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.

JOHNS HOPKINS HOSPITAL, THE 600 NORTH WOLFE STREET BALTIMORE, MD 21287 June 3, 2016
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
Based on review of the medical records it was determined that the hospital failed to certify patient #3's capacity to make informed decisions but instead relied on her daughter as a surrogate decision maker as evidenced by:

Patient #3 presented to the ED 3/31/16 after fall at home with altered mental status. Patient #3 was admitted to Nelson 8. Patient #3 was asked if he/she had an advanced directive and stated "yes" but the patient did not wish to have a copy placed in his/her medical record. Since patient #3 had an altered mental status. the patient's daughter documented as his/her decision maker during the patient stay. Further review of the medical records revealed that the hospital staff failed to document the required certifications by two physicians indicating that the patient lacked capacity to make decisions about care. In order to use the daughter as the decision maker, the hospital must determine that the patient lacked the capacity to make their own decisions.
VIOLATION: PATIENT RIGHTS: ADMISSION STATUS NOTIFICATION Tag No: A0133
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on the review of medical records it was determined that patient #3 was kept in the hospital on observation status but was provided with the necessary notice as evidenced by:
Patient #4 is a 79 male who (MDS) dated [DATE]. Patient #4 was placed on observation status by the ED for cardiac monitoring. The notification form informing the patient of their observation status as outpatient level of care was not provided to patient #4 in the ED or upon arrival to an observation bed on Nelson 8. Patient #4 was not made aware of his observation status and therefore, was unaware of the possible financial implications associated with an observation stay.