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CALIFORNIA PACIFIC MEDICAL CTR - ST. LUKE'S CAMPUS 3555 CESAR CHAVEZ STREET SAN FRANCISCO, CA 94110 May 31, 2012
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review, the facility failed to enforce their policy on Patient Rights and Responsibilities when an Emergency Department (ED) physician (MD 1) was unnecessarily insensitive and uncaring in his verbal exchanges with Patient 1.

Findings:

In a telephone interview on 3/28/12 at 2:45 PM, Patient 1 stated she had gone to the ED on 2/19/12 for treatment of terrible pain in her right leg. Patient 1 said she was initially examined by a doctor (Physician Assistant - PA 1)on the preceding shift but he told her he was going off duty and MD 1 would continue her (Patient 1's) examination and treatment. Patient 1 complained that MD 1 never examined her. She stated MD 1 never examined her but only stood across the hall at the nurses station. Patient 1 stated she sent her [AGE] year old son out to the nursing station to ask a nurse to bring her a bedpan. Her son told Patient 1 that the nurse had told him she would check with MD 1. Patient 1 stated she waited awhile but no one came with the bedpan so she got off the guerney and walked to the door to try to get a nurse to bring a bedpan. Patient 1 stated MD 1 was still across the hallway at the nurses station and he started yelling at her "You walked in here, you can walk to the bathroom." Patient 1 said MD 1 continued yelling at her so that her son, the nurses, and everyone else in the ED could here him saying that she repeatedly came to the ED looking for narcotics. Patient 1 said this embarrassed her because MD 1 was insinuating she was a drug addict rather than a patient in pain. Patient 1 said at this point MD 1 did order a pain shot for her and then MD 1 asked security to remove her from the ED. Patient 1 stated the security guard called the night supervisor who said she would investigate the whole matter.

On 5/31/12, review of Patient 1's ED record indicated she had arrived in the ED on 2/19/12 ambulatory; Patient 1 was triaged at 9:18 PM. Her chief complaint was "lower back pain radiating to right leg since 3:30 PM." Patient 1 identified her pain level as ten on a scale of ten. The triage nurse (Registered Nurse - RN 1) wrote Patient 1 was oriented, conversive, and cooperative. Of note at triage was her blood pressure of 199/128 despite having taken her blood pressure medications that day.

Patient 1 was placed in a room and had a nursing examination performed by RN 2 at 9:30 PM. RN 2 noted that Patient 1 appeared comfortable and was cooperative. RN 2 did not rate Patient 1's pain according to the ten point scale, nor did RN 2 document another blood pressure measurement.

Patient 1 was examined by PA 1 at 9:49 PM. PA 1 noted Patient 1 was alert and oriented. PA 1 noted Patient 1 would not actively move her right leg but passive movement caused pain. PA 1 ordered torodol 60 mg (milligram) IM (intramuscularly) for pain at 9:43 PM.

RN 2 documented that Patient 1's pain level at 10:15 PM was still ten of ten, and her blood pressure had decreased to 156/98.

MD 1 wrote a text note at 10:22 PM which said "...I then told her (Patient 1) that she was seen to walk into the ed without difficulty so she should be able to walk to the bathroom (about 10 paces). At that point she began screaming that she wanted narcotics. The torodol shot was given a short time later but she continued to scream about narcotics...."

Record review indicated Patient 1 was given the torodol pain injection at 10:25 PM by RN 2.

RN 2 wrote a note at 10:37 PM that "pt (patient) is arguing and yelling in the room at EDMD. security called."

RN 2 discharged Patient 1 to home at 10:39 PM with instructions to follow up with her (Patient 1's) primary medical doctor (MD 3). MD 1 indicated the discharge diagnosis was "Sciatica" (lower back pain which radiates down a leg).

Torodol (toradol) is a NSAID (nonsteroidal anti-inflammatory drug) used for the relief of moderate to severe pain. When given IM it becomes effective in 30 to 60 minutes after injection (from Lexi-Comp 2000, a nationally recognized source of pharmaceutical information).

In an interview on 5/31/12 at 9:30 AM, the Medical Director of the ED (MD 2) and the Nursing Director of the ED (RN 3) stated they had reviewed and investigated this case.

RN 3 stated he had spoken with RN 1 and RN 2 but neither of them remembered the encounter between Patient 1 and MD 1.

MD 2 stated he had reviewed the ED record and he discussed the case with MD 1. MD 2 said he counseled MD 1 regarding his inappropriate verbal approach to patients who were seeking pain management.

MD 2 said he spoke directly with Patient 1 to apologize for her unpleasant experience in the ED, and he spoke with Patient 1 and her primary physician, MD 3, about a pain management program for Patient 1.

The facility policy "Patient Rights and Responsibilities" stated "Every patient deserves to be treated with respect, dignity, and concern." These rights include: "5. Considerate and respectful care and to be made comfortable..." and "7. Receive care is a safe setting that is free of all forms of abuse or harassment."

Patient 1 came to the ED for pain relief of an acute exacerbation of her right leg sciatica. Patient 1 had a pain scale rating of ten of ten. Patient 1 was calm and cooperative prior to her discussion with MD 1. MD 1 made unnecessary insensitive and uncaring verbal comments to Patient 1 which embarrassed, insulted, and angered her. It was only after this exchange with MD 1, that Patient 1 received any medication for pain relief.