HospitalInspections.org

Based on interview and record review, the facility failed to ensure protection of the rights of two (2) of five sampled discharged ER patients.

Two(2) sampled patients ( Patient # 6, # 8 ) were informed by nursing staff they had "holds" and could not leave the unit or hospital.

Findings include:

TX # 00200957

Patient # 6

Review of complaint intake # TX 00200957 read: " ... a Physician Assistant (PA) said 'you can walk right out the door.' I said OK and proceeded to do so. A nurse called security and told me to stop. I asked why, she responded: 'You know you have a hold on you can't leave.' ..." Using threat of force to keep someone in an area is...illegal..."

Review of Patient # 6's clinical record revealed he was 36 years old and voluntarily admitted to the Emergency Room (ER) on 06-21-14 at 5:48 p.m.with diagnosis of attempted suicide. On 06-21-14 at 8:28 p.m.. Registered Nurse # 13 documented : " pt. highly agitated and attempting to elope. Pt aggressively came out of room and stated 'I'm leaving and you can't stop me. I'm leaving.' Pt. grabbed his bag from counter and was attempting to throw this bag at staff. Code Grey was called to room. Pt screaming and acting violently. Pt redirected to his room and was told that he is in a hold and cannot leave due to hold."

Patient # 8

Review of the clinical record of Patient # 8 revealed he was a 45 year old male admitted to the ER on 06-21-14 at 2:40 p.m. with diagnosis of suicidal ideation. On 06-22-14 at 8:04 p.m.. Registered Nurse # 13 documented : " pt. up and about in unit...pt informed that he is on hold and that he is prohibited from leaving the unit at this time..."

Interview on 09-12-14 at 3:10 p.m. with Behavioral Health Director ID # 5 she stated in the ER there was no such thing as a "HOLD." A patient could be under an "Emergency Detention Warrant" or under the custody of law enforcement and be legally held. Other that these circumstances in the ER, patients have a right to leave at any time. If leaving against medical advice (AMA) the patient would be informed of the treatment recommended and risks of refusal. The patient would be asked to sign the AMA form prior to leaving the ER.

On 09-12-14 at approximately 2:15 p.m., four (4) Registered Nurses (RN) in the ER were interviewed. All four (4) RNs appropriately described the process for admission of a patient who had attempted suicide or had suicidal ideation. All four (4) correctly verbalized patient safety factors including environmental and appropriate observation / monitoring levels.

Continued interviews with the RNs in the ER revealed inconsistencies in their understanding of patient rights related to "holding." The RNs stated the following:

RN # 8: "...I believe we can legally keep a patient here for 24 hours; I am not sure.."

RN # 9: "...We have a legal responsibility for patient safety.... If a patient tried to leave and we feel it is unsafe, we would call Security and inform the doctor. The doctor would then decide if it was OK to let them go or force them to stay.."

RN # 11: "... If a patient wanted to leave and we felt it was unsafe for them...we would tell them 'you can't leave' and call security...but we don't hold them..."

Interview on 09-12-14 at 3:45 p.m. with ER Director # 12, she acknowledged there were opportunities for clarifying ER nursing staff understanding of patient rights with respect to leaving the ER or being placed on a "hold."

Record review of facility policy titled "Patient Rights and Responsibilities," revised date 6/13, read: "...D Right of the patient ...to make informed heath care treatment decision...4. Request or refuse treatment to the extent permitted by law and to be informed of the medical consequences of such refusal. Patients are given information regarding their right to accept/refuse treatment, and the right to informed consent, upon admission..."