HospitalInspections.org

A0115

This CONDITION is not met as evidenced by:

Based on medical record review, document review, policy review, and interview, the facility failed to protect and promote the rights of all patients related to the use of restraints as evidence by: facility security officers used handcuffs to restrain Patient #1 and Patient #2 (A0154).

On 12/05/23 at 01:08 PM, an Immediate Jeopardy situation was identified for the CoP of Patient Rights. The facility implemented immediate interventions that included: the removal of handcuffs from all security officers and clinical staff; and re-education on the restraint/seclusion policy; and re-education on state/federal regulations related to restraint and seclusion, patient rights, and use of least restrictive methods. Auditing will be conducted daily for a period of one week to ensure staff compliance to policy and regulations by the quality assurance department. At 05:30 PM, the Immediate Jeopardy was removed based on onsite surveyor verification of the immediate actions implemented by the facility through observations, policy review, document review, and interviews.

Cross Reference:

482.13(e)- Patient Rights All patients have the right to be free from physical or mental abuse, and corporal punishment. All patients have the right to be free from restraint or seclusion, of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff.

Based on document review, policy review, medical record review, video review, and interview, the facility does not ensure that all patients have the right to be free from physical or mental abuse, corporal punishment, and restraint imposed as a means of coercion, discipline, convenience, or retaliation by staff as evidenced by: facility security officers utilized locking, metal handcuffs to subdue and restraint Patient #1 on 06/10/23 & 11/19/23 and Patient #2 on 06/21/23. Handcuffs are considered a law enforcement restraint device and not considered a safe, appropriate healthcare restraint intervention for use by hospital staff, including security officers. The use of handcuffs in the healthcare setting could result in a negative outcome to patients.

Findings include:

Review of the "New York State Department of Health Dear Chief Executive Officer Letter 17-13-Security Guards and Restraints," dated 11/02/17 indicated that hospitals must ensure that security staff are specifically authorized to use restraints and are not utilizing law enforcement devices such as handcuffs, chains, manacles, leg irons, etc. to restrain patients.

Review of policy "Restraint and Seclusion," last reviewed 06/13/23 indicated that that a restraint is any manual method, physical hold or mechanical device, material, or equipment that immobilizes or reduces the ability of a patient to move his or her arms, legs, body, or head freely or a drug or medication when it is used as a restriction to manage the patient's behavior or restrict the patient's freedom of movement and is not a standard treatment or dosage for the patient's condition. A mechanical physical restraint does not include devices such as handcuffs or other restrictive devices applied by law enforcement.

Review of policy "Patient in Custody of Law Enforcement (Forensic Patients)," dated 07/27/23 indicated that custodial restraints such as handcuffs, shackles, etc. will only be utilized when a forensic officer (law enforcement) is present and in direct observation of the patient.

Review of facility security officer and nursing staff training/education related to restraints and seclusion does not include guidance on the use of handcuffs.

Review of medical record for Patient #1 revealed on 06/11/23 at 12:13 AM, the nurse documented that on 06/10/23 at 08:00 PM, Patient #1 became agitated, started yelling, throwing furniture, and attempting to barricade the doorway. Security came to the unit. The provider was contacted and ordered Ativan two milligrams and Benadryl 50 milligrams via intramuscular injection. Patient #1 was offered medications but stated "if you come in here with a needle, I'm gonna stab you in the neck." At 09:03 PM, security officers entered the room. Patient #1 became violent and attempted to grab a security officers pepper spray. At 09:04 PM, security officers handcuffed Patient #1. At 09:05 PM, intramuscular injections were administered. At 09:19 PM, Patient #1 was walked to the seclusion room by security officers. At 09:21 PM, Patient #1 was placed in the seclusion room and handcuffs were removed.

Review of the security officer report dated 06/10/23 at 08:00 PM indicated that Staff (M), Security Officer, Staff (AA), Security Officer, and Staff (FF), Security Officer reported to the adult inpatient Behavioral Health unit due to Patient #1 barricading self in their room, making several threats of physical violence towards staff, and throwing a cup of water into an electrical outlet. At 09:03 PM, Staff (M), Staff (AA), and Staff (FF) entered the room to restrain Patient #1. Staff (M), Staff (AA), and Staff (FF) went "hands on" (manual restraint) in an attempt to bring Patient #1 to the ground. All three security officers and Patient #1 fell onto the chairs that were barricading the door. As a result, Patient #1 was able to unlatch Staff (FF)'s pepper spray and attempted to pull it out. Staff (AA) and Staff (FF) were able to get Patient #1's hand away from the spray. At 09:04 PM, Staff (M) placed Patient #1 in handcuffs. Patient #1 was escorted to the seclusion room. At 09:21 PM, Staff (M) released the handcuffs.

Review of the emergency department medical record for Patient #1 revealed on 11/19/23 at 02:55 PM, Staff (G), Emergency Department Registered Nurse documented that while security officers were removing items from Patient #1's room, Patient #1 ran from the room. Patient #1 became combative when escorted back to the room by security officers. Security officers started to do a three person restraint. Patient #1 began to punch the security officers. Security officers placed Patient #1 in handcuffs. At 03:15 PM, Staff (G), documented that the handcuffs were removed.

Review of the security video for emergency department room #128 dated 11/19/23 at 02:53 PM revealed Staff (II), Security Officer, attempted to gain control of Patient #1's legs. Staff (L), Security Officer and Staff (M), Security Officer attempted to regain control of Patient #1's arms. Staff (M) removed handcuffs from their waist and applied the handcuffs on Patient #1's right wrist. Patient #1 was rolled over on their stomach while Staff (M) applied the handcuffs to Patient #1's left wrist. Patient #1 was sat up. Staff (L) and Staff (M) stood up while Staff (II) held Patient #1's wrists. Staff (M) exited the room and stood in the doorway. Staff (II) let go of Patient #1's wrists, stood up, and exited the room. Patient #1 stood up with their arms behind their back, handcuffs clearly visible. At 03:13 PM, the two female Jamestown police officers entered the room with a male staff member and removed the handcuffs. (Review of the video did not show that Patient #1 was swinging at security staff and/or hit and choked Staff (M). However, during the video, there is approximately 30 seconds that Staff (L), and Staff (II) obstruct visualization of Patient #1 and Staff (M) on the ground, prior to Staff (M) applying the handcuffs to Patient #1).

Review of the security officer reports dated 11/19/23 at 01:48 PM indicated that Staff (L), Security Officer, was called to the emergency department by Staff (K), Patient Care Technician to assist with Patient #1. At 01:53 PM, security officers attempted to do a three person manual restraint. Patient #1 attempted to choke and punched Staff (M) in the face. At 02:59 PM, Patient #1 was handcuffed (by security officers). Security officers cleared the room and closed the door per direction of Staff (G), Registered Nurse. Patient #1 remained in their room until Jamestown Police arrived at 03:02 PM. At 03:05 PM intramuscular medications were administered. Security staff were directed to remove the handcuffs from Patient #1 by Staff (VVV) and Staff (WWW), both Emergency Department Registered Nurses. Security staff were directed by Jamestown police to keep the handcuffs on for safety. Staff (L), Security Officer, called Staff (S), Security Manager, to informed them of the situation and was directed to remove the handcuffs. At 03:12 PM, intramuscular medications were administered to Patient #1. At 03:15 PM, the handcuffs were removed, and all staff cleared the room.

Interview on 12/04/23 at 11:20AM with Staff (E), Emergency Department Registered Nurse and the charge nurse on 11/19/23, was made aware by Staff (H), Registered Nurse that Patient #1 was in handcuffs. Staff (E) instructed the security officers to remove the handcuffs, but security refused citing Patient #1 was too violent and that Jamestown police instructed security officers to keep the handcuffs on Patient #1 until they (Jamestown police) arrive. Staff (E) texted Staff (F), Registered Nurse, to ask what to do. Staff (F) responded that the handcuffs must be removed. Security officers were instructed again to remove the handcuffs, which they refused. Jamestown police arrived, Patient #1 was given medications, and the handcuffs were removed.

Interview on 12/04/23 at 11:28AM with Staff (I), Emergency Department Patient Care Technician stated that Patient #1 was agitated and violent in the hallway trying to leave. Patient #1 was placed on the floor by security office after acting violently and swinging at staff. Patient #1 struck one of the security officers which prompted security to handcuff Patient #1. Security officers called the Jamestown police. One of the guards removed the handcuffs after medication was administered.

Interview on 12/04/23 at 11:55AM with Staff (L), Security Officer, revealed on 11/19/23, Staff (L), Security Officer, Staff (M), Security Officer and Staff (II), Security Officer responded to the emergency department to assist with Patient #1 who was making threats towards staff and threatening to leave. Staff (L), Security Officer, and the other security officers attempted a three-point restraint. Patient #1 was struggling, making it difficult to be restrained. At some point, Patient #1 punched and choked Staff (M), Security Officer, resulting in Staff (M), Security Officer, placing Patient #1 in handcuffs. Staff (L), Security Officer, did not witness Patient #1 punching or choking Staff (M), Security Officer. Once Patient #1 was placed in handcuffs, all three security staff exited the room and locked the door. The Jamestown police were contacted, by security staff and instructed the security officers to keep Patient #1 in handcuffs until their arrival. Patient #1 was in handcuffs for about 10 to15 minutes until Jamestown police arrived and Staff (G), Registered Nurse, administered medications.

Interview on 12/04/23 at 01:03 PM with Staff (G), Emergency Department Registered Nurse, who stated that on 11/19/23, security officers were attempting to restrain Patient #1 when Patient #1 apparently punched one of the security staff. Patient #1 was placed in handcuffs. Two Jamestown police officers arrived, and Patient #1 was given intramuscular medications. After the medications were administered, the handcuffs were removed. Staff (G) stated security staff call Jamestown police.

Telephone interview on 12/05/23 at 10:05 AM with Staff (M), Security Officer, revealed they were called to the emergency department due to Patient #1 "acting up." Staff (M) and two other security officers attempted to talk to Patient #1, who was agitated and attempting to leave the unit. Patient #1 continued to escalate and tried to abscond. Patient #1 began to fight. Security officers decided to place Patient #1 in a physical restraint. Staff (M) stated that Patient #1 kicked, punched, and attempted to choke Staff (M). Due to Patient #1's size and the danger to staff, Staff (M), placed Patient #1 in handcuffs. Jamestown Police were called for assistance while the other guards called their supervisor. Jamestown Police arrived and assisted with medicating Patient #1. Once Patient #1 was medicated, the handcuffs were removed.

Interview on 12/05/23 at 03:05 PM with Staff (II), Security Officer, revealed that security officers responded to the emergency department because Patient #1's behavior was escalating. Security officers were directed by Staff (G), Registered Nurse, to return Patient #1 to their room. Patient #1 became combative while security staff attempted to direct them back into their room. Patient #1 was placed in physical restraint and taken to the floor. During the physical restraint, Staff (M), Security Officer, stated to Staff (II) and Staff (L) that Patient #1 had punched and attempted to choke Staff (M). Staff (II) stated that they did not witness Patient #1 punching or choking Staff (M). Staff (M) placed Patient #1 in handcuffs. The security officers left the room and locked the door. Jamestown police were called. Clinical staff, Jamestown Police, and security officers entered the room twice to medicate Patient #1. The handcuffs were removed after the second medication administration.

Review of the emergency department medical record for Patient #2 revealed on 06/21/22 at 09:55 PM, Patient #2 was brought in via ambulance for an examination of an intoxicated, impaired, or incapacitated person by alcohol and/or substances requested by the Jamestown police due to the possibility of Patient #2 being unable to care for self and placing self in dangerous situations. Patient #2 was under the influence of a narcotic/drug and had cut and burned themself and as a result. Patient #2 was unable to function without the assistance of police. At 10:06 PM Patient #2 ran out of the emergency department. Security officers attempted to stop Patient #2. Patient #2 punched a security officer in the head. Patient #2 was placed in handcuffs, put on a gurney, and brought back into the emergency department. The burn to left arm was first degree and no treatment was needed. The emergency department providers physical assessment of Patient #2 revealed Patient #2 was alert and oriented with normal heart rate and rhythm. Jamestown police were called due to Patient #2 physically assaulting staff. Patient #2 was stable and was discharged to the police.

Review on 12/06/23 of the security report dated 06/22/23 revealed on 06/21/23 at 09:54 PM, Staff (GG), Security Officer, was called to assist with an absconding patient (Patient #2). Patient #2 had been brought in approximately 15 minutes before by Jamestown police via ambulance for a mental health examination and was not allowed to leave. Patient #2 began to struggle with Staff (GG), grabbed Staff (GG)'s shirt, and punched Staff (GG) multiple times in the face. This caused abrasions and light bleeding under Staff (GG)'s left eye. Patient #2 punched Staff (GG) four more times and ripped their shirt. Staff (GG) assisted Patient #2 to the ground. At 10:00 PM, Staff (GG) handcuffed Patient #2. Other security officers responded, and Patient #2 was placed on to a stretcher (handcuffed). At 10:06 PM, Jamestown police were called. Staff (GG) filed a report and pressed charges. Jamestown police arrested and left with Patient #2.

Interview on 12/06/23 at 10:26 AM with Staff (B), Vice President of Patient Care/Chief Nursing Officer, and Staff (C), Clinical Director Nursing/Quality, confirmed these findings.