HospitalInspections.org

Based on interview and record review, the facility failed to uphold the rights of 1 of 4 sampled patients, admitted involuntarily, to participate in decision- making regarding their care (Patient #1).

The facility failed to obtain a timely EDW (Emergency Detention Warrant) and support Patient #1's legal rights.

Findings include:
#TX00282705

Record review of complaint intake # TX00282705, dated 3/27/18, revealed allegations that Patient #1, was admitted to facility under an EDW on 3/18/18 and was held past the 48 hour expiration time period without legal process obtained.

Record review Patient #1's clinical record revealed the following:
-Patient was admitted to the facility on 3/18/18.
-EDW was obtained by the facility on 3/18/18.
-EDW expired 3/20/18.
-Progress notes from psychiatrist dated 3/19/18, 3/20/18, 3/21/18, & 3/23/18
indicated patient remained psychotic and delusional.
-Social worker progress notes dated 3/22/18 indicated an attempt was made
to obtain another EDW. Progress notes on 3/23/18 stated the EDW request
was denied.
-Patient #1 was discharged to home on 3/24/18: two of the discharge
diagnoses were Schizophrenia and Delusion of pregnancy.


In an interview on 4/18/18 at 10:50 am with Emergency Room (ER) Charge Nurse #51, he stated that after patients were admitted to floor from the ER, as patient #1 was on 3/18/18, it was the social worker's responsibility to follow up and obtain EDW if indicated.

In an interview on 4/18/18 at 1:50 pm with Social Worker #52, she stated she was unable to obtain an EDW on 3/22/18 because it was denied. She could not explain the delay why there was a two-day lapse before attempting to obtain another EDW. Social Worker #52 was unable to produce a copy of the EDW that was denied.

Record review on of facility policy titled "Patient Rights (System) dated March 2016 read: " ... ...4. Decisions About Care and Treatment... The patient has a right to participate in decisions about his/her care and treatment and to receive information necessary to enable him/her to make treatment decisions that reflect his/her wishes. Hospital departments will establish procedures or processes as follows: .....b. Take reasonable steps to determine the patient's wishes for a designated representative, as allowed by State law, to exercise the patient's right to participate in developing and implementing the plan of care ... ...."

Record review of facility policy titled "Emergency Detention Order (EDO) [Emergency Detention Warrant] or Order of Protective Custody (OPC)-Patient Care", dated March 2012, stated " ... ....b. Involuntary Admission .....vi Time Limit of EDO. An EDO is valid for forty-eight (48) hours, excluding weekends and holidays. The 48 hours includes any time the patient spends waiting in the facility for medical care before the patient receives the preliminary examination."