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.

THE MONROE CLINIC 2005 5TH STREET MONROE, WI 53566 Dec. 20, 2017
Based on record review and interview in 1/10 medical records reviewed out of a sample of 10 the facility failed to ensure that the patient (#1) understood the risks of refusing treatment.

Findings include:

Medical records for #1 reviewed on 12/19/2017. Patient Care Summary (PCS) flowsheet lists that "Hygiene Care" which includes bathing/skin care, oral care, and perineal care was provided to #1 during inpatient stay from 9/2-9/15/2017 except when refused. PCS flowsheets states #1 refused cares on following dates:

9/6/2017: 1020 Refused oral care; 2115 Refused bathing, skin care, oral care, perineal care
9/7/2017: 1821 Refused bathing, skin care, oral care, perineal care
9/8/2017: 2000 Refused oral care.

Reviewed nursing progress notes on 12/19/2017. Nursing progress note dated 9/9/2017 at 2051 states "Spoke to Dr ...about pressure area to L buttocks and that mepilex was applied ..."

12/20/2017 review of policy "Patient Rights and Responsibilities" policy #RI-044-EthC page 3 under Refusal of Treatment states: "The patient has the right to refuse treatment to the extent permitted by law and to be informed of the consequences of such refusal ..." The medical record for #1 contained no documentation that staff informed #1 of consequences of refusing hygiene care.

Interview with Quality Director B on 12/20/2017 at 1:30 pm regarding lack of documentation reflecting #1 was informed of the consequences of refusing bathing, skin, oral and perineal care. B confirmed the findings and stated "We cannot find any documentation, this may be a teaching opportunity for us."