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.

EVERGREEN HEALTH MONROE 14701 179TH SE MONROE, WA 98272 Aug. 14, 2017
VIOLATION: PATIENT RIGHTS Tag No: A0115
Based on interview, record review and review of facility policies and procedures the facility failed to ensure a patient's rights were protected.

Failure to ensure patient rights are protected puts patients at risk for unmet care needs and mental health harm.
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**




Based on interview, record review and review of facility policies and procedures the facility failed to protect a patient (Patient #1) from abuse and neglect.

Failure to protect patients from abuse and neglect puts patients at risk for physical harm and mental anguish.

Findings include:

1. The facility "Patient Rights and Responsibilites" dated 6/23/17, stated "Courteous and respectful treatment of person and property, privacy, and freedom from abuse and discrimination."

2. A contact for Patient #1 was interviewed by telephone on 8/9/17 at 8:30 AM by the surveyor. The contact stated they had viewed on several occasions' staff ignoring answering the patient's call lights and withholding meals unless the patient did the exercises first or sat up in the chair. The patient also had their television turned off during the day if they did not participate in physical therapy.

3. Patient #1 was interviewed on 8/10/17 at 9:30 AM. The patient stated the facility staff began treating them poorly when the patient refused to be discharged back to their home on 7/13/17.
The patient had come to the hospital on [DATE] after their family was unable to provide the level of care the patient required. The patient stated the attitude of the staff became rude with some staff making comments that she did not need to be in the hospital. If she asked to get up later than what the staff felt she should they would tell her she would not get her meal tray.

The patient was not asked about how she felt about her care plan. The patient stated she was told by the physician, nurse manager and one staff nurse unless she followed the plan she would not get to watch televsion (TV) or her meal trays.

The patient call lights were ignored at times and she would only get her calls for help answered at specific times during the shift. The patient went on to say she agreed with the plan of care but disagreed with the fact she could not change the time she got up and did her exercises.

4. Record review revealed the hospitalist progress note dated 7/20/17 read in part
"Patient will have her toileting, medication, and safety needs met however no other visits from RN/aide for fan changes, moving pillows, etc other than at prescribed times during the day".

Care plan dated 7/26/17 stated "No telephone in reach, patient can receive calls then take away essentially not to be at patient side for constant use. Limit going in to room only for safety needs, hygiene needs, and chair to bed transfers and delivery of food trays. Non-emergent/safety needs need to be addressed at meal times. Limit speaking with patient. No small talk, no personal talk. Professional necessary interaction only."

On 8/4/17 the hospitalist entry read "lights on, TV and crosswords/books available while in chair however TV can be turned off if patient not complaint with care plan. When patient pushes the call light staff will check on her safety however non-urgent requests will wait until the next mealtime check in, patient can use the call light when needing prn (as needed) medications, during the night patient will have a check in three times for non-urgent requests".

5. The above information was verified with Staff C (nurse manager) on 8/10/17 at 11:00 AM. The manager stated the above interventions were intended to help the patient comply with their plan of care.

6. Patient #1 was interviewed on 8/14/17 at 8:30 AM. The patient stated after the state surveyor visit the patient was now allowed to have 24 hour access to her TV, chose the time she wanted to get up and perform their exercises.
VIOLATION: PATIENT RIGHTS: PRIVACY AND SAFETY Tag No: A0142
Based on interview, record review and review of facility policies and procedures the facility failed to implement safety measures to protect a patient (Patient #1) from verbal abuse.

Failure to protect patients from verbal abuse causes patient mental anguish and possibly puts patients at risk for psychological harm.

Findngs include:

1. The facility policy titled "Criteria for Identifying and Reporting Victims of Abuse or Neglect", approved 7/25/16 read in part abuse needed to be reported to the appropriate management staff and to the Department of Health hotline.

2. On 8/14/2017 at 8:30 AM, Patient #1 was interviewed. The patient stated the licensed nurse on duty on 8/8/17 was especially rude to her after she was incontinent of her bowels. The nurse told her she would lose her TV privileges becasue of the incontinence. The nurse was always rude but on this day there was a witness to the incident.

3. On 8/14/17 at 9:30 AM Staff E (Nursing Assistant) was interviewed. Staff E stated they heard the licensed nurse say to Patient #1 because of of being incontinent of their bowels they would lose their TV privileges. The nurse was rude but Staff E did not report this to anyone but acknowledged this was not acceptable to treat patients in this manner.

4. On 8/14/17 at 10:00 AM Staff D (Chief Quality Officer) stated incidents of patient abuse which included being rude to the patient needed to be reported to managment for investigation and the Washington State Department of Health as appropriate.