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.

PARKLAND HEALTH AND HOSPITAL SYSTEM 5200 HARRY HINES BLVD DALLAS, TX 75235 June 15, 2012
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review the hospital failed to ensure 1 of 1 patient (Patient #1) was provided a safe environment for both physical and emotional health. RN Staff #5 entered (Patient #1's) room on the morning of 05/03/12 at approximately 02:00 AM and is alleged to have performed a physical assessment which included (Patient #1's) genitalia. (Patient #1) was being treated for an infected finger and manual examination of the patients external genitalia was not consistent with the assessment or treatment of the patients presenting problem or primary diagnosis.

Findings included:

The physician note dated 04/17/12 timed at 18:55 PM reflected, "(Patient #1) is a [AGE] year old male...had an injury with rebar after a fall 5 days prior to admission. He noticed worsening swelling and purulent drainage on the right index finger...he came to the ED (Emergency Department) on 04/09/12...patient was taken to the OR (Operating Room)...there was some bony erosion at the dorsal aspect of the joint...x-ray findings suggestive of osteo[DIAGNOSES REDACTED] and septic arthritis...neck no cervical lymphadenopathy..."

The physician progress note dated 05/02/12 timed at 13:18 PM reflected, "Pain in finger with stretching and ROM (range of motion) exercises only...neck supple...stable..."

The nursing progress note documented by RN Staff #3 dated 05/02/12 timed at 18:52 PM reflected, "Report received from off going RN...Sheriff at bedside...at 19:35 PM initial assessment completed...pt stated pain in r (right) index finger...pain medication given...sheriff at bedside ...at 20:47 PM pt stated pain has been relieved...05/03/12 at 07:19 AM...report given to on coming RN..." No documentation was found which indicated relieving RN Staff #5 documented an assessment was completed on (Patient #1).

On 06/07/12 at 02:45 PM (Patient #1) was interviewed. (Patient #1) stated on the morning of 05/03/12 at about 02:00 AM RN Staff #5 entered his room and told him he needed to complete a physical assessment. (Patient #1) stated the nurse pulled the privacy curtain and said he needed to check his pulse in his neck, chest, and armpits. RN Staff #5 checked the nodes in his neck, axilla, and chest (lymph nodes) and said he needed to check the nodes in his groin as they were the same. (Patient #1) stated RN Staff #5 touched him "down there" (pointing to his privates). (Patient #1) stated RN Staff #5 made him feel uncomfortable. (Patient #1) stated RN Staff #5 fondled his privates. RN Staff #5 finished and left the room.(Patient #1) was asked if any nurse at the hospital had performed a similar assessment on him. (Patient #1) stated, "No only RN Staff #5." (Patient #1) stated he pushed the call bell a short time later and his nurse Staff #3 came into the room. (Patient #1) stated he informed RN Staff #3 that RN Staff #5 touched him inappropriately during an assessment. (Patient #1) stated RN Staff #5 did this to him previously on the morning of 04/26/12. (Patient #1) stated he did not say anything the first time because who would believe him he is an "inmate." (Patient #1) stated it upsets him still and struggles emotionally with this event. (Patient #1) stated no one assessed him after the event and/or provided any type of counseling.

On 06/07/12 at approximately 03:45 PM Staff #16 was interviewed. Staff #16 stated he was unaware until today (06/07/12) that (Patient #1) alleged one of the Hospital staff touched (Patient #1) in a sexual manner. Staff #16 stated he would be sure (Patient #1) received counseling services.

On 06/08/12 at 02:30 AM RN Staff #3 was interviewed by telephone. RN Staff #3 stated (Patient #1) was stable on her shift 05/02/12 07:00 PM to 05/03/12 07:00 AM. RN Staff #3 said she asked RN Staff #5 to relieve her for lunch break for thirty minutes at approximately 02:00 AM. RN Staff #3 stated she informed RN Staff #5 her patients were fine and just answer any call lights. RN Staff #3 stated a short time after she returned from her break (Patient #1) pushed his call light. RN Staff #3 said she asked (Patient #1) what he needed and (Patient #1) asked her if she instructed RN Staff #5 to do an assessment on him (Patient #1) during her break. RN Staff #3 said she told (Patient #1) "no." RN Staff #3 stated there was no reason for RN Staff #5 to do a physical assessment on (Patient #1). RN Staff #3 stated (Patient #1) informed her RN Staff #5 pulled the curtain around the bed and proceeded to check his neck, axilla, chest and then pulled his pants down and touched (Patient #1) in the patients (Patient #1) genitalia. RN Staff #3 stated RN Staff #5 did not report (Patient #1) had any problems while she was gone on break. RN Staff #3 said RN Staff #5 did not document anything pertaining to the assessment. RN Staff #3 said she reported the event to the Charge Nurse. RN Staff #3 was asked if she re-assessed the patient for bruises, marks and notified the physician. RN Staff #3 stated "No."

On 06/08/12 at 11:30 AM RN Staff #5 was interviewed by telephone. RN Staff #5 stated he knew (Patient #1) as he previously cared for him. On the morning of 05/03/12 RN Staff #5 stated he went into the patient's room at approximately 02:00 AM to do a focused assessment. RN Staff #5 stated he checked the patients neck, axilla and groin pulling his pants down checking the lymph nodes. RN Staff #5 stated (Patient #1's) lymph nodes were swollen. The surveyor asked RN Staff #5 the reason he assessed (Patient #1) pulling his pants down. RN Staff #5 said the patient had swollen lymph nodes. RN Staff #5 was questioned as to why he would assess a patient's groin area when the patient's affected and treated site was his finger. RN Staff #5 did not answer the question. Staff #5 was asked where his documentation was recorded in the medical record that the physician was notified. Staff #5 offered no explanation. RN Staff #5 was asked whether he assessed all his patient's in the above manner. RN Staff #5 stated, "No." RN Staff #5 was asked if (Patient #1) called for assistance utilizing his call bell during Staff #3's lunch break. RN Staff #5 said (Patient #1) did not request any assistance.

The Hospital policy entitled, "Assessment-Reassessment" with a revision date of 05/12 reflected, "All patients receiving inpatient...and appropriate follow-up assessments based upon their individual needs including physical, psychological...care and/or treatment provided by all health care professionals will be based on each patient's specific needs...each patient is to be reassessed according to the guidelines established by the clinical discipline and/or significant change in patient condition...all involved caregivers are responsible for communication of patient care needs ...focused assessment...in a focused assessment the nurse is "focusing" on a patient problem or complaint. A focused assessment is defined as a reassessment of one or more body systems in response to a new abnormal finding, an existing abnormal finding, or documentation of a previous abnormal finding that has returned to within defined limits..."
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on interview and record review the hospital failed to ensure 1 of 1 patient (Patient #1) was evaluated and/or assessed by an RN after (Patient #1) verbalized RN Staff #5 entered his room on the morning of 05/03/12 at approximately 02:00 AM and reportably performed a physical assessment which included (Patient #1's) privates. (Patient #1) verbalized to RN Staff #3 that RN Staff #5 was sexually inappropriate with him. RN Staff #3 did not document the event, notify the physician and/or re-assess/evaluate (Patient #1's) physical and emotional status according to the hospital's own policy.

Findings included:

The physician note dated 04/17/12 timed at 18:55 PM reflected, "(Patient #1) is a [AGE] year old male...had an injury with rebar after a fall 5 days prior to admission. He noticed worsening swelling and purulent drainage on the right index finger...he came to the ED (Emergency Department) on 04/09/12...patient was taken to the OR (Operating Room)...there was some bony erosion at the dorsal aspect of the joint...x-ray findings suggestive of osteo[DIAGNOSES REDACTED] and septic arthritis...neck no cervical lymphadenopathy..."

The nursing progress note documented by RN Staff #3 dated 05/02/12 timed at 18:52 PM reflected, "Report received from off going RN...Sheriff at bedside...at 19:35 PM initial assessment completed...pt stated pain in r (right) index finger...pain medication given...sheriff at bedside...at 20:47 PM pt stated pain has been relieved...05/03/12 at 07:19 AM...report given to on coming RN..." There was no documentation RN Staff #3 completed an assessment of (Patient #1) after learning of an allegation of staff to patient sexual abuse.

On 06/07/12 at 02:45 PM (Patient #1) was interviewed. (Patient #1) stated on the morning of 05/03/12 at about 02:00 AM RN Staff #5 entered his room and told him he needed to complete a physical assessment. (Patient #1) stated the nurse pulled the privacy curtain and said he needed to check his pulse in his neck, chest, and armpits. RN Staff #5 checked the nodes in his neck, axilla, and chest (lymph nodes) and said he needed to check the nodes in his groin as they were the same. (Patient #1) stated RN Staff #5 touched him "down there" (pointing to his privates). (Patient #1) stated RN Staff #5 made him feel uncomfortable. (Patient #1) stated RN Staff #5 fondled his privates. (Patient #1) stated he reported this to RN Staff #3. (Patient #1) stated no one assessed him after the event and/or provided any type of counseling.

On 06/07/12 at approximately 03:45 PM Staff #16 was interviewed. Staff #16 stated he was unaware until today (06/07/12) that (Patient #1) alleged one of the Hospital staff touched (Patient #1) in a sexual manner. Staff #16 stated he would be sure (Patient #1) received counseling services.

On 06/08/12 at 02:30 AM RN Staff #3 was interviewed by telephone. RN Staff #3 stated (Patient #1) informed her Staff #5 pulled the curtain around the bed and proceeded to check his neck, axilla, chest and then pulled his pants down and touched (Patient #1) inappropriately in his privates.

On 06/08/12 at approximately 11:00 AM Staff #11 was interviewed. Staff #11 validated (Patient #1's) medical record did not contain any documentation that (Patient #1) was re-assessed after reporting an allegation of staff to patient sexual abuse.

On 06/08/12 at 11:30 AM RN Staff #5 was interviewed by telephone. On the morning of 05/03/12 RN Staff #5 stated he went into the patient's room at approximately 02:00 AM to do a focused assessment. RN Staff #5 stated he checked the patients neck, axilla and groin pulling his pants down checking the lymph nodes. RN Staff #5 stated (Patient #1's) lymph nodes were swollen. RN Staff #5 was asked where his documentation was recorded in the medical record and/or the physician was notified. Staff #5 offered no explanation.

On 06/08/12 at approximately 01:15 PM M.D. #14 was interviewed. M.D. #14 was asked by the surveyor if he was aware of any problem with swollen lymph nodes and/or any report the patient alleged he was touched by a male nurse in a sexual manner. M.D. #14 stated none of the staff notified him regarding the above.

The Hospital policy entitled, "Assessment-Reassessment" with a revision date of 05/12 reflected, "All patients receiving inpatient...and appropriate follow-up assessments based upon their individual needs including physical, psychological...care and/or treatment provided by all health care professionals will be based on each patient's specific needs..."