HospitalInspections.org

Based on observation, interview and record review the facility failed to protect patient's rights, placing all patients at risk for loss of their rights. Findings include:

---The facility failed to provide 4 current and 5 discharged patients with "An Important Message from Medicare." (A-0117)
---The facility failed to ensure 1 of 1 patients was allowed to leave the facility when requested to be discharged from the facility. (A-131)

Based upon policy review, document review, and interview the facility failed to ensure the "Important Message from Medicare" (IMM) was provided to 1 of 1 patients in a sample size of 10 resulting in Medicare patients being denied the right to appeal discharge. Findings include:


27065

Policy Review:
On 5/21/15 at 1400 the facility policy titled, "Informed Consent Policy," dated 9/12, was reviewed. The policy states: "A competent adult has the right to consent to or refuse a proposed medical or surgical, test or treatment for him or herself...The role of Hospital personnel in the consent process shall be to verify that the patient's informed consent form has been properly executed, including required signatures, or other appropriate documentation received before the procedure, test or treatment begins."

Observation and Interview:
On 5/21/15 at 1510 patient #19's consent forms were reviewed with nurse B. On 2/25/15 at 2129 patient #19 was documented as "Alert and Oriented" by an Emergency Department physician. The "General Consent For Treatment" form, dated 2/25/15 at 2138, states that patient #1 was "unable to sign" because "breathing Tx" (treatment). There was no documentation that this form was offered to the patient for signature after the breathing treatment was completed. The consent form titled "An Important Message from Medicare About Your Rights," dated 2/26/15, the patient's admission date, was found in the patient's record. That form was signed by the patient's daughter. There was no documentation explaining why the patient was not given this form to sign. Nurse B was unable to explain why patient #19 was not provided with the opportunity to sign the consent documents listed above.

Based on document review and interview, 1 of 1 patients (#1) who requested to leave (patient #1), out of a total survey sample size of 24 patients, was denied the right to leave in violation of the patient rights policy resulting in violation of patient # 1's rights and the potential to violate all patients, served by the facility, rights. Findings include:

Policy Review:
On 5/21/15 at 1430 the facility policy titled, "Patient Rights," dated 9/13, was reviewed. Under "Patient Rights" the policy states: "The right to participate in the development and implementation of his or her plan of care...The patient rights include being informed of his or her health status, being involved in care planning and treatment, and being able to request or refuse treatment."

Record Review:
On 5/21/15 at 1200 review of patient #1's clinical record revealed that patient #1 was admitted on 12/8/14. A 12/8/14 "Consultation" note by the facility's consulting psychiatrist states that patient #1 was "brought to the emergency room with a chief complaint of possible overdose." Under "Recommendations" the Psychiatry Consultant states: "Put (patient #1) on suicide precaution, and when he is stable, to transfer her to an inpatient psychiatric unit." A "Clinical Certification" note, stating that patient #1 is a person requiring mental health treatment was signed by the Consulting Psychiatrist on 12/11/14. On 12/12/14 the Consulting Psychiatrist's note states: "Continue suicide precaution. Transfer (unreadable symbol) in-pt (inpatient) Psych unit." No notes by a psychiatrist were found in patient #1's clinical record from 12/13/14-1/4/15, a total of 22 days. A 1/5/15 "Consultation" note by the Consulting Psychiatrist states: "social worker to make an arrangement for outpatient followup as quickly as possible." Patient #1 was discharged on 1/5/15 without documentation of receiving inpatient mental health treatment.

A 12/17/14 1900 Nursing Note states: "Pt (patient) threatening to leave and "walk out. Pt is petitioned. Tried explaining this to patient and patient states she doesn't care, she will 'walk out,' Security called. Security up to talk with patient along with charge nurse." Patient was not discharged.

Interview:
On 5/21/15 at approximately 1500 patient #1's clinical record was reviewed with nurse B. Nurse B confirmed the (above) record review findings. Nurse B confirmed that patient #1 was not admitted to the facility as a psychiatric patient since the facility does not have an in-patient psychiatric unit. Staff B was unable to explain the 12/17/14 Nursing Note (above) stating that the patient was "petitioned" since no evidence that a properly completed and executed legal document, to hold patient #1 for psychiatric treatment, could be found. Nurse B confirmed that patient #1's record did not contain documentation of properly executed and filed legal documents to support denying patient #1's request to leave on 12/17/14.