HospitalInspections.org

Based on a review of documentation and interview the facility failed to ensure the right to care in a safe setting.

Findings included:

Facility based policy entitled, "Sexual Acting Out and Sexual Victimization Prevention" stated in part,
"Austin Lakes Hospital shall implement a policy for patient/residents for protective measures the facility shall take for those who are vulnerable to sexual victimization by other patients who are on sexual precautions and receiving treatment in the facility. Patients shall not have sexual contact with one another. Patients are assessed for risk of sexual acting out behavior or of being sexually victimized.

B. Observation: ...
e. Staff will monitor for precursors to Sexually Acting Out behaviors:
* Early warning signs such as dressing/ undressing in front of peers, passing notes to peers, sitting closely or inappropriately with peers, provocative statements by patients, voyeurism, public masturbation, etc
* Development of relationships with peers, grooming behaviors with possible victims such as pretending to share common interests; gradual erosion of boundaries; making the intended victim feel special.
* History of sexual identity issues, poor impulse control.
* Awareness of Patients locations and identifying if they are missing/ in an unauthorized area.
f. Staff will observe the patient for such behaviors as sexually inappropriate interactions, inappropriate touching or attempts at inappropriate touching, poor boundaries, lingering near patient bedrooms or bathrooms,
g. Staff will report to the Chief Nursing Officer of designee observed or reported behaviors such as sexually inappropriate interactions, inappropriate touching or attempts at inappropriate touching, poor boundaries, lingering near patient bedrooms or bathrooms ..."

Review of the medical records for Patients # 2 and 3 revealed these two patients were found on 07/19/17 by a staff member during q 15 minute checks in a patient bathroom together, with both patients undressed/nude.
* Patient #2 (female denied any sexual interaction/contact occurred). Patient #3 (male) stated intercourse occurred.
* A physician note on Patient #3 on 07/18/17 (the day prior to the incident) stated in part, "He continues to have poor insight into his problem. He continues to report having mood swings. According to staff, it was reported that he was sexually inappropriate with a female peer and has to be redirected. He is not not physically aggressive on the unit."
* The sexually inappropriate behavior documented on 08/18/17 meets the criteria for precursors to sexually acting out behavior. This behavior was not addressed and sexually acting out precautions were not initiated by the physician. Early identification and addressing precursors such as being sexually inappropriate with a female peer has the potential to prevent such incidents as the two patents being found nude together in a patient bathroom the following day (07/19/17).

The facility based policy indicates the importance or identifying and addressing sexual acting out pre-cursors to prevent sexual contact between patients. The physician noted that staff had reported sexually inappropriate behavior by patient #3 the day prior to the incident, but not further follow up was preformed regarding this behavior and the risk for sexual perpetration/victimization by the patient. To provide care in a safe setting, the Sexually Acting Out policy should be followed and precursor behaviors addressed by and communicated within all disciplines at the facility.

The above findings were confirmed on 09/06/17 in an interview with staff member #1.