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.

HUEY P LONG MEDICAL CENTER 352 HOSPITAL BLVD PINEVILLE, LA Sept. 7, 2012
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview the hospital failed to ensure the patient's right to receive care in a safe setting. The hospital failed to ensure that patients who were admitted to emergency services and who were on Physician's Emergency Certificate (PEC'd) for suicidal ideations were provided care as per the hospital's policies and procedures to provide safety and prevent elopement from the hospital for 2 of 5 sampled patients (#3, 4). The hospital also failed to ensure that 2 random sampled patients (R1, R2) were adequately monitored as per policy and procedure. Findings:

Patient #3

Review of the medical record for patient #3 reflected the patient was a 26 y/o male who presented to the hospital's emergency department on 8/8/12 at 15:50 (3:50 p.m.). Review of the record reflected the patient was transported to the hospital by private transportation; companioned by parent(s). Further review reflected the patient's Chief Complaint was "Suicidal Ideation".

Review of the record reflected "History of Present Illness (HPI) Complains of Suicidal Ideation, Came from [Doctor] office with Parents and PEC. States 6 wk's ago overdosed on 30 xanax trying to kill himself. Yesterday he told his dad to shoot him because he wanted to die. Pt states he has done drugs for a long time with a friend. A couple months ago the friend that he did drugs with overdoses in front of him. That is when he became suicidal....."

Review of the record reflected a "Psychologist Emergency Certificate" dated 8/8/12 at 1515 (3:15 p.m.) which was completed by a Psychologist who was not affiliated with the hospital. Further review of the Psychologist Emergency Certificate (PEC) reflected patient #3 was currently suicidal; dangerous to self; gravely disabled and unwilling to seek voluntary admission. Review of the PEC reflected the patient was to be transported to the hospital by family.

Further review reflected patient #3 was assessed at the hospital to be alert and oriented. It was noted that the patient was agitated, anxious and cooperative. Review reflected the patient was assigned to an ED room at 16:23 (4:23 p.m.). Review of the ED Nursing Notes reflected the patient was evaluated by S12, MD (Medical Doctor) at 16:40 (4:40 p.m.) and the PEC was faxed to the nursing supervisor.

Review of the Medical Decision Making (MDM) notes completed by S12, MD reflected documentation dated 8/8/12 at 16:51 "PT CAME WITH PEC BY PCP". Further review reflected patient #3 was diagnosed with Suicidal Ideation by S12, MD and was medically cleared at 17:33 (5:33 p.m).

Review of the hospital's "Suicide Risk Assessment" completed by S7, RN on 8/8/12 at "?1645 (4:45 p.m.) reflected patient #3 was assessed by S7, Registered Nurse (RN) as "High Risk" for Suicide and assessed as an Elopement Risk at 1845 (6:45 p.m).

Review of Nursing Notes dated 8/8/12 at 22:15 (10:15 p.m.) reflected patient #3 eloped from the facility's ER doors. It was noted that hospital security attempted to search the area but was unable to find the patient. Documentation reflected the police department was notified.

Continued review of patient #3's record revealed "Discharge Instructions and Patient Disposition" dated 8/8/12 at 2230 (10:30 p.m.) revealed documentation by S11, LPN which reflected patient #3 "Eloped: Patient left without notifying staff; attempted to locate patient but was unsuccessful;

Interview on 9/5/12 at approximately 2:20 p.m. with S7, RN confirmed she completed the Suicide Risk Assessment and Elopement Risk assessment on patient #3. S7 stated patients who were assessed as High Risk would be placed on 1:1 observation. S7 further stated that patient #3 was assessed as High Risk and should have been on 1:1 observation according to the hospital's ED policy.

Review of the statement completed by S11, LPN revealed "we had 3 patients checked into the Mental Health Section of the ER. The CART team arrived to talk to one of the patients. They were going in and out of that patients room. One patient had just recently been transferred to another unit in the hospital. One of the patients had recently been checked into this section and she was still being processed in. Another was needing to be checked in. This patient was accompanied by 2 ambulance drivers and an [city] Police Officer. The hallway was filled with a lot of people so I asked security for help......"At 10:15 pm, security asked me how many patients we had and I pointed.........Then security asked where the male patient was and I told him he was in the bathroom. Security went to check and did not locate him......"

Patient #4

Review of the medical record for patient #4 revealed the patient was admitted to ED on 8/22/12 with diagnoses of Depression and Suicidal Ideation. Review of the hospital's "Hospital Abuse/Neglect Initial Report" reflected the patient ran out of the alarmed emergency exit when S15, Security Guard got up to follow another mental health patient to the bathroom.

Patient R1

Review of the medical record for R1 reflected the patient was triaged at the hospital's ED for Suicidal Ideation. Further review reflected the patient had "several superficial cuts to both arms from knocking the window out the back of his truck yesterday". The patient was admitted to the ED mental health holding area.

There was no documentation to reflect the patient was placed on 1:1 observation as per policy and procedure.

Patient R2

Review of the record for patient R2 revealed the patient (MDS) dated [DATE] at 1510 (3:10 p.m) and was triaged in the ED for Suicidal Ideation. Further review of the record reflected the patient "HAS PLANTS TO KILL HIMSELFS, BEING PEC BY PCP". Review of the record reflected the patient was admitted to the ED's mental holding area.

There was no documentation to reflect the patient was placed on 1:1 Observation as per the ED's policies and procedures.


Review of the hospital's policies and procedures reflected an Administrative policy (ADM-TX-047) for Suicide Precautions with an effective date of 11/08 and revision date of 12/11.

The purpose of the policy reflected "To provide a safe environment for patients who have been identified at high risk for suicide or suicidal." Further review of the policy reflected that:

"Patient who have been identified through the Suicide Risk Assessment (Risk and Protective Factors) form #HPL606 as being at risk for suicide (harmful to themselves) and admitted for treatment and protection shall require a physician's order for suicide precautions.

The Suicide Lethality Assessment & Level Observation Tool form #HPL607 shall be completed by an RN.

Patients at high risk will have Level I - 1:1 Observation. Lower risk patients may have Level 11-Close Observation or Level III Observation as ordered by the physician."

Further review of the policy reflected the definition for Level I observation "When the patient has a physician's order for 1:1 Observation, the assigned nursing staff member shall remain within arms length of the patient and is required to maintain "head to toe" visual contact......... The nursing staff member assigned to the care of this patient shall remain with this patient at all times (positioned between patient and exit door) and not be assigned any other additional duties (hence, ratio shall not exceed 1:1)........

Review of the Emergency Department's policies and procedures manual revealed a policy (#02-007) for 1:1 Observation with an Origin date of 9/08; Effective date 08/11; and Revision date of 08/11. Review of the policy reflected "Patients with suicidal ideations with a well-formulated plan, recent suicidal gesture, homicidal ideation possessing the means to harm the intended victim, shall be monitored 1:1............ Security and/or the assigned staff shall maintain observation and supervision of the client until 1:1 staffing has been assigned........... a. Those high-risk patients that are placed on a PEC shall be closely observed and safeguarded until the client is admitted to the hospital's psychiatric unit or transferred to another facility............"

Interview on 8/29/12 at approximately 9:15 a.m., with S5, RN, House Supervisor, confirmed that he was the House Supervisor on duty when patient #3 eloped. S5 confirmed the patient was not assigned to 1:1 Observation. S5, further stated that there were 2 people assigned to the mental holding area (S11,LPN and a Tech) however; he stated the Tech was pulled to another floor and S11, LPN was the only nursing staff working on the unit. S5, RN confirmed there had been elopements in the past and a log book was maintained with all elopements.

Interview with S4, RN Manager on 9/5/12 at approximately 11:00 a.m. revealed during the time of patient #3's elopement, the ED was short of staff, and a Tech had been pulled from ED to work on another unit. Therefore, there was only one nurse (S11, LPN) assigned to the mental holding area.

Interview with S2, DON on 9/5/12 at approximately 9:43 a.m. revealed that patients in the ED's designated Mental Health area are all considered to be on close observation unless the physician order 1:1 observation. In a further interview with S2, DON on 9/7/12 at approximately 8:45 a.m., she confirmed the hospital's policy concerning 1:1 Observation was not followed.

Interview on 9/5/12 at 4:00 p.m. with S12, MD revealed he was the physician who evaluated Patient #3 on 8/8/12. S12, stated that 1:1 Observation was not ordered for Patient #3. However, S12 stated the nurses should follow the policies and procedures for 1:1 Observation.

Further interview with S14, Medical Director, on 9/6/12 at approximately 11:00 a.m., he stated the patients in the ED are under "direct observation". S14, stated the physicians do not necessarily write 1:1 Observation for patients in the ED. However, S14, Medical Director confirmed the nurses should follow the policies and procedures for 1:1 Observation of Suicidal Patients.
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview the hospital failed to ensure a registered nurse supervised and evaluated the nursing care for each patient by failing to accurately evaluate and implement measures to provide appropriate care for 2 of 5 sampled patients (#3, 4) and 2 random sampled patients (R1, R2) who were committed by an emergency certificate and treated in the ED. Findings:

Review of the medical record for patient #3 reflected the patient was a 26 y/o male who presented to the hospital's emergency department on 8/8/12 at 15:50 (3:50 p.m.). Review of the record reflected the patient was transported to the hospital by private transportation; companioned by parent(s). Further review reflected the patient's Chief Complaint was "Suicidal Ideation".

Review of the record reflected "History of Present Illness (HPI) Complains of Suicidal Ideation, Came from [Doctor] office with Parents and PEC. States 6 wk's ago overdosed on 30 xanax trying to kill himself. Yesterday he told his dad to shoot him because he wanted to die. Pt states he has done drugs for a long time with a friend. A couple months ago the friend that he did drugs with overdoses in front of him. That is when he became suicidal....."

Review of the record reflected a "Psychologist Emergency Certificate" dated 8/8/12 at 1515 (3:15 p.m.) which was completed by a Psychologist who was not affiliated with the hospital. Further review of the Psychologist Emergency Certificate (PEC) reflected patient #3 was currently suicidal; dangerous to self; gravely disabled and unwilling to seek voluntary admission. Review of the PEC reflected the patient was to be transported to the hospital by family.

Further review reflected patient #3 was assessed at the hospital to be alert and oriented. It was noted that the patient was agitated, anxious and cooperative. Review reflected the patient was assigned to an ED room at 16:23 (4:23 p.m.). Review of the ED Nursing Notes reflected the patient was evaluated by S12, MD (Medical Doctor) at 16:40 (4:40 p.m.) and the PEC was faxed to the nursing supervisor.

Review of the Medical Decision Making (MDM) notes completed by S12, MD reflected documentation dated 8/8/12 at 16:51 "PT CAME WITH PEC BY PCP". Further review reflected patient #3 was diagnosed with Suicidal Ideation by S12, MD and was medically cleared at 17:33 (5:33 p.m).

Review of the hospital's "Suicide Risk Assessment" completed by S7, RN on 8/8/12 at "?1645 (4:45 p.m.) reflected patient #3 was assessed by S7, Registered Nurse (RN) as "High Risk" for Suicide and assessed as an Elopement Risk at 1845 (6:45 p.m).

Review of Nursing Notes dated 8/8/12 at 22:15 (10:15 p.m.) reflected patient #3 eloped from the facility's ER doors. It was noted that hospital security attempted to search the area but was unable to find the patient. Documentation reflected the police department was notified.

Continued review of patient #3's record revealed "Discharge Instructions and Patient Disposition" dated 8/8/12 at 2230 (10:30 p.m.) revealed documentation by S11, LPN which reflected patient #3 "Eloped: Patient left without notifying staff; attempted to locate patient but was unsuccessful;

Interview on 9/5/12 at approximately 2:20 p.m. with S7, RN confirmed she completed the Suicide Risk Assessment and Elopement Risk assessment on patient #3. S7 stated patients who were assessed as High Risk would be placed on 1:1 observation. S7 further stated that patient #3 was assessed as High Risk and should have been on 1:1 observation according to the hospital's ED policy.

Review of the statement completed by S11, LPN revealed "we had 3 patients checked into the Mental Health Section of the ER. The CART team arrived to talk to one of the patients. They were going in and out of that patients room. One patient had just recently been transferred to another unit in the hospital. One of the patients had recently been checked into this section and she was still being processed in. Another was needing to be checked in. This patient was accompanied by 2 ambulance drivers and an [city] Police Officer. The hallway was filled with a lot of people so I asked security for help......"At 10:15 pm, security asked me how many patients we had and I pointed.........Then security asked where the male patient was and I told him he was in the bathroom. Security went to check and did not locate him......"

Patient #4

Review of the medical record for patient #4 revealed the patient was admitted to ED on 8/22/12 with diagnoses of Depression and Suicidal Ideation. Review of the hospital's "Hospital Abuse/Neglect Initial Report" reflected the patient ran out of the alarmed emergency exit when S15, Security Guard got up to follow another mental health patient to the bathroom.

Patient R1

Review of the medical record for R1 reflected the patient was triaged at the hospital's ED for Suicidal Ideation. Further review reflected the patient had "several superficial cuts to both arms from knocking the window out the back of his truck yesterday". The patient was admitted to the ED mental health holding area.

There was no documentation to reflect the patient was placed on 1:1 observation as per policy and procedure.

Patient R2

Review of the record for patient R2 revealed the patient (MDS) dated [DATE] at 1510 (3:10 p.m) and was triaged in the ED for Suicidal Ideation. Further review of the record reflected the patient "HAS PLANTS TO KILL HIMSELFS, BEING PEC BY PCP". Review of the record reflected the patient was admitted to the ED's mental holding area.

There was no documentation to reflect the patient was placed on 1:1 Observation as per the ED's policies and procedures.


Review of the hospital's policies and procedures reflected an Administrative policy (ADM-TX-047) for Suicide Precautions with an effective date of 11/08 and revision date of 12/11.

The purpose of the policy reflected "To provide a safe environment for patients who have been identified at high risk for suicide or suicidal." Further review of the policy reflected that:

"Patient who have been identified through the Suicide Risk Assessment (Risk and Protective Factors) form #HPL606 as being at risk for suicide (harmful to themselves) and admitted for treatment and protection shall require a physician's order for suicide precautions.

The Suicide Lethality Assessment & Level Observation Tool form #HPL607 shall be completed by an RN.

Patients at high risk will have Level I - 1:1 Observation. Lower risk patients may have Level 11-Close Observation or Level III Observation as ordered by the physician."

Further review of the policy reflected the definition for Level I observation "When the patient has a physician's order for 1:1 Observation, the assigned nursing staff member shall remain within arms length of the patient and is required to maintain "head to toe" visual contact......... The nursing staff member assigned to the care of this patient shall remain with this patient at all times (positioned between patient and exit door) and not be assigned any other additional duties (hence, ratio shall not exceed 1:1)........

Review of the Emergency Department's policies and procedures manual revealed a policy (#02-007) for 1:1 Observation with an Origin date of 9/08; Effective date 08/11; and Revision date of 08/11. Review of the policy reflected "Patients with suicidal ideations with a well-formulated plan, recent suicidal gesture, homicidal ideation possessing the means to harm the intended victim, shall be monitored 1:1............ Security and/or the assigned staff shall maintain observation and supervision of the client until 1:1 staffing has been assigned........... a. Those high-risk patients that are placed on a PEC shall be closely observed and safeguarded until the client is admitted to the hospital's psychiatric unit or transferred to another facility............"

Interview on 8/29/12 at approximately 9:15 a.m., with S5, RN, House Supervisor, confirmed that he was the House Supervisor on duty when patient #3 eloped. S5 confirmed the patient was not assigned to 1:1 Observation. S5, further stated that there were 2 people assigned to the mental holding area (S11,LPN and a Tech) however; he stated the Tech was pulled to another floor and S11, LPN was the only nursing staff working on the unit. S5, RN confirmed there had been elopements in the past and a log book was maintained with all elopements.

Interview with S4, RN Manager on 9/5/12 at approximately 11:00 a.m. revealed during the time of patient #3's elopement, the ED was short of staff, and a Tech had been pulled from ED to work on another unit. Therefore, there was only one nurse (S11, LPN) assigned to the mental holding area.

Interview with S2, DON on 9/5/12 at approximately 9:43 a.m. revealed that patients in the ED's designated Mental Health area are all considered to be on close observation unless the physician order 1:1 observation. In a further interview with S2, DON on 9/7/12 at approximately 8:45 a.m., she confirmed the hospital's policy concerning 1:1 Observation was not followed.

Interview on 9/5/12 at 4:00 p.m. with S12, MD revealed he was the physician who evaluated Patient #3 on 8/8/12. S12, stated that 1:1 Observation was not ordered for Patient #3. However, S12 stated the nurses should follow the policies and procedures for 1:1 Observation.

Further interview with S14, Medical Director, on 9/6/12 at approximately 11:00 a.m., he stated the patients in the ED are under "direct observation". S14, stated the physicians do not necessarily write 1:1 Observation for patients in the ED. However, S14, Medical Director confirmed the nurses should follow the policies and procedures for 1:1 Observation of Suicidal Patients.
VIOLATION: QUALIFIED EMERGENCY SERVICES PERSONNEL Tag No: A1112
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and interview the hospital failed to ensure adequate nursing personnel qualified in emergency care to meet the written emergency procedures and needs anticipated by the facility. The facility failed to ensure 2 of 5 sampled patients (#3, 4) and 2 random sampled patients (R1, R2) admitted to ED mental holding area were adequately supervised to meet their medical needs as per the hospital's policies and procedures. Findings:

Patient #3

Review of the medical record for patient #3 reflected the patient was a 26 y/o male who presented to the hospital's emergency department on 8/8/12 at 15:50 (3:50 p.m.). Review of the record reflected the patient was transported to the hospital by private transportation; companioned by parent(s). Further review reflected the patient's Chief Complaint was "Suicidal Ideation".

Review of the record reflected "History of Present Illness (HPI) Complains of Suicidal Ideation, Came from [Doctor] office with Parents and PEC. States 6 wk's ago overdosed on 30 xanax trying to kill himself. Yesterday he told his dad to shoot him because he wanted to die. Pt states he has done drugs for a long time with a friend. A couple months ago the friend that he did drugs with overdoses in front of him. That is when he became suicidal....."

Review of the record reflected a "Psychologist Emergency Certificate" dated 8/8/12 at 1515 (3:15 p.m.) which was completed by a Psychologist who was not affiliated with the hospital. Further review of the Psychologist Emergency Certificate (PEC) reflected patient #3 was currently suicidal; dangerous to self; gravely disabled and unwilling to seek voluntary admission. Review of the PEC reflected the patient was to be transported to the hospital by family.

Further review reflected patient #3 was assessed at the hospital to be alert and oriented. It was noted that the patient was agitated, anxious and cooperative. Review reflected the patient was assigned to an ED room at 16:23 (4:23 p.m.). Review of the ED Nursing Notes reflected the patient was evaluated by S12, MD (Medical Doctor) at 16:40 (4:40 p.m.) and the PEC was faxed to the nursing supervisor.

Review of the Medical Decision Making (MDM) notes completed by S12, MD reflected documentation dated 8/8/12 at 16:51 "PT CAME WITH PEC BY PCP". Further review reflected patient #3 was diagnosed with Suicidal Ideation by S12, MD and was medically cleared at 17:33 (5:33 p.m).

Review of the hospital's "Suicide Risk Assessment" completed by S7, RN on 8/8/12 at "?1645 (4:45 p.m.) reflected patient #3 was assessed by S7, Registered Nurse (RN) as "High Risk" for Suicide and assessed as an Elopement Risk at 1845 (6:45 p.m).

Review of Nursing Notes dated 8/8/12 at 22:15 (10:15 p.m.) reflected patient #3 eloped from the facility's ER doors. It was noted that hospital security attempted to search the area but was unable to find the patient. Documentation reflected the police department was notified.

Continued review of patient #3's record revealed "Discharge Instructions and Patient Disposition" dated 8/8/12 at 2230 (10:30 p.m.) revealed documentation by S11, LPN which reflected patient #3 "Eloped: Patient left without notifying staff; attempted to locate patient but was unsuccessful;

Interview on 9/5/12 at approximately 2:20 p.m. with S7, RN confirmed she completed the Suicide Risk Assessment and Elopement Risk assessment on patient #3. S7 stated patients who were assessed as High Risk would be placed on 1:1 observation. S7 further stated that patient #3 was assessed as High Risk and should have been on 1:1 observation according to the hospital's ED policy.

Review of the statement completed by S11, LPN revealed "we had 3 patients checked into the Mental Health Section of the ER. The CART team arrived to talk to one of the patients. They were going in and out of that patients room. One patient had just recently been transferred to another unit in the hospital. One of the patients had recently been checked into this section and she was still being processed in. Another was needing to be checked in. This patient was accompanied by 2 ambulance drivers and an [city] Police Officer. The hallway was filled with a lot of people so I asked security for help......"At 10:15 pm, security asked me how many patients we had and I pointed.........Then security asked where the male patient was and I told him he was in the bathroom. Security went to check and did not locate him......"


Patient #4

Review of the medical record for patient #4 revealed the patient was admitted to ED on 8/22/12 with diagnoses of Depression and Suicidal Ideation. Review of the hospital's "Hospital Abuse/Neglect Initial Report" reflected the patient ran out of the alarmed emergency exit when S15, Security Guard got up to follow another mental health patient to the bathroom.

Patient R1

Review of the medical record for R1 reflected the patient was triaged at the hospital's ED for Suicidal Ideation. Further review reflected the patient had "several superficial cuts to both arms from knocking the window out the back of his truck yesterday". The patient was admitted to the ED mental health holding area.

There was no documentation to reflect the patient was placed on 1:1 observation as per policy and procedure.

Patient R2

Review of the record for patient R2 revealed the patient (MDS) dated [DATE] at 1510 (3:10 p.m) and was triaged in the ED for Suicidal Ideation. Further review of the record reflected the patient "HAS PLANTS TO KILL HIMSELFS, BEING PEC BY PCP". Review of the record reflected the patient was admitted to the ED's mental holding area.

There was no documentation to reflect the patient was placed on 1:1 Observation as per the ED's policies and procedures.

Interview on 8/29/12 at approximately 9:15 a.m., with S5, RN, House Supervisor, he confirmed that he was the House Supervisor on duty when patient #3 eloped. S5 confirmed the patient was not assigned to 1:1 Observation. S5, further stated that there were 2 people assigned to the mental holding area (S11,LPN and a Tech) however; he stated the Tech was pulled to another floor and S11, LPN was the only nursing staff working on the unit. S5, RN confirmed there had been elopements in the past and a log book was maintained with all elopements.

Interview with S4, RN Manager on 9/5/12 at approximately 11:00 a.m. revealed during the time of patient #3's elopement, the ED was short of staff, and a Tech had been pulled from ED to work on another unit. Therefore, there was only one nurse (S11, LPN) assigned to the mental holding area.

Review of the Emergency Department's policies and procedures manual revealed a policy (#02-007) for 1:1 Observation with an Origin date of 9/08; Effective date 08/11; and Revision date of 08/11. Review of the policy reflected "Patients with suicidal ideations with a well-formulated plan, recent suicidal gesture, homicidal ideation possessing the means to harm the intended victim, shall be monitored 1:1............ Security and/or the assigned staff shall maintain observation and supervision of the client until 1:1 staffing has been assigned........... a. Those high-risk patients that are placed on a PEC shall be closely observed and safeguarded until the client is admitted to the hospital's psychiatric unit or transferred to another facility............"

Interview with S2, DON on 9/5/12 at approximately 9:43 a.m. revealed that patients in the ED's designated Mental Health area are all considered to be on close observation unless the physician order 1:1 observation. In a further interview with S2, DON on 9/7/12 at approximately 8:45 a.m., she confirmed the hospital's policy concerning 1:1 Observation was not followed.