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MEMORIAL HOSPITAL 4500 MEMORIAL DRIVE BELLEVILLE, IL 62226 April 10, 2013
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
Based on review of the In-Patient Reservation form, staff and patient interviews it was determined in 1 of 1 (Pt #1) patients reviewed who presented for admission, the Hospital failed to ensure all patients were fully informed of their rights to request or refuse treatment.
Findings include:

1. The "In-Patient Reservation" form for Pt #1 was reviewed. The form indicated a reservation date of 3/14/13 for observation of Pt #1 with the diagnoses: "Hyperemesis Gravidarum, dehydration."

2. On 4/9/13 at 9:45 AM A-1 (An Admissions Coordinator) and A-2 (An Admissions Coordinator) were interviewed. A-2 verified that the only medical insurance Pt #1 had was with Harmony. A-2 contacted Pt #1's OB/GYN's office and Z-1 (Nurse Practitioner) was informed that Pt #1's insurance was no longer accepted at the Hospital effective 3/1/13. A-1 indicated in a written statement that during her telephone conversation with Z-1, Z-1 stated that Pt #1 needed to leave the Hospital and "go to (nearby Hospital) Emergency Department". A-1 then asked if Pt #1 was to be sent to (nearby Hospital) Emergency Department, then couldn't Pt #1 be seen in Memorial's emergency room . Z-1 said "No, she needs more care than that. I will call (nearby Hospital) Emergency Department and would you please let the patient know that?" A-1 told the nurse practitioner (Z-1) that she was uncomfortable doing that and it was not her place to tell a patient to leave the Hospital.

3. On 4/9/13 at 10:26 AM, N-1 (Direct Care Staff Nurse) was interviewed with N-2 (the 2C Nurse Manager) present. The personal statement of N-1 was also reviewed. It was indicated that Pt #1 presented by wheelchair from her OB/GYN's office. Pt #1 was placed in C241, vitals were taken and she was given an emesis basin. A call was received from the nurse practitioner (Z-1) and she asked to talk to Pt #1. N-1 wrote, "Patient voiced understanding of the insurance coverage and stated that she was directed to go to (nearby Hospital) for care ...." N-1 could not recall if she informed Pt #1 of Pt #1's right to be treated at Memorial Hospital.

4. Attempts were made to contact Pt. #1 by phone. On 4/11/13 at 3:45 PM a phone interview was conducted with Pt #1. During the interview, Pt #1 stated that while Pt #1 was in the 2C assessment room, the nurse told Pt #1 there were problems with Pt #1's medical insurance and that the doctor's office wanted to talk to Pt #1. At that time Pt #1 was informed by the nurse practitioner (Z-1) that Memorial no longer accepted Pt #1's insurance and Pt #1 was told to go to a nearby Hospital. Pt #1 was taken by wheel chair to the front door where Pt #1's sister picked Pt #1 up and took Pt #1 to the nearby Hospital where Pt #1 was admitted .