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.

JOHNSON CITY MEDICAL CENTER 400 N STATE OF FRANKLIN RD JOHNSON CITY, TN 37604 Nov. 30, 2012
VIOLATION: PATIENT RIGHTS: PARTICIPATION IN CARE PLANNING Tag No: A0130
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, observation, interview, and facility policy review, the facility failed to protect the rights of one patient (#6) of 10 patients reviewed.

The findings included:

Patient #6, a minor child, was admitted to the facility on on [DATE] with diagnoses to include Conduct Disorder and Attention Deficit Hyperactivity Disorder.

Medical record review of the History and Physical, dated November 3, 2012, revealed the patient was committed on an emergency basis with suicidal ideation and violent behavior towards the mother.

Medical record review of the Plan of Care, dated November 3, 2012, revealed problem #3 as " ...potential violence related to domestic assault of the mother ... " Continued review revealed the patient would " ...demonstrate appropriate interaction with the family and would understand the importance of the intent to follow through with aftercare plan prior to discharge ... " Continued review revealed the patient's therapist was to " ...meet with the patient and the family to discuss discharge planning preparation prior to discharge ... "

Observation on November 7, 2012, at 11:50 a.m., revealed the patient, the patient's mother, and the patient's stepfather at the nursing station signing discharge paperwork.

Interview in the office of the therapist with the patient's mother on November 7, 2012. at 12:10 p.m., revealed the mother reported having had a meeting scheduled on November 8, 2012 with the patient and the therapist to discuss limits and restrictions the patient would be expected to abide by after discharge. Continued interview revealed the patient's mother received a call on November 6 from a social worker reporting that the patient was being discharged on [DATE] at 10:30 a.m. Continued interview revealed the mother felt the patient was not ready for discharge as the patient had "attacked" the mother while the patient was hospitalized . Continued interview revealed the mother was concerned the patient and the mother had not met with therapist to discuss the limitations and restrictions the patient would have to follow after discharge.

Interview conducted with the patient in the office of the therapist on November 7, 2012, at 12:20 p.m., revealed the patient did not know of the discharge until "a few minutes ago".

Medical record review of the therapist note dated November 3, 2012 at 1:30 PM revealed the patient met with the therapist for the initial assessment. Continued review of the therapist notes revealed the next meeting occurred on November 6, 2012 at 2 PM which was a patient and family meeting. Continued review revealed "mom will address consequences for acting out at school in Thursday's (November 8th) session".

Interview in the conference room with the patient's therapist and the facility Clinical Integration Officer on November 7, 2012, at 2:15 p.m., confirmed the meeting was scheduled to take place before discharge to assist the patient and the mother related to understanding the rules and regulations expected of the patient after discharge. Continued interview confirm the meeting did not occur.

Interviewed in the conference room with the patient's physician on November 7, 2012, at 3:45 p.m., confirmed the meeting prior to discharge did not occur.

Review of the facility document Patient Rights and Responsibilities revealed "...the purpose of this written statement is to inform you and or your child of your right as a patient...1. You have the right to competent, considerate, and courteous treatment and services within our capacity without discrimination. 2. You have the right to complete information and to ask questions about all aspects of your care including those who provided and charges associated with the care. 3. You have the right to be involved in all aspects of your care including an appropriate response to reports of pain and to agree to or refuse treatment after it is explained to you. Your family may be involved also if you choose or if you are decisionally incapacitated or are a child..."

Interview in the conference room with the Clinical Integration Officer on November 7, 2012, at 3:45 p.m., confirmed the meeting with the patient's therapist between the patient and the patient's mother regarding rules and regulations expected of the patient after discharge did not occur; the patient's/mother's right to complete information had not been upheld; and the patient's rights had been violated.