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Based on a review of medical records, staff interviews and hospital policy it was determined that the hospital failed to respect the rights of Patient #3 (P3) and Patient #5 (P5) in regards to making decisions pertaining to their care. This was evident in 2 of 10 records reviewed for patient's rights involving consent.

The policy for 'Informed Consent' was reviewed. It stated "According to Maryland Law, a priority surrogate consent is not acceptable with regard to treatment of a mental disorder". It further states that "if informed consent cannot be obtained from the patient, the hospital may petition for guardianship of the patient".

1.) Patient #3 was a 65+ year old patient who was a voluntary admission to the hospital for the evaluation and treatment of a psychiatric condition. Physician and social work documentation listed 'self' (meaning the patient), as the person responsible for medical and mental health decisions. The voluntary admission form and consent for treatment were signed by the patient.

Review of documentation by the Social Worker determined that they had several meetings with the patient's spouse regarding treatments and the plan of care. However, no documentation was found to show that the patient was involved in the treatment process nor was any documentation found indicating lack of capacity. It was documented multiple times that the family was contacted however, under 'Patient participated in meeting' the answer was 'No' with no explanation as to why the patient was not or could not be involved in planning or decisions.

On the day prior to discharge, it was documented by Social Work that the patient's spouse was contacted regarding where the patient would be discharged to and also the patient's MOLST (Medical Orders for Life-Sustaining Treatment) form. The note indicated that the MOLST form was emailed to and filled out by the spouse. No documentation was found stating the patient was unable to make their own decisions regarding care, discharge or end of life wishes. The patient was discharged to an Assisted Living facility per Social Work recommendation and the spouse's consent.

2.) Patient #5 was a 70+ year old patient who was a voluntary admission to the hospital for the evaluation and treatment of a psychiatric condition. Physician and social work documentation listed 'self' (meaning the patient), as the person responsible for medical and mental health decisions. The voluntary admission form and consent for treatment were signed by the patient.

Review of documentation by the Social Worker determined that several meetings were held with the patient's adult children regarding treatments and the plan of care. It was documented multiple times that 'family contact was made' and under the section 'Patient participated in meeting', the answer was 'No', again with no explanation. Physician documentation involving treatments stated that one of the adult children was making decisions regarding stopping and/or continuing those treatments.

In an interview on 9/3/2019 at 1:30pm, a Social Worker stated that it was their understanding that neither P3 or P5 were able to understand the information given, therefore the treatment and discharge planning were deferred to the families. No documentation was found stating the patients lacked capacity or were not capable of making decisions regarding their care.

Based on review of open and closed records and staff interviews, it was determined that the hospital failed to include Patient #3 (P3) and Patient #5 (P5) in the discharge evaluation and planning process.

1.) Patient #3 was a 65+ year old patient who was voluntarily admitted to the hospital for evaluation and treatment of a psychiatric condition. Review of physician documentation determined that under the section for medical and mental health decision maker, both stated 'self'. According to documentation, the patient was alert and oriented on admission.

Review of documentation by the Social Worker determined that they had several meetings with the patient's spouse regarding discharge. However, no documentation was found to show that the patient was involved in the evaluation, planning or implementation of the discharge process. It was documented multiple times that 'family contact was made' however, under the 'Patient participated in meeting' section, the answer was 'no'. P3 was discharged to an Assisted Living facility per Social Work recommendation and the spouses consent.

In an interview on 9/3/2019 at 1:30pm, two social workers stated that it was their understanding that the patient was not always able to understand the information given, therefore the discharge planning was deferred to the spouse. There was no indication in the record that the patient lacked capacity.

2.) Patient #5 was a 70+ year old patient who was voluntarily admitted to the hospital for evaluation and treatment of a psychiatric condition. Review of physician documentation determined that under the section for medical and mental health decision maker, both stated 'self'. The voluntary admission form and consent for treatment were signed by the patient.

Social work documentation stated that the patient's adult children were involved with the initial and ongoing discharge evaluation and planning. Documentation under "patient participated in meeting", the answer was 'no'. The plan was discussed for the patient to be discharged to an Assisted Living facility that was to be determined by the adult children.

Both patients signed a voluntarily admission form and consents for treatment, therefore they should have been involved in the discharge evaluation and planning process unless deemed incapable or incompetent to make decisions.