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.
| TEXAS HEALTH PRESBYTERIAN HOSPITAL PLANO | 6200 W PARKER RD PLANO, TX 75093 | Feb. 11, 2015 |
| VIOLATION: COMPLIANCE WITH 489.24 | Tag No: A2400 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, Hospital A failed to comply with 489.24 (e) (1)-(2) for 1 of 1 patient (Patient #1) in that the ED staff at Hospital A's Emergency Department (ED) did not contact Hospital B (Psychiatric hospital) to secure an available bed for the transfer of (Patient #1) who was deemed suicidal and who required inpatient mental health treatment. Hospital A subsequently discharged (Patient #1) to police custody without ensuring (Patient #1's) mental health needs were met. Findings Included: History and Physical by (Physician #1) at (Hospital A) 2/1/2015 14:14 PM "(Patient #1) is a [AGE] year old female who presents to the ED via EMS (emergency medical services) with a friend after intentionally overdosing on likely either Adderall or Xanax per friend. Friend stated the patient had a few beers with him last PM and drove home at 1 AM, then sent him a text indicating suicidal intent a few hours later. Friend states they found the patient lying unconscious on the floor in her apartment, but denies any blood or signs of trauma. Friend states that (Patient #1) attempted suicide in September 2014 by overdosing on Adderall and Xanax (possibly Ambien), which are the only two medications he knows she has at her apartment. There are no other associated symptoms, complaints, or modifying factors at this time... (Patient #1) is lethargic, but responsive to verbal stimulation. Can shake head yes and no. No evidence of trauma...Urine drug screen positive for amphetamines...1505 PM (Patient #1) is awake, alert, and can speak...Rechecked patient. (Patient #1) admits to taking Adderall and is not able to carry on conversation, but still seems confused. Will admit...Spoke to (Physician #2) who is aware of assessment/workup in the ED and agrees to admit the patient...1901 PM (Patient #1) is attempting to leave the ED. Contacted ED security, (Patient #)1 has already been APOWW (arrest by police officer without warrant) by police and the ED staff has called local police to come assist. (Patient #1) is now alert and oriented and carries normal conversation but very aggressive and angry for being admitted ...(Patient #1) trying to leave ER and on her way out the door police has arrived and has taken custody of patient. (Patient #1) has been medically cleared but was previously APOWW 'ed by local police department and will now be released into their custody for suicide attempt." Physician # 1 diagnosis at 1541: "Suicide attempt Drug overdose, initial encounter Altered mental status Orders to Admit 2/1/2015 1542 ...The condition of the patient at this time is stable." History and Physical by Physician #2 (Hospitalist) 2/1/2015 2141 "...Assessment: 1. Suicide attempt 2. Altered mental status 3. Sinus tachycardia with slightly elevated blood pressure. 4. Hyperkalemia 5. Depression 6. Previous history of suicide attempt 7. Alcohol use/intoxication. 8. History of seizure disorder ...Plan: 1. Admit to ICU or telemetry with sitter. Offer stepdown 2. IV fluids, I's and O's 3. N. P. O. (nothing per mouth) 4. CT scan of the head without contrast 5. Monitor for any elevation in blood pressure, heart rate. 6. If getting admitted to the ICU overnight, will have intensivist 's input. 7. We will need inpatient psych once medically stable and cleared for discharge. 8. Lovenox for DVT prophylaxis." Telephone Interview with (Physician #1) on 2/11/2015 at 8:15 PM (Physician #1) stated he does remember this patient and when he came on duty, (Patient #1) was in a treatment room and had been APOWW'ed by the local police department. He stated (Patient #1) was not very alert and was very sleepy when he tried to examine her. (Patient #1) was intoxicated and extremely sleepy and was not able to talk to him or the other staff members. The social worker tried to talk to the patient and perform a psychiatric evaluation but the patient was too intoxicated. He decided that (Patient #1) needed to be admitted so she could be further evaluated and she was a threat to herself. He stated he contacted (Physician #3) and he agreed to admit (Patient #1) to the ICU. When (Patient #1) was admitted , there were no beds available. (Patient #1) remained in the ER for 3 hours waiting for a bed. (Patient #1) became more awake and wanting to leave the ER. (Physician #1) stated (Patient #1) was attempting to leave the ER and an off duty police officer on duty in the ER was called to come sit with the patient...(Patient #1) continued to want to leave the ER. The APOWW was issued by the local police and they were called. The local police came back to the hospital. Since (Patient #1) was an APOWW, the local police took (Patient #1) back into their custody and left the emergency room . Hospital B's medical record for (Patient #1) dated 2/1/2015 revealed the following: The document entitled "Notification of Emergency Detention" dated 2/1/2015 timed at 1:00 PM reflected, "(Patient #1) called a co-worker and told him, 'I can't live like this and asked him to cover work shifts because she would not be around anymore and said, "I've made up my mind, tonight's the night."...for this reason, I present this notification to seek temporary admission to (Hospital A) inpatient mental health facility of hospital facility for the detention of (Patient #1) on an emergency basis." The notes of (Hospital B's) Psych Evaluation on 2/1/2015 at 2320 reflected "(Patient #1) was at (Hospital A) and discharged to police to transport to (Hospital B)...Per (Hospital A) note (Patient #1) was medically cleared before given the patient in police custody...(Patient #1) is not a good historian. It was reported at (Hospital A) that (Patient #1) had overdosed on Adderall but she had reported that it was lamictal when she got here. (Patient #1) reports she had taken the pills to kill herself. (Patient #1) tells me that it was not lamictal or adderall but could not recall the name (so this would be third pill...would report taking.)...crying and tearful now. (Patient #1) reports that reasons she wanted to kill herself are personal and she does not want to tell me now... still feels hopeless at this time and crying. (Patient #1) denies auditory/visual hallucinations...denies feeling anyone is out to hurt or harm her...Axis I: Mood Disorder NOS; Rule out Benzo Dependence; Rule out major depressive disorder ...Recommend inpatient psychiatric hospital, when bed is available." There was no indication that a doctor to doctor consult was initiated by (Hospital A) or that the receiving hospital had capacity and capability to accept Patient #1. "An Order of Protective Custody was completed on 2/2/2015...(Patient #1) will be transferred from evaluating facility (Hospital B) under an Order of Protective Custody (OPC) to receiving facility (Hospital C)...The patient 's mental status examination reveals that she is depressed, she is not very cooperative, she has poor insight and judgment." Cross refer to Tag 2409. |
||
| VIOLATION: APPROPRIATE TRANSFER | Tag No: A2409 | |
| **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on record review and interviews, Hospital A failed to provide an appropriate transfer for 1 of 1 patient (Patient #1) in that the ED staff at Hospital A's Emergency Department (ED) did not contact Hospital B (Mental Health Hospital) to secure an available bed for (Patient #1) who was deemed suicidal and who required inpatient mental health treatment. Hospital A subsequently discharged (Patient #1) to Police custody without ensuring (Patient #1's) mental health needs were met and that the receiving hospital had capacity and capability. Findings included: Review of Hospital A's Emergency department medical record for (Patient #1) dated 2/1/2015 revealed the following: History and Physical by (Physician #1) at (Hospital A) 2/1/2015 14:14 PM "(Patient #1) is a [AGE] year old female who presents to the ED via EMS (emergency medical services) with a friend after intentionally overdosing on likely either Adderall or Xanax per friend. Friend stated the patient had a few beers with him last PM and drove home at 1 AM, then sent him a text indicating suicidal intent a few hours later. Friend states they found the patient lying unconscious on the floor in her apartment, but denies any blood or signs of trauma. Friend states that (Patient #1) attempted suicide in September 2014 by overdosing on Adderall and Xanax (possibly Ambien), which are the only two medications he knows she has at her apartment. There are no other associated symptoms, complaints, or modifying factors at this time...(Patient #1) is lethargic, but responsive to verbal stimulation. Can shake head yes and no. No evidence of trauma...Urine drug screen positive for amphetamines...1505 PM (Patient #1) is awake, alert, and can speak...Rechecked patient. (Patient #1) admits to taking Adderall and is not able to carry on conversation, but still seems confused. Will admit...Spoke to (Physician #2) who is aware of assessment/workup in the ED and agrees to admit the patient...1901 PM (Patient #1) is attempting to leave the ED. Contacted ED security, (Patient #)1 has already been APOWW (arrest by police officer without warrant) by police and the ED staff has called local police to come assist. (Patient #1) is now alert and oriented and carries normal conversation but very aggressive and angry for being admitted ...(Patient #1) trying to leave ER and on her way out the door police has arrived and has taken custody of patient. (Patient #1) has been medically cleared but was previously APOWW'ed by local police department and will now be released into their custody for suicide attempt." Physician #1 diagnosis at 1541: "Suicide attempt Drug overdose, initial encounter Altered mental status Orders to Admit 2/1/2015 1542...The condition of the patient at this time is stable." History and Physical by Physician #2 (Hospitalist) 2/1/2015 2141 "...Assessment: 1. Suicide attempt 2. Altered mental status 3. Sinus tachycardia with slightly elevated blood pressure. 4. Hyperkalemia 5. Depression 6. Previous history of suicide attempt 7. Alcohol use/intoxication. 8. History of seizure disorder ...Plan: 1. Admit to ICU or telemetry with sitter. Offer stepdown 2. IV fluids, I''s and O's 3. N. P. O. (nothing per mouth) 4. CT scan of the head without contrast 5. Monitor for any elevation in blood pressure, heart rate. 6. If getting admitted to the ICU overnight, will have intensivist's input. 7. We will need inpatient psych once medically stable and cleared for discharge. 8. Lovenox for DVT prophylaxis." Telephone Interview with (Physician #1) on 2/11/2015 at 8:15 PM (Physician #1) stated he does remember this patient and when he came on duty, (Patient #1) was in a treatment room and had been APOWW'ed by the local police department. He stated (Patient #1) was not very alert and was very sleepy when he tried to examine her. (Patient #1) was intoxicated and extremely sleepy and was not able to talk to him or the other staff members. The social worker tried to talk to the patient and perform a psychiatric evaluation but the patient was too intoxicated. He decided that (Patient #1) needed to be admitted so she could be further evaluated and she was a threat to herself. He stated he contacted (Physician #3) and he agreed to admit (Patient #1) to the ICU. When (Patient #1) was admitted , there were no beds available. (Patient #1) remained in the ER for 3 hours waiting for a bed. (Patient #1) became more awake and wanting to leave the ER. (Physician #1) stated (Patient #1) was attempting to leave the ER and an off duty police officer on duty in the ER was called to come sit with the patient...(Patient #1) continued to want to leave the ER. The APOWW was issued by the local police and they were called. The local police came back to the hospital. Since (Patient #1) was an APOWW, the local police took (Patient #1) back into their custody and left the emergency room . Hospital B's medical record for (Patient #1) dated 2/1/2015 revealed the following: The document entitled "Notification of Emergency Detention" dated 2/1/2015 timed at 1:00 PM reflected, "(Patient #1) called a co-worker and told him, I can't live like this and asked him to cover work shifts because she would not be around anymore and said, I've made up my mind, tonight's the night...for this reason, I present this notification to seek temporary admission to (Hospital A) inpatient mental health facility of hospital facility for the detention of (Patient #1) on an emergency basis." The notes of Hospital B's) Psych Evaluation on 2/1/2015 at 2320 reflected "(Patient #1) was at (Hospital A) and discharged to police to transport to (Hospital B)...Per (Hospital A) note (Patient #1) was medically cleared before given the patient in police custody...(Patient #1) is not a good historian. It was reported at (Hospital A) that (Patient #1) had overdosed on Adderall but she had reported that it was lamictal when she got here. (Patient #1) reports she had taken the pills to kill herself. (Patient #1) tells me that it was not lamictal or adderall but could not recall the name (so this would be third pill...would report taking.)...crying and tearful now. (Patient #1) reports that reasons she wanted to kill herself are personal and she does not want to tell me now..still feels hopeless at this time and crying. (Patient #1) denies auditory/visual hallucinations...denies feeling anyone is out to hurt or harm her...Axis I: Mood Disorder NOS; Rule out Benzo Dependence; Rule out major depressive disorder...Recommend inpatient psychiatric hospital, when bed is available." There was no indication that a doctor to doctor consult was initiated by Hospital A or that the receiving hospital had capacity and capability to accept Patient #1. "An Order of Protective Custody was completed on 2/2/2015...(Patient #1) will be transferred from evaluating facility (Hospital B) under an Order of Protective Custody (OPC) to receiving facility (Hospital C)...The patient 's mental status examination reveals that she is depressed, she is not very cooperative, she has poor insight and judgment." |
||