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Based on document review and interview, the facility failed to obtain valid consent for 4 (P-4, 5, 7, 10) of 10 pediatric patients reviewed, and failed to protect the safety of 2 of 10 patients (P-4 and P-6) resulting failure to obtain valid consents and the potential for poor patient outcomes. Findings include:

See specific tags:

A-0131: Failure to provide informed decisions.
A-0144: Failure to pursue patient safety.

Based on interview and record review, the facility failed to obtain consent from a responsible party for 1 (P-4) of 10 patients reviewed and failed to identify the person giving consent for treatment in 3 (P-5, P-7, and P-9) of 10 pediatric patients resulting in the potential for uninformed and invalid consent. Findings include:

On 10/8/2024 at 1520 during document review it was revealed that P-4, a 16-year-old female was brought to the Emergency Room (ER) via ambulance for suicidal attempt on 7/10/2024. P-4 general consent indicated under patient signature, "verbal consent from patient - suicidal."

On 10/9/2024 at 1000 during document review it was revealed that P-5, was a 15-year-old female brought to the (ER) for sinus tachycardia and viral pharyngitis on 8/12/2024. P-5 general consent was signed but failed to indicate the relationship to the patient.

On 10/9/2024 at 1015 during document review it was revealed that P-7, was a 3-year-old female brought to the (ER) for lethargy and altered mental status on 8/7/2024. P-7 general consent was signed but failed to indicate the relationship to the patient.

On 10/9/2024 at 1020 during document review it was revealed that P-9, was a 17-year-old male brought to the (ER) for nausea, vomiting, and diarrhea on 8/6/2024. P-9 general consent was signed but failed to indicate the relationship to the patient.

On 10/9/2024 at 1025 during an interview with the Director of Registration, "Staff N", was queried about the consent for P-4 a minor patient. Staff N agreed that P-4 was a minor and could not give consent for herself. Staff N was then queried about the lack of documentation of relationship with P-5, P-7, and P-9. Staff N responded, "There is a glitch within the computer system that if a consent is signed after the patient had been brought back in the ED that the relationship could not be added due to the computer program."

Based on interview and record review, the facility failed to protect the safety of 2 (P-4 and P-9) of 3 minor patients reviewed by failing to contact Child Protective Services (CPS), resulting in the potential for poor patient outcomes including death. Findings include:

On 10/8/2024 at 1530 during document review of P-4 medical record it was revealed that P-4 was a 16-year-old female brought to the facility ED via ambulance on 7/10/2024 for suicidal ideation after being found sitting on railroad tracks. P-4 was accompanied by her parent who became upset with facility staff after being asked not to lie in the patient's bed. P-4 left the ED with the parent.

According to the physician's documentation on 7/10/2024 for P-4 the following was documented under Psychiatric, "Clearly is suicidal and admits she was sitting on the tracks trying to get hit by a train."

ED Provider Note under Medical Decision Making, "The patient is a 16 y.o. (year-old) female who presented with suicidal ideation. She admits to sitting on the train tracks in an attempt to get hit by a train. She denies taking any medication at home in an attempt to harm herself ...I spoke with social work who will plan to speak with the patient."

The provider's discharge note read, "I (staff O) spoke with social work (staff P) after they spoke with the patient and mom. Mom was mad at ED staff after she was asked by nursing staff why she was using the bed and daughter was not. Mom says that she cannot get comfortable in the chair due to health problems. It sounds like the daughter tries to please mom. She needs mental health help, but mom says this is an embarrassment.

Mom walked out of the ED with daughter. Social work will likely contact CPS. There was not enough in terms of signs of physical abuse to say that mom cannot make a decision that I don't agree with as she is still the patient's legal guardian.

Patient was discharged from hospital as AMA (against medical advise)/eloped at 0550."

On 10/8/2024 at 1600 an interview was conducted with the Director of Social Work (staff M) for the facility. Staff M was queried about the physician's note referencing that the social worker would contact CPS for the parent leaving with the minor patient prior to having a mental health screening. Staff M stated that she had reviewed P-4 medical record and had been in touch with the social worker (staff P) working in the ED on that day. Staff M stated staff P had stated she had forgot to contact CPS and had failed to document in the patient's (P-4) medical record. Staff M was then asked when staff P had forgot that she had not contacted CPS. Staff M stated, "Today."

On 10/9/2024 at 0930 an interview was conducted with staff P, social worker. Staff P was queried if she was aware that P-4 had left with her mother prior to being discharged. Staff P stated she was aware that P-4 had left with her mother. Staff P was asked if she evaluated P-4. Staff P stated, "Yes." Staff P was then queried if she was supposed to contact CPS. Staff P stated, "Yes." Staff P stated she had not documented her assessment nor had she contacted CPS.

On 10/9/2024 at 0945 during record review of P-7 medical record it was revealed that P-7 was a 15-year-old female brought to the ED on 5/12/2024 for overdose of THC (Tetrahydrocannabinol compound - It is the principal psychoactive constituent of cannabis) gummies. P-7 had consumed 19 THC gummies at her home residence. There was no documentation demonstrating that P-7's parents were reported to CPS.

On 10/9/2024 at 1020, an interview occurred with staff M, the Director of Social Work. Staff M was queried if P-7 parents should have been reported to CPS for P-7 overdose of THC gummies which where not secured in the parent's home. Staff M stated, "Yes."

On 10/9/2024 at 1050, a document review occurred of the policy titled, "System Nursing Q-25 Child Protection Law - Basic Duties and Responsibilities Policy," date not provided. According to the policy it reads under the subtitle, "What must be reported...3. What Must Be Reported: a. Reasonable cause is a concept that seeks to impose an objective standard in evaluating facts. Reasonable cause is present when a hypothetical person of reasonable prudence would, in assessing the facts, suspect that child abuse and/or child neglect is occurring." The policy further states, "c. Child neglect is harm or threatened harm to a child's health or welfare by a person responsible for the child's health or welfare which occurs through either negligent treatment, including the failure to provide adequate food, clothing, shelter, or medical care, or placing a child at an unreasonable risk by the failure to eliminate that risk."