The information below comes from the statement of deficiencies compiled by health inspectors and provided to AHCJ by the Centers for Medicare and Medicaid Services. It does not include the steps the hospital plans to take to fix the problem, known as a plan of correction. For that information, you should contact the hospital, your state health department or CMS. Accessing the document may require you to file a Freedom of Information Request. Information on doing so is available here.

SPRINGFIELD HOSPITAL PO BOX 2003 SPRINGFIELD, VT 05156 July 8, 2014
VIOLATION: COMPLIANCE STATE AND LOCAL LAWS AND REGS Tag No: C0814
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on staff interview and record review, during the provision of care and services staff failed to maintain patient rights in accordance with State statute, Title 18, Chapter 42; Bill of Rights for Hospital Patients; ? 1852. 1) The patient has the right to considerate and respectful care at all times and under all circumstances with recognition of his or her personal dignity, and ? 1852. 5) The patient has the right to refuse treatment to the extent permitted by law, for 1 of 3 applicable patients (Patient #1).
Findings include:
Per record review staff failed to provide care in a respectful and dignified manner by failing to adhere to the CAH's policy for restraint use.
Per record review the policy, titled Restraint and Seclusion Policy last approved on 4/7/14 states "...Restraint and seclusion will not be used as a means of coercion, discipline, convenience or retaliation by staff ... It is our responsibility to facilitate the discontinuation of restraint or seclusion as soon as possible...we are committed to preserving the patient's safety and dignity when restraint or seclusion is used." Procedures listed in the policy include " maintain dignity and respect during restraint and seclusion use through ...attention to the patient ' s needs ...patient comfort related to toileting will be assessed. " Procedures regarding restraint orders include " The order for physical restraint for acute behavioral management is limited to: Four (4) hours for adults " .
Patient # 1, whose diagnoses include mania and delusional thoughts and behavior, was admitted to the Windham Center/ PPS Excluded Distinct Part Psychiatric Unit of Springfield hospital on [DATE].
Per record review, Physician Progress Notes for 5/27/14 at 5:15 P.M. record the patient is " angry, agitated, grossly delusional ...threatening to assault staff. ...refuses to discuss voluntary medication use with MD ... patient was offered oral medications which s/he refused. ... patient escorted from courtyard where s/he has been shouting for several hours down to h/her room ...patient placed in restraint bag " .
At 10:08 P.M. the physician documents " patient seen ... patient placed in restraint bag around dinner time ... patient has not been out of restraints to use bathroom since 1800 [6:00 P.M.] ... "
Nursing Notes for 10:05 P.M. record " Dr. Miller told patient that if s/he took medication we would allow h/her out of the restraint to go to the bathroom " . The patient was then offered an anti-psychotic medication. At 10:15 P.M. Nursing Notes report Patient #1 " spit out 15 mg tablet. 5 mg tablet was not found. Dr. Miller informed and s/he told this RN to continue with restraint " .
At 1:15 A.M. on 5/28/14 Nursing Notes state the patient " complained of need to urinate; encouraged to do so in restraint suit " . 4 ? hours later Nursing Notes record " [Patient #1]
has been on constant 1 on 1 observation for this shift. S/he has been restrained in the restraint bag as well. ...has made several requests to go to the bathroom. Patient was offered PRN [as needed] meds in order to enable h/her to get up to use the bathroom, as Dr. Miller specified. "
AT 5:47 A.M. Patient #1 " reported s/he urinated in restraint bag. Reassured s/he ' d get cleaned up once out of restraints. "
Per record review at 6:15 A.M. on 5/28/14 a Physician Order is written " to release patient from body restraint bag " .
Nursing Notes from 6:20 A.M. document " MD called re: patient assessment after having been in restraints since yesterday evening. Orders given to release patient from restraints but to remain behind locked double doors in the hallway. Patient agreed to take PRN medications first and then s/he could shower. "
A Nursing Note written 34 minutes after the order to release Patient #1 from the body restraint bag records the patient was " requesting a cigarette and to use phone at 6:30 A.M. checks ...s/he could have a cig and use the phone if s/he took medication first. Patient agreed. This RN, along with 2 MHWs [Mental Health Workers] and another RN entered patient ' s room ...patient was raised to an upright position and supported while s/he took 20mg liquid Haldol [an antipsychotic] ... mouth was checked and clear. Patient then removed from the restraint and allowed to use the toilet ...and assisted to the shower. Clean clothes were provided " .
Per record review of Social Services notes from 6/4/14 " [Patient #1] spoke about how traumatizing it had been to be in the restraint bag and believes a line had been crossed. States that s/he does not believe it was necessary to be in the bag as long as s/he was...tearful throughout exchange in which s/he talked about being in restraints ... "
Per interview with the Nursing Director of the Windham Center Inpatient Psychiatric Unit on 7/8/14 at 1:14 P.M. the Director confirmed Patient #1 was not treated with respect and dignity regarding multiple requests to go to the bathroom and being forced to void then remain in the soiled restraint bag. The Director also confirmed coercion was used regarding releasing Patient #1 from the restraint bag only if s/he took a voluntary medication, and confirmed that the physician ' s order for restraint was not written for 4 hours and was not renewed per policy, and that Patient #1 remained in the restraint bag for greater than 12 hours, and was not released from the restraint immediately after the order for the restraint to be discontinued was written.
VIOLATION: PROVISION OF SERVICES Tag No: C1004
Based on patient/patient representative and staff interviews as well as record review the Condition of Participation for Provision of Services was not met as evidenced by:
Per record review, the Windham Center/ PPS Excluded Distinct Part Psychiatric Unit of Springfield Hospital staff failed to maintain dignity and respect during restraint use, used coercion in order for the patient to accept medications, and failed to follow procedures regarding orders for physical restraints per hospital policy.
Refer to tag: 271
VIOLATION: PATIENT CARE POLICIES Tag No: C1006
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on staff interview and record review, the Critical Access Hospital (CAH) failed to provide care and services in accordance with established polices for 1 of 3 applicable patients (Patient #1).
Findings include:
Per record review, the Windham Center/ PPS Excluded Distinct Part Psychiatric Unit of Springfield Hospital staff failed to maintain dignity and respect during restraint use, used coercion in order for the patient to accept medications, and failed to follow procedures regarding orders for physical restraints per hospital policy.
Per record review the policy, titled Restraint and Seclusion Policy last approved on 4/7/14 states "...Restraint and seclusion will not be used as a means of coercion, discipline, convenience or retaliation by staff ... It is our responsibility to facilitate the discontinuation of restraint or seclusion as soon as possible...we are committed to preserving the patient's safety and dignity when restraint or seclusion is used." Procedures listed in the policy include " maintain dignity and respect during restraint and seclusion use through ...attention to the patient ' s needs ...patient comfort related to toileting will be assessed. " Procedures regarding restraint orders include " The order for physical restraint for acute behavioral management is limited to: Four (4) hours for adults " .
Patient # 1, whose diagnoses include mania and delusional thoughts and behavior, was admitted to the Windham Center/ PPS Excluded Distinct Part Psychiatric Unit of Springfield hospital on [DATE].
Per record review, Physician Progress Notes for 5/27/14 at 5:15 P.M. record the patient is " angry, agitated, grossly delusional ...threatening to assault staff. ...refuses to discuss voluntary medication use with MD ... patient was offered oral medications which s/he refused. ... patient escorted from courtyard where s/he has been shouting for several hours down to h/her room ...patient placed in restraint bag " .
At 10:08 P.M. the physician documents " patient seen ... patient placed in restraint bag around dinner time ... patient has not been out of restraints to use bathroom since 1800 [6:00 P.M.] ... "
Nursing Notes for 10:05 P.M. record " Dr. Miller told patient that if s/he took medication we would allow h/her out of the restraint to go to the bathroom " . The patient was then offered an anti-psychotic medication. At 10:15 P.M. Nursing Notes report Patient #1 " spit out 15 mg tablet. 5 mg tablet was not found. Dr. Miller informed and s/he told this RN to continue with restraint " .
At 1:15 A.M. on 5/28/14 Nursing Notes state the patient " complained of need to urinate; encouraged to do so in restraint suit " . 4 ? hours later Nursing Notes record " [Patient #1]
has been on constant 1 on 1 observation for this shift. S/he has been restrained in the restraint bag as well. ...has made several requests to go to the bathroom. Patient was offered PRN [as needed] meds in order to enable h/her to get up to use the bathroom, as Dr. Miller specified. "
AT 5:47 A.M. Patient #1 " reported s/he urinated in restraint bag. Reassured s/he ' d get cleaned up once out of restraints. "
Per record review at 6:15 A.M. on 5/28/14 a Physician Order is written " to release patient from body restraint bag " .
Nursing Notes from 6:20 A.M. document " MD called re: patient assessment after having been in restraints since yesterday evening. Orders given to release patient from restraints but to remain behind locked double doors in the hallway. Patient agreed to take PRN medications first and then s/he could shower. "
A Nursing Note written 34 minutes after the order to release Patient #1 from the body restraint bag records the patient was " requesting a cigarette and to use phone at 6:30 A.M. checks ...s/he could have a cig and use the phone if s/he took medication first. Patient agreed. This RN, along with 2 MHWs [Mental Health Workers] and another RN entered patient ' s room ...patient was raised to an upright position and supported while s/he took 20mg liquid Haldol [an antipsychotic] ... mouth was checked and clear. Patient then removed from the restraint and allowed to use the toilet ...and assisted to the shower. Clean clothes were provided " .
Per record review of Social Services notes from 6/4/14 " [Patient #1] spoke about how traumatizing it had been to be in the restraint bag and believes a line had been crossed. States that s/he does not believe it was necessary to be in the bag as long as s/he was...tearful throughout exchange in which s/he talked about being in restraints ... "
Per interview with the Nursing Director of the Windham Center Inpatient Psychiatric Unit on 7/8/14 at 1:14 P.M. the Director confirmed Patient #1 was not treated with respect and dignity regarding multiple requests to go to the bathroom and being forced to void then remain in the soiled restraint bag. The Director also confirmed coercion was used regarding releasing Patient #1 from the restraint bag only if s/he took a voluntary medication, and confirmed that the physician ' s order for restraint was not written for 4 hours and was not renewed per policy, and that Patient #1 remained in the restraint bag for greater than 12 hours, and was not released from the restraint immediately after the order for the restraint to be discontinued was written.