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JACKSON MEMORIAL HOSPITAL 1611 NW 12TH AVE MIAMI, FL 33136 Jan. 10, 2017
VIOLATION: PATIENT RIGHTS: EXERCISE OF RIGHTS Tag No: A0129
Based on record review and interview the facility failed to honor the patient right to have the patient's next of kin, proxy or designated representative to exercise rights on behalf of the patient in 1 of 11 sampled patients(SP) #1.



The findings:

Review of the emergency department physician ' s notes showed sample patient (SP) #1 was admitted with a diagnosis of AMS (altered mental status) and syncope on 11/15/2016. The physician progress notes dated 11/16/2016 noted that the patient is totally confused. The assessment and plan: 1. Dementia with behavior disturbance. On 11/17/2016, the physician progress notes showed that SP #1 is incapable of making medical judgement for himself, I have initiated the baker act which will lead to his being on a one-to-one supervision and it is appropriate for him to be admitted to inpatient psychiatric unit when a bed is available. The " Certificate of Professional Initiating Involuntary Examination " showed he was examined on 11/17/2016 and was signed on 11/16/2016 by the physician. Sampled patient (SP) #1 Discharge Summary dated 11/18/2016 at 11:18 am showed a 74- year old patient who presented to the (Emergency Department )ED with aggressive risk behavior, and near syncope. Other associated history: dementia with multiple evaluation for psychiatric disorders and violent behavior, anxiety and psychosis. The patient is very confused. He (SP #1) is responding to his name but is incoherent, and he is unable to bring correct information at this time. However, the patient does not seem to be in distress.

Review of the patient consents showed that he signed his consents.

Record review of SP #1 record did not show evidence that the facility filed a petition to the court to appoint a guardian for the pt. since there is no family or nearest of kin.
There is no proxy or patient representative.

Interview with Behavioral Unit Director on 1/10/2017 at 1:50 pm revealed that SP# 1 Baker Act was in place on 11/17/2016.

Interview with Case Manager (CM-A) on 1/10/2017 at 11:47 am revealed she has no recollection of details. She described the process to transfer and stated we look for family; sometimes takes weeks to locate. If we cannot locate, social worker will do due diligence to locate next of kin. We use after 3 days a Social Work Advantage- a proxy form; it uses third party people and serves as their proxy. But, we don ' t use this on BA (baker act) patients.

Interview with the Director of Case Management (CM) on 1/10/2017 at 10:53 am revealed if the pt. is confused and has no information on advance directives, due diligence in finding a family or nearest of kin is done by the CM or CSW (Clinical Social Worker). Previous admission documents and transfer documents from another facility are checked to see if there are any contact person/family to help determine if pt. has advance directives or serve as the proxy after pt. is being determined as incapacitated by the physician. In the case of a Baker Act patient who is without an advance directive and a known family or next of kin, the facility files a petition to the court for involuntary admission and when the pt. appears to the court, it is also included in the petition for the court, to appoint a guardian for the pt. since there is no family or nearest of kin.


The policy " Baker Act with the subject: Designation Of A Health Care Proxy (Decision Maker) (dated January 2013) states that the hospital adheres to the Florida Statues Chapter 394 and Administrative Rule 65E-5.170 by ensuring that in the absence of an advanced directive, the facility makes every effort to assist with the designation of an appropriate health care proxy to provide interim consent to treatment. The facility did not adhere to its policy.

The policy " Discharge Planning " dated 07/2013 states that the patient/family will be involved in the discharge planning. The facility did not adhere to its policy.

The policy subject: " Advance Directives/Living Wills " (dated 07/2013) states that when a patient appears incapable of making health care decisions regarding his/her care, the attending physician must evaluate the patient to determine if the patient lacks capacity to make decisions or wishes known, and document his/her evaluation in the medical record and on form (C-639-B). The physician evaluation will be documented on the top portion of form. If the physician determines that the patient lacks capacity to make health care decisions, then an alternate decision maker (health care surrogate, proxy, guardian, etc.) should be identified. B. Health Care Proxy. If a patient has not appointed a Health Care Surrogate and is unable to select one or if the person selected by the patient is unable to serve in that capacity the hospital may request a proxy.
The facility did not adhere to its policy.