left shoulder. Patient #2 sat straight up in the gurney in four-point restraints.
-At 13:55, Staff (O), Hospital Public Safety Officer took both of their hands and "slammed" the left side of Patient #2 ' s head into the gurney.
-At 13:57, Staff (O), Hospital Public Safety Officer released their right hand from Patient #2 ' s head and held the left side of their head at the jawline.
-At 14:02, Patient #2 and all staff were no longer seen.

Review on 10/28/24 of the "Department Incident Report," dated 10/07/24, revealed Staff (MM) was reviewing video footage from an unrelated incident and witnessed Staff (M), Hospital Police Safety Officer slam Patient #2 against the wall in emergency medical services triage area in the medical emergency department. Staff (MM) reported this event to Staff (N), Director of Safety and Security. Staff (M), Hospital Police Safety Officer was with Patient #2 who was brought in by police to the emergency department triage area. Staff (M), Hospital Police Safety Officer slammed Patient #2 up against the wall and aggressively pushed Patient #2's head onto the bed using both hands to hold Patient #2 ' s head down with an excessive use of force. Staff (O), Hospital Police Safety Officer slammed Patient #2 down during transport to the CPEP and pushed Patient #2's head down into the bed with both hands while Patient #2 was in four-point restraints. The hospital policies and processes for these events were the use of force policy and the hospital ' s code of conduct. Facts supporting the allegations were video review and witness statements that indicated Staff (M) and Staff (O), both Hospital Police Safety Officers, exercised excessive use of force identified as patient abuse. The recommended action was termination.

Interview on 10/28/24 at 11:30 AM, Staff (K), Assistant Vice President Behavioral Health, revealed they reviewed the video surveillance regarding Patient #2. Staff (K) discussed the video findings with Staff (N), Director of Safety and Security. It was determined that an unnecessary use of force was used on Patient #2 by Staff (M) and Staff (O), Hospital Public Safety Officers.

Interview on 10/29/24 at 11:15 AM, Staff (KK), Patient Care Technician, revealed they were sitting as a 1:1 monitor of another patient when two police officers brought Patient #2 into the emergency department. Patient #2 was verbally aggressive and agitated. Hospital public safety officers were aggressive with Patient #2 by holding all four limbs and holding down Patient #2's head into the gurney with a spit hood in place. Staff (KK) stated there was no reason for Patient #2 to have their head held down if all four limbs were restrained.