HospitalInspections.org

Based on policy review, document review, medical record review and interview, the facility failed to ensure a patient's representative was involved in all aspects of developing the plan of care, including the discharge plan for 1 of 3 (Patient #3) sampled patients.

The findings included:

1. Review of the facility's "Health Care Decision-Makers" policy (revised 3/8/22) revealed, "...1. if the patient has specified a health care agent to act on his or her behalf through an advance directive, other power of attorney document or proxy directive, or has a court appointed guardian or conservator with the authority to make Health Care Decisions, then that person will serve as the patient's HCDM [Health Care Decision Maker]..."

2. Review of a court order document dated 6/20/19 revealed, "...1. [Patient #3] has been determined by the Court to lack the mental capacity to contract or manage his own affairs...2. That the Court on February 8, 2016 entered an amended order naming the ward's mother, [name of mother] as the conservator of [Patient #3] and removed legal rights from [Patient #3]...3. The court has attached to this order a Supplemental Order removing powers or rights from [Patient #3]...4. [Patient #3] does not have the right to decide where he wants to live, what medical treatment he should have...It is therefore ORDERED, ADJUDGED AND DECREED 1. That the conservatorship for [Patient #3] shall remain in full force and effect with [name of mother] appointed as her son's conservator...4. That [Patient #3] has no right to refuse health care, placement or any of the other rights and powers taken from him as a result of the Court's order that he could not care for himself..."

3. Medical record review revealed Patient #3 was admitted to the facility on 11/20/22 with diagnoses that included Foreign Body Ingestion, Bipolar Disorder with psychotic features, Anxiety, History of traumatic brain injury.

Review of a 12/14/22 Case Management (CM) note revealed, "Patient discharge disposition remains-6404 to be rescinded should patient remain free of restraints and foreign body ingestion within 24-48 hour time frame. Pt [patient] behaviors have remained stable-6404 rescinded per MD [medical doctor]. Noted psych recommendations for removal of 6404 as well. Pt medically cleared, 6404 rescinded, DC [discharge] orders have been entered...CM spoke with multiple parties to coordinate DC. CM spoke with mother at length...CM explained to mother that patient is medically cleared and stable for DC. .Pt mother acknowledges, has reluctantly agreed to pick patient up after work...RN/Patient [registered nurse] notified. Transport scheduled with mother for 1500 [3:00 PM]...Patient refusing to await mothers arrival. CM referred to CM manager to review dischrge [discharge] disposition with patient. Per CM manager, transport arranged, patient discharged...."

The facility failed to communicate the change in discharge plans with Patient #3's conservator. Patient #3 did not have the right or power to make the decision to leave the facility by himself.

In an interview on 12/20/22 at 8:18 AM, Patient #3's mother verified she was her son's conservator. Patient #3's mother verified the facility let Patient #3 leave the hospital without notifying her first. Patient #3's mother verified as conservator she should have been notified of Patient #3 wanting to leave, and should have been the one to make the decision if the patient was safe to be discharged from the hospital by himself.

In an interview on 12/21/22 at 1:38 PM, the manager of Case Management was asked about the discharge disposition of Patient #3. The manager stated Patient #3 was no longer a "hold", was alert and oriented and wanted to leave. The patient wanted to get out of the building and smoke and did not want to wait for his mother. The manager stated they deemed Patient #3 to have capacity since he was no longer a 6404 hold. The manager verified transportation was called and the patient left the facility on 12/14/22 by himself. The manager verified she did not know Patient #3's mother was his conservator, and did not know he could not make medical decisions and placement decisions for himself.