HospitalInspections.org

Based on review of hospital policy, grievance file reviews and staff interviews, hospital staff failed to provide a written response of a grievance to a patient or patient representative according to hospital policy for 1 of 5 grievance files reviewed (Pt #15).

The findings include:

Review of the hospital's policy, "Complaints and Grievances - Patients", dated September 2010, revealed "...II. POLICY....C. Complaints/ grievances will be resolved, when possible, within a reasonable timeframe. Patients who have made a grievance are provided with a written notice of the grievance resolution consistent with applicable law ....If the complaint cannot be resolved promptly by staff present, the complaint becomes a 'grievance,' and the process for handling grievances is followed. ..." Further policy review revealed "...Grievances...2. D. Send a grievance response, in writing, to the patient within 7 days of receiving the grievance....If the grievance cannot be resolved within 7 days of receiving the grievance, the Patient Relations/Guest Services department....will inform the patient in writing that the facility is still working to resolve the grievance and that a follow-up, written grievance response will be sent within 30 days....If there is still no resolution after 30 days, another letter is sent to the patient updating him/her of the status of the grievance investigation. ..." Continued policy review revealed "...DEFINITIONS Grievance - a formal or informal written or verbal concern made by the patient or the patient's representative to the facility regarding the patient's care (when the complaint is not resolved at the time of the complaint by staff present)....Written complaints are always considered grievances. E-mails and faxes are considered 'written.'....Issues that the patient requests be handled as a grievance or when the patient requests a facility response....Complaint - A complaint is a verbal concern made by the patient or the patient's representative that usually can be resolved on the spot by those staff present or those who can quickly be at the patient's location. Complaints do not require written responses. Examples of complaints may include, but are not limited to,: Requests for a change in bedding; Requests for housekeeping of a room; or Requests for serving preferred food and beverages. ..."

File review on 05/15/2014 of a Patient Relations Event revealed an e-mail response was sent to Patient #15's son on 01/24/2013 in follow-up to a concern. The response indicated the patient's family "...felt that they were not treated with respect." Review revealed the case was closed on 01/25/2013. Further review revealed an email back from the son on 01/25/2013 stating he did not see an action plan to prevent future episodes. Further review revealed another email to the son on 01/30/2013 at 1531 offering a meeting with a Nursing Director, which was followed by documentation of a phone call from the patient's son on 01/30/2013 at 1539 where he was "...demanding an 'action plan' that included a course in professionalism and HIPAA (Health Insurance Portability and Accountability Act). ..." Further review revealed notification to department leaders of the concerns as well as a note that the complaint was not "...a quality of care concern or a patient care concern." Further review did not reveal any change in "Type of Event" from complaint to grievance.

Further File review revealed documentation of a Patient Relations Event, date of notification 02/04/2013, of a phone call from the son to the Case Manager on 02/01/2013 listing additional concerns, including that a group of the physicians had decided that "chest compressions would not be performed on the patient should the patient code" and that a medication (Amikacin) had decreased Patient #15's kidney function and questioning if that could have been intentional. The "Type of Event" was listed as a "Complaint", the "Area of Concern" was "Quality of Care", and the "Care Issues" were "Conflict with Care". Further review revealed documentation that a physician spoke with the patient's sons to address their concerns. Review revealed the "Date Closed 02/04/2013". Further review did not reveal a follow-up letter was sent per hospital policy.

Continued review of a patient file revealed a staff email on 02/19/2013 for a meeting to "...pull group together to discuss how best to support this patient and family....At this point all of the families (family's) concerns have been addressed in the moment with staff present and handled as a complaint NOT a grievance. ..."

Interview on 05/15/2014 at 1100 with the Manager of Patient Relations and Guest Services revealed the hospital staff discussed "multiple times whether (the concerns) were a complaint or a grievance." Interview revealed administrators and managers had dialogue and email or text correspondence with family regarding concerns. Interview confirmed this was not treated as a grievance and no written response was sent. Interview confirmed the staff failed to follow the hospital's grievance policy.