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 Dec. 7, 2016
VIOLATION: PATIENT RIGHTS Tag No: A0115
A complaint survey was conducted on 11/28/16 through 12/7/16 at Erlanger Medical Center. Patient #3 and #4 were evaluated in the Emergency Department (ED). During the admission to the ED, the patients were physically assaulted by a contracted security officer. The facility failed to provide care in a safe setting and failed to protect Patients #3 and #4 from abuse.

Refer to Standard A-144 and A-145.
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on facility policy review, medical record review, incident report review, and interviews, the facility failed to ensure 2 patients (#3 and #4) received care in a safe setting of 21 patients reviewed.

The findings included:

Review facility policy, Patient Rights, dated 10/2005 revealed "...You, the patient, have the right to...Be free from physical or mental abuse or harassment and corporal punishment..."

Review facility policy, Abuse Reporting, dated 10/1999 revealed "...If patient abuse is observed or suspected, the witness (s) is required to report this immediately to their supervisor, the House Supervisor, or call the Integrity Hotline..."

Medical record review revealed Patient #3 was admitted to the Emergency Department (ED) on 9/27/16 at 10:51 PM for complaint of "...being out of control...mother states pt was recently released from jail and is now refusing to take medications...also acting out violently..."

Medical record review of a nurses note dated 9/27/16 at 10:55 PM revealed "...pt [patient] escorted to room 8 for eval...he quickly fled back to the waiting room. Pt stopped by sheriff officer and staff...pt made a scene in the lobby yelling....just shoot me, I'm black, just kill me...pt escorted by officer to room 14 [seclusion room] after repeatedly being asked to cooperate...Further review of a nurses noted dated 9/28/16 at 12:16 AM revealed "...Patient tried to escape the ED...placed in seclusion room..." Continued review revealed the patient was provided a medical screening exam by a physician and a psychiatric evaluation by a crisis counselor with arrangements made for continued outpatient treatment. Continued review revealed the patient was discharged home with mother in stable condition on 9/28/16 at 5:12 AM. Further review of the medical record revealed the physicial exam documented on 9/28/16 at 6:08 AM documented no injuries or trauma.

Review of a facility incident dated 10/2/16 revealed "...Date of Occurrence: 9/27/16...While reviewing a 10/2/2016 report of physical abuse [for Patient #4] a different complaint of abuse [for Patient #3] was discussed by the nurse who completed the report. The information from the report is as follows. Law Enforcement Officer (LEO) was also deescalated on [DATE]th [9/27/16] when escorting a [AGE] year old [Patient #3] to the seclusion room. With this case the LEO yelled expletives repeatedly causing disturbance to other patients and continued to be aggressive, punching the patient in the face, after he [the patient] was pinned on the ground and cooperating...Nursing documentation indicates that patient was escorted to exam room for evaluation and fled to waiting room when asked to change into gown. Patient was stopped by LEO and staff...Patient was escorted to room by LEO...LEO was witnessed by a second nurse to push the patient onto the stretcher in the room, jump on the patient, and yell and curse at the patient...A third staff member witnessed the LEO use his right hand/arm to strike the head/face of the patient..."

Review of written statement by Registered Nurse (RN) #1 dated 10/6/16 revealed "...[LEO] was deescalated on [DATE]th when escorting a [AGE] year old [Patient #3]...to the seclusion room...the officer yelled expletives repeatedly...continued to be aggressive, punching the patient in the face, after he was pinned on the ground and cooperating...officer was sternly told to stop and that was enough, before he got off the patient..."

Medical record revealed Patient #4 was admitted to the Emergency Department (ED) on 10/2/16 at 5:05 AM for complaint of blunt trauma to back.

Medical record review of a nurse's note dated 10/2/16 at 5:05 AM revealed "...patient uncooperative...alert and using lots of profanity towards ems [emergency medical services] and staff members..."

Medical record review of a discharge note dated 10/2/16 at 5:14 AM revealed "...discharged ...signed out against medical advice..."

Medical record review of a physician's note dated 10/2/16 at 6:02 AM revealed "...patient was agitated from time of arrival, swearing at EMS ...I examined patient and asked him if we could do some blood work and x-rays and patient said...I don't want them. I'm getting the hell out of here...Refused to sign AMA [against medical advice] paperwork and walked out toward exit..."

Review of a facility incident report dated 10/2/16 revealed "...Date of Occurrence: 10/2/16...Patient [#4] arrived via ambulance, irritated and cussing Emergency Medical Service (EMS) personnel...Patient was deescalated by staff, triaged, and assessed by provider...Patient then refused treatment stating...I don't want them. I'm getting the hell out of here...Patient refused to sign AMA paperwork, began walking around the ER in attempt to exit...Patient continued to be agitated as he was escorted out of the department by Law Enforcement Officer (LEO) who is employed by Erlanger's security contractor...The LEO was viewed shoving the patient out the front door of the ER onto his back...Officer followed the patient out the door continuing to fight...The LEO yelled at the patient, telling him to leave and to get off the property while pointing in direction to leave. The LEO was observed by nursing staff repeatedly tackling the patient to the ground while yelling. Contracted Security Officer (CSO1) and nurse attempted to calm down the LEO. Patient ran from LEO...with the CSO1 and the LEO following. A second CSO (CSO2) witnessed the patient's head being hit onto the concrete by the LEO...Per our process, the LEO was suspended pending the completion of this investigation...The patient was witnessed to scream and curse at the LEO and invade the LEO's personal space...The LEO was witnessed pushing the patient away...The CSO1 assisted the LEO in wrestling the patient to the ground and placing him into custody...At one point, LEO was witnessed to bounce and scuff the patient's head on the pavement and to have knee pressure applied to the patient's back while applying handcuffs..." Further review of the incident report revealed the patient was arrested, placed in a police car, and taken to jail by the LEO.

Review of a written statement by RN #1 dated 10/6/16 revealed "...Patient (Patient #4) refused to sign AMA paperwork...began walking around ER in attempt to exit...Patient remains agitated as he was escorted out of the dept by HCSO [Hamilton County Sheriff Officer/LEO]...[LEO] shove the patient out the front door of the ED onto his back...Observed the officer repeatedly tackling the patient to the ground...[named security firm]...and I both attempted to calm down the SO [LEO] telling him to stop and let the kid go...I told [LEO] he either needed to arrest the boy or let him go...At this time the officer stated that arresting him is what he was attempting to do..."


Interview with the Clinical Compliance Officer (CCO) and the Corporate Compliance Officer (CCO) on 11/30/16 at 10:30 AM, in the Administration Conference Room, confirmed the facility failed to ensure patients receive care in a safe setting and the facility failed to follow facility policy.

Interview with RN #1, by telephone on 12/6/16 at 6:15 PM, confirmed she did not promptly report the incident involving Patient #3 until the incident with Patient #4 occured on 10/2/16.
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on facility policy medical record review, incident report review, and interviews, the facility failed to ensure 2 patients (#3 and #4) were free from abuse of 21 patients reviewed.

The findings included:

Review facility policy, Patient Rights, dated 10/2005 revealed "...You, the patient, have the right to...Be free from physical or mental abuse or harassment and corporal punishment..."

Review facility policy, Abuse Reporting, dated 10/1999 revealed "...If patient abuse is observed or suspected, the witness (s) is required to report this immediately to their supervisor, the House Supervisor, or call the Integrity Hotline..."

Medical record review revealed Patient #3 was admitted to the Emergency Department (ED) on 9/27/16 at 10:51 PM for complaint of "...being out of control...mother states pt was recently released from jail and is now refusing to take medications...also acting out violently..."

Medical record review of a nurses note dated 9/27/16 at 10:55 PM revealed "...pt [patient] escorted to room 8 for eval...he quickly fled back to the waiting room. Pt stopped by sheriff officer and staff...pt made a scene in the lobby yelling....just shoot me, I'm black, just kill me...pt escorted by officer to room 14 [seclusion room] after repeatedly being asked to cooperate...Further review of a nurses noted dated 9/28/16 at 12:16 AM revealed "...Patient tried to escape the ED...placed in seclusion room..." Continued review revealed the patient was provided a medical screening exam by a physician and a psychiatric evaluation by a crisis counselor with arrangements made for continued outpatient treatment. Continued review revealed the patient was discharged home with mother in stable condition on 9/28/16 at 5:12 AM. Further review of the medical record revealed the physicial exam documented on 9/28/16 at 6:08 AM documented no injuries or trauma.

Review of a facility incident dated 10/2/16 revealed "...Date of Occurrence: 9/27/16...While reviewing a 10/2/2016 report of physical abuse [for Patient #4] a different complaint of abuse [for Patient #3] was discussed by the nurse who completed the report. The information from the report is as follows. Law Enforcement Officer (LEO) was also deescalated on [DATE]th [9/27/16] when escorting a [AGE] year old [Patient #3] to the seclusion room. With this case the LEO yelled expletives repeatedly causing disturbance to other patients and continued to be aggressive, punching the patient in the face, after he [the patient] was pinned on the ground and cooperating...Nursing documentation indicates that patient was escorted to exam room for evaluation and fled to waiting room when asked to change into gown. Patient was stopped by LEO and staff...Patient was escorted to room by LEO...LEO was witnessed by a second nurse to push the patient onto the stretcher in the room, jump on the patient, and yell and curse at the patient...A third staff member witnessed the LEO use his right hand/arm to strike the head/face of the patient..."

Review of written statement by Registered Nurse (RN) #1 dated 10/6/16 revealed "...[LEO] was deescalated on [DATE]th when escorting a [AGE] year old [Patient #3]...to the seclusion room...the officer yelled expletives repeatedly...continued to be aggressive, punching the patient in the face, after he was pinned on the ground and cooperating...officer was sternly told to stop and that was enough, before he got off the patient..."

Medical record revealed Patient #4 was admitted to the Emergency Department (ED) on 10/2/16 at 5:05 AM for complaint of blunt trauma to back.

Medical record review of a nurse's note dated 10/2/16 at 5:05 AM revealed "...patient uncooperative...alert and using lots of profanity towards ems [emergency medical services] and staff members..."

Medical record review of a discharge note dated 10/2/16 at 5:14 AM revealed "...discharged ...signed out against medical advice..."

Medical record review of a physician's note dated 10/2/16 at 6:02 AM revealed "...patient was agitated from time of arrival, swearing at EMS ...I examined patient and asked him if we could do some blood work and x-rays and patient said...I don't want them. I'm getting the hell out of here...Refused to sign AMA [against medical advice] paperwork and walked out toward exit..."

Review of a facility incident report dated 10/2/16 revealed "...Date of Occurrence: 10/2/16...Patient [#4] arrived via ambulance, irritated and cussing Emergency Medical Service (EMS) personnel...Patient was deescalated by staff, triaged, and assessed by provider...Patient then refused treatment stating...I don't want them. I'm getting the hell out of here...Patient refused to sign AMA paperwork, began walking around the ER in attempt to exit...Patient continued to be agitated as he was escorted out of the department by Law Enforcement Officer (LEO) who is employed by Erlanger's security contractor...The LEO was viewed shoving the patient out the front door of the ER onto his back...Officer followed the patient out the door continuing to fight...The LEO yelled at the patient, telling him to leave and to get off the property while pointing in direction to leave. The LEO was observed by nursing staff repeatedly tackling the patient to the ground while yelling. Contracted Security Officer (CSO1) and nurse attempted to calm down the LEO. Patient ran from LEO...with the CSO1 and the LEO following. A second CSO (CSO2) witnessed the patient's head being hit onto the concrete by the LEO...Per our process, the LEO was suspended pending the completion of this investigation...The patient was witnessed to scream and curse at the LEO and invade the LEO's personal space...The LEO was witnessed pushing the patient away...The CSO1 assisted the LEO in wrestling the patient to the ground and placing him into custody...At one point, LEO was witnessed to bounce and scuff the patient's head on the pavement and to have knee pressure applied to the patient's back while applying handcuffs..." Further review of the incident report revealed the patient was arrested, placed in a police car, and taken to jail by the LEO.

Review of a written statement by RN #1 dated 10/6/16 revealed "...Patient (Patient #4) refused to sign AMA paperwork...began walking around ER in attempt to exit...Patient remains agitated as he was escorted out of the dept by HCSO [Hamilton County Sheriff Officer/LEO]...[LEO] shove the patient out the front door of the ED onto his back...Observed the officer repeatedly tackling the patient to the ground...[named security firm]...and I both attempted to calm down the SO [LEO] telling him to stop and let the kid go...I told [LEO] he either needed to arrest the boy or let him go...At this time the officer stated that arresting him is what he was attempting to do..."

Interview with the Clinical Compliance Officer (CCO) and the Corporate Compliance Officer (CCO) on 11/30/16 at 10:30 AM, in the Administration Conference Room, confirmed the facility failed to ensure patients were protected from abuse and the facility failed to follow facility policy.