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.

ERLANGER MEDICAL CENTER 975 E 3RD ST CHATTANOOGA, TN 37403 April 27, 2012
VIOLATION: PATIENT RIGHTS Tag No: A0115
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility policy, medical record review, review of facility investigation documentation, review of a police report, review of an arrest report and interview, the facility failed to protect and promote the right to freedom from sexual abuse for one patient (#3) of five sampled patients.

The findings included:

Review of facility policy Number: 8316.965 last revised in February, 2009, revealed, "...You, the patient, have the right to:...Competent, safe, considerate, respectful and dignified care...Receive care in a safe setting and to be free from mental or physical abuse or harassment..."

Review of facility policy Number: 8316.1055 last revised in October, 2010, revealed, "...To provide a guideline for the employee that suspects abuse, regarding responsibilities and required actions...When any person, regardless of age, presents for treatment and the staff has reason to suspect that the person has been the subject of abuse...the appropriate authorities will be notified. (Security, Police Department, ...Department of Human Services...Adult Protective Services..."

Medical record review revealed Patient #3 presented to the facility's emergency room on [DATE], at 7:19 p.m.

Medical record review of an Emergency Department (ED) Emergency Record dated November 9, 2011, AT 9:28 p.m. revealed, "Triage... (Registered Nurse - RN #1)...patient states was hit in nose with fist 2 hours ago...Domestic abuse is confirmed by victim..."

Medical record review of a Registered Nurse's note (RN #2) dated November 9, 2011, at 11:00 p.m., revealed, "I have been notified by hospital security that pt (patient) is alleging a sexual assault took place while...awaiting placement into an exam room. (Patient) notified (police) and they are on their way..."

Medical record review of the ED (Emergency Department) physician's documentation dated November 9, 2011, revealed, "...(11:49 p.m.) presents with nasal injury and alleged sexual assault. pt (patient) states was playing with (patient's) boyfriend when (patient) took an elbow to (patient's) knows (nose). Pt also states...was sexually assaulted up in radiology...Alert and oriented X (times) 3. Patient appears uncomfortable..."

Medical record review of an ED Nursing Assessment : Sexual Assault dated November 9, 2011, at 11:50 p.m., revealed, "...Sexual assault at (9:30 p.m.)...Location of sexual assault: (facility)...states (patient was taken to 2nd floor xray room #2 by a male who then removed (patient's) pants and penetrated...vagina with (emergency room Technician #1's) fingers...Patient is unsure of any ejaculation outside body orifice, Sites possibly on floor of xray room #2, after the assault took place pt states (patient) was brought back to the waiting area where (patient) called (police department) to report what happened."

Medical record review of the ED physician's documentation dated November 9, 2012, revealed, "...(11:52 p.m.) ...will dc (discharge) to rape crisis..."

Review of facility investigation documentation (Security Report) provided by the facility on April 23, 2012, and dated November 9, 2011, revealed, "...Offense or Incident SEXUAL ASSAULT...Time Occurred 9/Nov/2011 appx (approximately) (9:30 p.m.)...was alerted to call dispatch stat (immediately)...victim had called (police) to report...had been sexually assaulted by an E/R tech (ER Technician - ER Tech #1) named (name deleted)...(police) in turn called hospital security...call to (police) was at appx 22:41 (approximately 10:41 p.m.), we were contacted at (10:49 p.m...(RN #2), Deputy...and myself spoke with (Patient #3) in triage room...(police) arrived on the scene at appx (11:30 p.m.). After talking with the victim, (patient) lead (led) us to the room at second floor x-ray room 2 where the assault is alleged to have taken place. At appx (11:45 p.m.) room was secured by myself for (police) investigator..."

Review of a police report dated November 9, 2011, revealed, "...Complainant (Patient #3)...at (11:21 p.m.)...responded to rape at (facility's address)...spoke with (Patient #3)...waiting to be treated for an unrelated injury...when...approached by (ER Tech #3)...lead (led)...to the second floor of the hospital to X-ray room #2...as soon as they entered the X-ray room...sat on the exam table...said (ER Tech #3) then pushed...body against (Patient #3)...proceeded to pull (patient's) pants down...aggressively inserted...fingers into...vagina...(patient) said (ER Tech #1) then quickly turned to...right side and did something that (patient) thought was ejaculating in the floor...responded to investigate the crime scene to process the X-ray room..."

Interview with the Program Administrator Emergency Services on April 23, 2012, at 3:05 p.m., in a conference room, revealed the facility had "ongoing training" and she stated, "...no education regarding this incident because no one was aware until there was an arrest."

Telephone interview with a third shift Security Supervisor on April 26, 2012, at 2:57 p.m., revealed he completed the Security Report dated November 9, 2011. The Security Supervisor stated, "...I went to the ER. (Patient #3) was sitting there and crying...(Patient) checked time of call to (police) on (patient's) cell phone...(patient) said (Alleged Perpetrator's) name was (ER Tech #1's first name)...went to ER and spoke to (RN #2) charge nurse. Asked if (RN #2) had a tech named (ER Tech #1) working and (RN #2) pointed (ER Tech #1) out to me...(Patient) led us to where rape had taken place. There was evidence...stains on floor...appeared still wet. I had no doubt about what it was. In my opinion it was semen...(Patient) was still very uncomfortable talking about it even after we had talked to (patient)..."

Review of a Uniformed Arrest Report - Affidavit of Complaint provided by the Hamilton County General Sessions Court on April 27, 2012, revealed, "...Date Arrested 04/05/2012...Arrestee (ER Tech #1)...Offense: Rape...The Victim (Patient #3)...reported...was at (facility)...(ER Tech #1)...took (patient) to an X-Ray examination room on the second floor under the presumption...being taken for medical treatment...after the sexual acts were completed (ER Tech #1) ejaculated onto the floor...Inv. (Investigator...) with the Crime Scene Unit collected samples of bodily fluids that were observed to be on the floor...The swab samples taken from the exam room were then sent to be forensically compared...the DNA profile of the semen matched that of (ER Tech #1)...Based on the aforementioned facts, there is probable cause to believe that (ER Tech #3) did commit the offense of Rape by forcibly penetrating the victim's vagina with (ER Tech #1's) fingers without (Patient #3's) consent..."

Personnel file review revealed ER Tech #3 was hired on January 3, 2011.

Interview with the facility's Director of Quality Improvement on April 23, 2012, at 2:05 p.m., revealed the facility had investigated an allegation of rape made by Patient #3 in November, 2011. Continued interview confirmed ER Tech #1was suspended following the allegation and had not returned to work. She stated, "It is my understanding there was no charge until about a week ago."

Telephone interview with the facility's Corporate Preparedness Officer on April 26, 2012, at 1:52 p.m., confirmed the facility failed to report the patient's allegation of sexual abuse to the Department of Human Services and/or Adult Protective Services as required by facility policy.


C/O: #
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility policy, medical record review, review of facility investigation documentation, review of an arrest report, and interview, the facility failed to provide the right to freedom from sexual abuse for one patient (#3) of five sampled patients.

The findings included:

Review of facility policy Number: 8316.965 most recently revised in February, 2009, revealed, "...You, the patient, have the right to:...Competent, safe, considerate, respectful and dignified care...Receive care in a safe setting and to be free from mental or physical abuse or harassment..."

Medical record review revealed Patient #3 presented to the facility's emergency room on [DATE], at 7:19 p.m.

Medical record review of a Registered Nurse's note (RN #2) dated November 9, 2011, at 11:00 p.m., revealed, "I have been notified by hospital security that pt (patient) is alleging a sexual assault took place while...awaiting placement into an exam room. (Patient) notified (police) and they are on their way..."

Medical record review of the ED (Emergency Department) physician's documentation dated November 9, 2011, revealed, "...(11:49 p.m.) presents with nasal injury and alleged sexual assault. pt (patient) states was playing with (patient's) boyfriend when (patient) took an elbow to (patient's) knows (nose). Pt also states...was sexually assaulted up in radiology...Alert and oriented X (times) 3. Patient appears uncomfortable..."

Medical record review of an ED Nursing Assessment : Sexual Assault dated November 9, 2011, at 11:50 p.m., revealed, "...Sexual assault at (9:30 p.m.)...Location of sexual assault: (facility)...states (patient was taken to 2nd floor xray room #2 by a male who then removed (patient's) pants and penetrated...vagina with (emergency room Technician #1's) fingers...Patient is unsure of any ejaculation outside body orifice, Sites possibly on floor of xray room #2, after the assault took place pt states (patient) was brought back to the waiting area where (patient) called (police department) to report what happened."

Medical record review of the ED physician's documentation dated November 9, 2012, revealed, "...(11:52 p.m.) ...will dc (discharge) to rape crisis..."

Review of facility investigation documentation (Security Report) provided by the facility on April 23, 2012, and dated November 9, 2011, revealed, "...Offense or Incident SEXUAL ASSAULT...Time Occurred 9/Nov/2011 appx (approximately) (9:30 p.m.)...was alerted to call dispatch stat...victim had called (police) to report...had been sexually assaulted by an E/R tech (ER Technician - ER Tech #1) named (name deleted)...(police) in turn called hospital security...call to (police) was at appx (approximately 10:41), we were contacted at (10:49...(RN #2), Deputy...and myself spoke with (Patient #3) in triage room...(police) arrived on the scene at appx (11:30 p.m.). After talking with the victim, (patient) lead (led) us to the room at second floor x-ray room 2 where the assault is alleged to have taken place. At appx (11:45 p.m.) room was secured by myself for (police) investigator..."

Telephone interview with a third shift Security Supervisor on April 26, 2012, at 2:57 p.m., revealed he completed the Security Report dated November 9, 2011. The Security Supervisor stated, "...I went to the ER. (Patient #3) was sitting there and crying...(Patient) checked time of call to (police) on (patient's) cell phone...(patient) said (Alleged Perpetrator's) name was (ER Tech #1's first name)...went to ER and spoke to (RN #2) charge nurse. Asked if (RN #2) had a tech named (ER Tech #1) working and (RN #2) pointed (ER Tech #1) out to me...(Patient) led us to where rape had taken place. There was evidence...stains on floor...appeared still wet. I had no doubt about what it was. In my opinion it was semen...(Patient) was still very uncomfortable talking about it even after we had talked to (patient)..."

Review of a Uniformed Arrest Report - Affidavit of Complaint provided by the Hamilton County General Sessions Court on April 27, 2012, revealed, "...Date Arrested 04/05/2012...Arrestee (ER Tech #1)...Offense: Rape...The Victim (Patient #3)...reported...was at (facility)...(ER Tech #1)...took (patient) to an X-Ray examination room on the second floor under the presumption...being taken for medical treatment...after the sexual acts were completed (ER Tech #1) ejaculated onto the floor...Inv. (Investigator...) with the Crime Scene Unit collected samples of bodily fluids that were observed to be on the floor...The swab samples taken from the exam room were then sent to be forensically compared...the DNA profile of the semen matched that of (ER Tech #1)...Based on the aforementioned facts, there is probable cause to believe that (ER Tech #3) did commit the offense of Rape by forcibly penetrating the victim's vagina with (ER Tech #1's) fingers without (Patient #3's) consent..."

Interview with the facility's Director of Quality Improvement on April 23, 2012, at 2:05 p.m., revealed the facility had investigated an allegation of rape made by Patient #3 in November, 2011. Continued interview confirmed ER Tech #1 was suspended following the allegation and had not returned to work. She stated, "It is my understanding there was no charge until about a week ago."

C/O: #
VIOLATION: NURSING CARE PLAN Tag No: A0396
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, observation, and interview, the facility failed to keep current a care plan for one patient (#2) of five sampled patients.

The findings included:

Patient #2 was admitted to the facility on on [DATE], with diagnoses including Malnutrition.

Medical record review of a Wound Care Note dated April 19, 2012, revealed...sacral St II (Stage 2) Pressure sore 0.7 x 0.8 cm (centimeter)..." Medical record review of the current care plan with the patient's nurse (Registered Nurse - RN #1) on April 23, 2012, revealed the pressure sore was not addressed in the patient's care plan.

Observation with RN #3 on April 23, 2012, at 1:20 p.m., revealed the patient in bed positioned on the left side, and a pressure sore on the sacral area, pink, and less than dime-sized.

Interview with RN #4 on April 23, 2012, at approximately 1:10 p.m., in a break room, revealed care plans may include paper and/or electronic documentation

Interview with the unit's Trauma Leader on April 23, 2012, at 1:15 p.m., in a break room, confirmed the facility failed to address the patient's pressure sore in the resident's care plan.