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.

Based on interview and review of documents, it was determined that the hospital failed to provide Patient #1 with a written notice that contained the name of the hospital contact person, the steps taken on behalf of the patient to investigate the patient's grievance, the results of the grievance process, and the date of completion. The hospital's failure to do so resulted in Patient #1 losing her/his right to have the information regarding the grievance resolution and potentially placed all patients of the hospital, whose complaints had not been resolved through the grievance process, at risk for loss of their rights.

Findings include:

On 4/14/2014, the hospital was asked to provide a "list of all allegations/complaints/grievances/reports involving sexual assault in the hospital from November 2013 through the present..."
The list and documentation of the hospital's processing of all reports and allegations were reviewed and the name of Patient #1, who had reported a sexual assault by a hospital employee to the hospital in December, 2013, was not on the list of reported grievances

An Assistant Administrator (AA #1) was asked to provide documentation of how the hospital had processed the patient's allegations through the grievance process. AA#1 stated that the patient's allegations had been processed through the risk management process, and not through the grievance process.

On 4/17/2014, the Director of Patient Relations stated that the patient's allegations were not processed through the grievance process and the Patient Relations Department had not been told to investigate the allegations. S/he stated that a Risk Manager, who was no longer with the hospital, had processed the allegation through the Risk Management department. The Director acknowledged that the patient had not received written acknowledgement of her/his allegation/grievance and had not received a letter that described the hospital's final determination on the allegations.

The Director stated that some allegations/grievances were processed through the complaint and grievance process, and some were processed through the Risk Management department. S/he acknowledged that it would be possible to process a patient allegation/grievance through the Risk Management and grievance processes simultaneously. The Director also acknowledged that the patient's allegation of sexual assault by a hospital employee met the hospital's definition of a grievance as defined in hospital policy.

Review of the hospital's policy and procedure "Patient Complaints and Grievances" revealed the following:

...Grievance:...All written or verbal complaints regarding abuse, neglect or patient harm..."

The policy contained the following directives:
"II Grievance Process
...Grievances will be resolved in a timely manner. A timeframe for resolution is set at time of contact and is determined by the nature of the issue to be investigated. If the grievance cannot be resolved within 7 business days, patients will be notified in writing of the receipt of their grievance and a timeframe for resolution. The full investigation and resolution process should not exceed 30 business days from receipt of the grievance. If a grievance requires additional time for resolution, a timetable for resolution will be made with the input of the patient and HMC staff.

Patients will be notified of the resolution of their grievance in writing..."

Reference citations written under Tag 0144
Based on interview and review of hospital documents, it was determined that the hospital failed to ensure that all patients received care in a safe setting. The hospital's failure to dos so potentially placed all patients in the hospital at risk for unreported abuse/neglect.

Findings include:

Failure to Report Allegation of Sexual Assault to Local Law Enforcement
The Department of Health received a complaint that Patient #1's report of a sexual assault, by a hospital employee, in December, 2013, had not been reported to the Seattle Police Department (SPD).

On April 17, 2014, an Assistant Administrator (Assistant Administrator #3) stated that s/he had not contacted the SPD. S/he stated that upon becoming aware of the patient's allegation, the hospital followed the complaint and grievance policy for processing the hospital's internal investigation of the allegation.

Review of the policy and procedure (P&P) "Patient Complaints and Grievances" revealed a document that described the process for complaints and grievances. The P&P had 4 attachments.

Attachment #1 - Directed staff to contact the Administrator on Call (AOC) if the complaint/grievance involved alleged sexual misconduct by staff.
Attachment #2 - Directed the AOC "...if patient/family wishes to involve the police, notify Director of Security Services that Seattle Police Department will be involved.
Security Services in turn was directed "If notified that patient/family wishes to file a police report with SPD, director will coordinate that interaction".
Attachment #3 - Directed staff to "Report to DOH if required...". The directions did not specify what circumstances should be reported to the DOH [Department of Health].
Attachment #4 - Did not give additional direction on reporting.

The CNO, both Assistant Administrators and the Associate Administrator acknowledged that a patient or patient's family could have personal reasons for choosing to not notify local law enforcement of a sexual assault, or any other incident, which occurred in the hospital. However, if the patient/family chose not to report, and the allegations against the perpetrator were true, then the hospital was potentially placing all patients in the hospital at risk for additional harm from the perpetrator.

Review of the hospital's P&P "Abuse/Neglect: Vulnerable Adults" revealed the following:

In accordance with Washington State law, Harborview Medical Center (HMC) reports obvious or suspected abuse, exploitation and/or negligent treatment, and/or abandonment of vulnerable adults...The Social Work Department follows HMC policy and adheres to state law in reporting the abuse/neglect of vulnerable adults...

..The report must be made to the appropriate law enforcement agency or the Washington State Department of Social and Health Services (DSHS) at the first opportunity, but in no case longer than 48 hours after there is reasonable cause to believe that a vulnerable adult has suffered abuse or neglect..."

All Harborview employees are mandated reporters. However, mandated reporting is typically coordinated by social work...

Social Work coordinates the report of all obvious or suspected abuse of a vulnerable adult to DSHS Adult Protective Service (APS) and DOH as appropriate..."

The only required reporting to the DOH, per the P&P was "...obvious or suspected abuse/maltreatment of vulnerable adults that may have occurred in another hospital..."

The P&P did not direct reporters who learned of allegations of abuse and neglect that occurred within Harborview Medical Center, to notify the DOH.

The P&P also stated:
"For Sexual Assaults:
If the assault occurred less than 96 hours ago coordinate with the Emergency Department to ensure the appropriate process for assessment, evidence collection, medical care, police reporting and counseling."

The P&P repeatedly instructed the reader to refer to DSHS [Department of Social and Health Services].
Discussion was held with the Associate Administrator and Assistant Administrators #1 and #3 about the role and regulatory authority of DSHS and the Department of Health. Clarifying discussion was held about which regulatory body had authority in hospitals (DOH) and which regulatory body had authority in residential care settings (DSHS).

The hospital's failure to follow it's current policy for the reporting of sexual assaults, as well as the failure to develop and implement a correct policy and procedure for the reporting of allegations of sexual assault may have contributed to the alleged sexual of Patient #1 not being reported to the Seattle Police Department or to the DOH.