HospitalInspections.org

Based on record review and interviews, the hospital failed (for one of ten patients sampled, Patient #1) to protect and promote the patient's rights.

See tag 0131.

Based on record review and interviews, the hospital failed to inform Patient #1's representative (guardian) of Patient #1's rights, including being informed of Patient #1's health status, being involved in care planning and treatment of Patient #1, and being able to request or refuse treatment of Patient #1. The hospital never contacted the guardian when Patient #1 was admitted to the hospital. The hospital never contacted the guardian during Patient #1's stay at the hospital. The hospital never contacted the guardian when Patient #1 died at the hospital. Also, the hospital failed to appropriately document the invocation/activation of the health care proxy (HCP) for Patient #2 and Patient #3 in accordance with the hospital's "Advance Directives and Palliative Care: Health Care Proxy, MOLST," policy.

Findings include:

The policy titled "Informed Consent," last reviewed 04/2021, states under section 5B2, "When a patient lacks the capacity to consent whether due to unconsciousness, disorientation, hallucinations, senility, or any other reason, and whether or not this is a temporary situation, consent to treatment of that patient must be secured from another responsible individual. The following individuals may consent on behalf of the patient in the following order: a. Healthcare proxy, b. Court appointed guardian, c. Spouse..."

Medical record review was conducted by the surveyor and the Quality Improvement Coordinator (QIC) on 05/31/2023 at 11:34 A.M. The medical record of Patient #1 indicated that the hospital had on file a document called "Letters of Guardianship for an Incapacitated Person." This document identified Patient #1 as an incapacitated person. Additionally, this document identified a permanent guardian.

The surveyor interviewed the Chief Quality Officer (CQO) on 06/01/2023 at 10:45 A.M. The CQO said that the guardian was not contacted during Patient #1's hospital stay nor was the guardian notified of Patient #1's death at the hospital.

The surveyor interviewed the CQO on 05/31/2023 at 1:10 P.M. The CQO stated that after the CQO consulted with the hospital attorney, the hospital attorney told the CQO that if a guardian is on file with a given patient, and the patient dies in the hospital, the guardian is still required to be notified.

Medical record review was conducted by the surveyor and the QIC on 05/31/2023 at 11:34 A.M. Patient #1's medical record indicated that Patient #1 signed a "Consent for Injection of Intravenous Contrast" document (a consent form that informs the patient of the use of a contrast dye, typically used during an imaging procedure) despite the hospital having the aforementioned "Letters of Guardianship for an Incapacitated Person" on file, indicating that Patient #1 was an incapacitated person with an assigned permanent guardian.

Medical record review was conducted by the surveyor and the QIC on 05/31/2023 at 11:34 A.M. The surveyor had identified that Patient #2 and Patient #3 no longer had the capacity to make their own medical decisions, during their respective hospital admissions.

The policy titled "Advance Directives and Palliative Care: Health Care Proxy, MOLST," last reviewed 01/2023, states under section 6J, "As stated by Massachusetts General Law Section 201D, "The authority of a health care agent shall begin after a determination is made, pursuant to the provisions of this section, that the principal lacks the capacity to make or to communicate health care decisions. Such determination shall be made by the attending physician according to accepted standards of medical judgment. The determination shall be in writing and shall contain the attending physician's opinion regarding the cause and nature of the principal's incapacity as well as its extent and probable duration. This written determination shall be entered into the principal's permanent medical record." (2018)."

The policy titled "Advance Directives and Palliative Care: Health Care Proxy, MOLST," last reviewed 01/2023, states under section 6K, "The attending physician may complete the "Health Care Proxy Invoking Form" and place on patient's medical chart, or document the invocation in the patient's medical record."

The surveyor interviewed the QIC on 06/01/2023 at 1:50 P.M. The QIC stated that after review of the medical record for Patient #2 and Patient #3, the QIC could not find definitive phrasing (evidence) in the medical record that the HCP for Patient #2 and Patient #3 had indeed been activated/invocated by an attending physician during the respective hospital admissions for Patient #2 and Patient #3.