HospitalInspections.org

Based on record review and staff interviews, it was determined the facility failed to follow its' own policies on reporting suspected abuse of a vulnerable adult patient who presented to the emergency room, for one patient (#1) in the selected sample of four. Findings include:

Review of Patient #1's medical record revealed he/she presented to the emergency department (ED) by ambulance from a nursing facility on 08/13/10 at approximately 11:00 PM. The chief complaint was listed as a fever and decreased responsiveness. A urinalysis performed in the ED revealed the sexually transmitted disease organism, trichomonas. The patient was admitted to the hospital with the diagnoses of abdominal wall cellulitis, gastric tube malfunction and urinary tract infection. The physician's history and physical examination dictated on 08/14/10 at 6:26 AM, noted the patient probably was the victim of elderly abuse related to the findings the patient had a bruise on the right side of the face and a sexually transmitted disease. A social services consult was ordered by the physician on 08/14/10 at 5:03 AM. On 08/15/10 at 10:45 AM a similar order documented "Social services evaluate for elder abuse". Review of social services progress notes revealed the state agency responsible for investigating elderly abuse was not informed of Patient #1's condition until 08/16/10.

A review of the hospital policies regarding suspected adult abuse revealed all known or suspected cases of adult abuse was to reported immediately to law enforcement and state social services agencies in accordance with State law at KRS 209. A report was also to be made to the house administrator or administrator on-call.

An interview with the executive vice president on 12/01/10 at 11:45 AM revealed the nurse, who noted the order on 08/14/10 for a social services consult, entered the order into the hospital computer system. The order was supposed to be automatically printed in the social services department. However, 08/14/10 was a Saturday and the social services department was not normally staffed on the weekends. The order was repeated on Sunday, 08/15/10, but this time the social worker was also contacted by telephone.

An interview conducted with the hospital social worker on 11/30/10 at 10:42 AM, revealed she was contacted on the morning of 08/15/10 by the unit secretary and informed the physician had concerns about possible sexual abuse of Patient #1. The nursing facility, where Patient #1 had been residing, was located in a different county. The sheriff's department for that county was contacted and the local social services on-call number was obtained. The social worker stated she called this number several times on 08/15/10 but was unable to contact the state worker until the morning of 08/16/10. The social worker stated she did not attempt to contact and inform law enforcement officials of the suspected abuse on 08/15/10. It could not be determined from interviews with the social worker, the executive vice president or review of the medical record that the on-call administrator was informed in accordance with hospital policies of the suspected abuse of Patient #1.