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.

KOOTENAI HEALTH 2003 KOOTENAI HEALTH WAY COEUR D'ALENE, ID 83814 Dec. 4, 2012
VIOLATION: PATIENT RIGHTS: GRIEVANCES Tag No: A0118
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, staff interview, and review of hospital policies and grievances, it was determined the hospital failed to ensure grievances were identified and promptly resolved for 1 of 11 patients (Patient #22) whose grievances were reviewed. This resulted in delayed investigation of a patient ' s concerns regarding a staff person ' s behavior toward patients. Findings include:

Patient #22's medical record documented a [AGE] year old male who was admitted on [DATE]. He presented to the ED with suicidal ideation and depression. Patient #22 was discharged AMA to the care of his parents on 9/23/12.

On 9/23/12 at 7:53 PM, an RN documented a conversation with Patient #22 and his parents. The note included the parents dissatisfaction with the treatment their son had received. The note documented the parents indicated the unit was not what they expected and stated "their son was admitted for suicidal ideation, not behavior issues." The note also said Patient #22's parents expressed concern about a specific male staff member who they reported had glared at them several times. The nurse's note also included Patient #22's complaint that the male staff member had singled him out and yelled at him. Documentation indicated Patient #22 was released AMA to the care of his parents as a result of their dissatisfaction with care.

The Patient Advocacy Manager was interviewed on 11/30/12, beginning at 10:30 AM. He stated the incident related to Patient #22 was initially documented and reported as an AMA discharge, but not a grievance. He went on to report that as a result of a recently revised process, he was reviewing reports of AMA discharges to ensure all grievances would be investigated. He stated the AMA discharge documention for Patient #22 would have been considered a grievance. He stated the investigation process, including phone contact with the family, should have been initiated approximately 2 weeks prior to the survey, but the facility had failed to do so. The 2 week time frame was based on the date the facility identified the grievance.

Patient #22 and his parents voiced their grievance, regarding a staff person ' s behavior toward patients, with facility staff on 9/23/12. As of 11/30/12, 68 days later, the facility had not yet begun investigation of the grievance.

The facility failed to investigate and promptly resolve Patient #22's
grievance.
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of medical records, hospital personnel records and interview of current adolescent patients who were chosen at random, it was determined the facility failed to provide an emotionally safe and supportive environment for 3 of 4 patients (1 current male patient, 1 current female patient and Patient #22). This failed practice had the potential to result in negative patient outcomes and interfere with the emotional safety of all adolescent patients. Findings include:

1. Patient interviews indicated patients did not feel emotionally safe.

a. A randomly selected female adolescent patient on the psychiatric unit was interviewed on 11/29/12, beginning at 1:53 PM. Interactions between staff and patients were discussed. The female patient stated most of the staff were very supportive and listened to patients when they had a problem or voiced a need. She provided positive feedback about many staff members, including nurses, mental health specialists, the physician and the therapist. She spoke of a male staff member who she identified by name. She described the male staff member as "a mean person who didn't treat patients with respect or understanding." She went on to say "He was working with the little kids one night this week, and he was yelling at them until he made someone cry. It almost made me cry to listen to him."

b. A randomly selected male adolescent patient on the psychiatric unit was interviewed on 11/29/12, beginning at 2:00 PM. The patient stated the Mental Health Specialist, noted above, was mean and had a gruff angry manner. The patient was not able to articulate any specific threatening behavior by the Mental Health Specialist but he was clearly bothered by the employee. The patient stated when he had to interact with the employee, he would think, "Please let him be nice this time. Please let him be nice this time." This interfered with the patient's ability to focus on his therapy.

The Director of Behavior Health was interviewed on 11/29/12, beginning at 2:45 PM. Results of the interview with both adolescent patients were discussed. She stated she was unaware of the on-going inappropriate and unprofessional behavior exhibited by the male Mental Health Specialist and indicated she would follow up immediately.

Patients did not feel emotionally safe on the adolescent psychiatric unit.

2. A closed record documented the dissatisfaction of a patient and his parents, indicating the patient did not feel emotionally safe and the patient and family were not treated with respect.

Patient #22's medical record documented a [AGE] year old male who was admitted on [DATE]. He presented to the ED with suicidal ideation and depression. Patient #22 was discharged AMA to the care of his parents on 9/23/12.

On 9/23/12 at 7:53 PM, an RN documented a conversation with Patient #22 and his parents. The note included the parents dissatisfaction with the treatment their son had received. The note documented the parents indicated the unit was not what they expected and stated "their son was admitted for suicidal ideation, not behavior issues." The note also included that Patient #22's parents identified and expressed concern about a specific male staff member, identified as the same individual spoken of by the current patients, who they reported had passed by and glared at them several times during the visit. The nurses note also stated Patient #22's complained the male staff member had singled him out and yelled at him. Documentation indicated Patient #22 was released AMA to the care of his parents as a result of their dissatisfaction with care.

Patient #22 and his parents did not feel they were treated appropriately and with respect.

3. The personnel file of an employee identified during current patient interviews and in Patient #22's medical record documented a pattern of unprofessional and inappropriate behavior.

The personnel file of a male Mental Health Specialist was reviewed with the Director of Behavioral Health on 11/28/12, beginning at 3:15 PM. The file included documentation of incidents that resulted in disciplinary action as follows:

An "EMPLOYEE EVENT RECORD," dated 4/04/07, documented 3 patient grievances had been reported. The document also included co-worker observations of inappropriate behavior toward patients, including inappropriate language, provoking behavior and lack of empathy related to patients' problems. An action plan to improve the employee's performance was implemented.

A document titled, "Notice of Performance and/or Job Related Behavior Concerns," dated 4/09/11 was reviewed. Areas of performance concern included:

- Lack of empathy
- Joking about patient problems
- Swearing
- Tone of voice - harsh and abrasive
- Harsh statements to patients

A "Notice of Performance - Intent to Terminate," dated May 5/05/11, was reviewed. The document discussed 6 incidents that were reported between 4/07/07 and 5/02/11. Areas of performance concern included:

- Breach of patient confidentiality
- Crossed professional and ethical boundaries
- Lack of empathy
- Argumentative with patient's family

Additionally, the document stated the employee was expected to meet specific standards of employee conduct and ethics included in the facility's "Code of Ethics and Conduct." Documentation included the employee was expected to provide a safe work place and protect the environment."

The performance notice also discussed a plan of action. The action plan included the employee was expected to "meet and sustain" the performance and behavioral expectations of a Mental Health Specialist employed by the facility. Another point in the plan of action indicated that failure to meet and sustain performance and/or behavioral standards of the facility would result in termination of employment.

The Director of Behavioral Health was interviewed on 11/28/12, beginning at 3:15 PM. She confirmed this Mental Health Specialist had a history of inappropriate interactions with patients and crossing professional/ethical boundaries.

The facility failed to consistently provide an emotionally safe and supportive environment for patients.