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HIGHLANDS REGIONAL MEDICAL CENTER 5000 KENTUCKY ROUTE 321 PRESTONSBURG, KY 41653 April 24, 2013
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
Based on interview, record review, and facility policy review, it was determined the facility failed to protect the right to be free from all forms of abuse for one of ten patients selected for review (Patient #3). A review of documentation revealed Patient #3 presented to the Emergency Department (ED) on 04/17/13 due to a hand injury and was assessed by a Nurse Practitioner (NP). Patient #3 called the facility on 04/18/13 at 10:09 AM and reported the NP "groped" the patient's groin while he/she was in the ED. Interview with the Risk Manager and review of facility policy revealed if an allegation of abuse was made regarding a facility employee, the employee would be suspended until an investigation was completed. However, based on documentation, the Nurse Practitioner worked in an office at the facility from 12:00 PM until 5:00 PM on 04/18/13, and was not suspended from the facility (as indicated in facility policy) until 5:00 PM, a timeframe of approximately seven hours after the facility became aware of the allegation.

The findings include:

Review of the facility's Abuse, Neglect, Prevention and Investigation policy, revised February 2012, revealed each patient would be free from abuse and mistreatment. The policy revealed abuse included physical harm, pain, mental anguish, verbal abuse, sexual abuse, or involuntary seclusion, and it was "the responsibility of all staff to provide a safe environment for the patients." In addition, the policy revealed suspected cases of patient abuse, neglect, or mistreatment would be reported immediately, thoroughly investigated, documented by the Administrator, and reported to the appropriate state agencies, physician, and families. The policy stated, "If the accused is an employee of the facility, he/she will be suspended until the investigation has been completed." The review revealed all alleged violations of abuse of a patient would be immediately reported to the House Director (HD), Chief Executive Officer (CEO), Vice President of Patient Care Services, and the facility's Social Services Department. In addition, according to the policy, the Administrator would thoroughly investigate and take steps to ensure and prevent further potential abuse during the investigation.

Review of Patient #3's medical record revealed the patient presented to the Emergency Department (ED) of the facility on 04/17/13 at 1:43 PM with a complaint of pain in the right hand and shoulder. The record further revealed a Nurse Practitioner (NP) evaluated Patient #3 and the patient left the facility without signing the discharge summary.

Review of an investigation by the facility of alleged sexual abuse, dated 04/18/13, revealed Patient #3 called the facility on 04/18/13 at 10:00 AM with an allegation of sexual abuse and stated the NP "groped" the patient's groin while he/she was in the ED. However, there was no documented evidence the facility suspended the NP from employment in accordance with facility policy when the facility was notified of the allegation of sexual abuse.

Interview with the NP on 04/23/13 at 3:20 PM revealed the NP evaluated Patient #3 in the ED on 04/17/13 for a hand injury and the patient requested Lorcet (a narcotic medication for pain). However, the NP stated he prescribed Motrin (an over-the-counter medication to treat fever and pain) and Ultram (a narcotic-like medication used to treat moderate to severe pain) for the patient's pain and the patient voiced a complaint to the House Supervisor (HS) about the medication that had been prescribed. The NP stated he worked in the facility on 04/18/13 from 12:00 PM to 5:00 PM conducting administrative duties and did not provide any care to patients on 04/18/13. According to the NP, he was made aware of the allegation of sexual abuse on 04/18/13 at approximately 5:00 PM and was informed by the facility that he was suspended from employment until an investigation was completed.

Interview with the House Director (HD) on 04/23/13 at 4:35 PM revealed the HD met with Patient #3 on 04/17/13 while the patient was being treated in the ED of the facility. The HD stated the patient did not complain about the NP "groping" him/her. The HD stated she became aware of an allegation of sexual abuse on 04/18/13.

Interview with the Director of Nursing (DON)/Risk Manager on 04/23/13 at 2:40 PM confirmed Patient #3 notified the facility on 04/18/13 at 10:09 AM of the allegation of sexual abuse against the NP that reportedly occurred on 04/17/13. The DON confirmed the NP worked at the facility on 04/18/13 from 12:00 PM to 5:00 PM but did not provide direct care to the patients. The DON further stated the facility notified the NP of the allegation on 04/18/13 at approximately 5:00 PM (approximately seven hours after the facility became aware of the allegation) and informed the NP he was suspended from employment until an investigation was completed. The DON acknowledged she was aware the facility's Abuse, Neglect, Prevention and Investigation policy stated an employee of the facility should be suspended until an investigation of abuse allegations had been completed. The DON did not state why the policy was not followed.

Interview with the Chief Executive Officer (CEO) of the facility on 04/23/13 at 2:00 PM revealed contracted practitioners were required to follow the facility's Abuse, Neglect, Prevention and Investigation policy. The CEO stated the facility's definition of employees included direct employees and contracted personnel, such as nurse practitioners and physicians. The CEO also stated he was aware of the allegation and acknowledged he was aware the facility's Abuse, Neglect, Prevention and Investigation policy stated an employee of the facility should be suspended until an investigation of abuse allegations had been completed. The CEO did not state why the policy was not followed.