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KALAMAZOO REGIONAL PSYCHIATRIC HOSPITAL 1312 OAKLAND DR KALAMAZOO, MI 49008 Feb. 11, 2014
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
Based on record review and interview the facility failed to recognize the communication rights of 1 of 1 patients (patient #9), placing all patients at risk of loss of communication rights. Findings include:

Policy Review:
Was conducted on 2/11/14 at 5:20 pm.
Communication and Visits, dated 5/14/10, states:
3. "The recipient's right to communicate by mail or telephone or receive visitors shall not be limited further except as authorized in the individual plan of services. Each limitation must be essential for one of the following reasons:
a. To prevent physical or emotional harm to the recipient or others, or
b. To prevent a violation of law."
4. "Any limitation on the recipient's right to communicate by mail or telephone or to receive visitors shall be reviewed by the hospital/center Behavior treatment Committee unless the target behavior is due to an active substantiated Axis I psychiatric diagnosis listed in the DMS-IV-TR..."
5. "Any limitation of a recipient's right to mail, telephone use or visits shall include the following:
a. Documentation of the justification for the limitation and that it is essential to achieve the purpose for which it was proposed
b. The date of the planned review and expected expiration date.
c. Recipient notification, including rational..."

Record Review:
On 2/11/14 from 1:00-4:15 pm review of patient #9's clinical record revealed the following:
1. A physician's note, by Dr. staff L, dated 10/10/13, listing complaints against the patient and his father. No other family members were discussed in the note. The note states: "All family members are on visitor restrictions." It does not state that these restrictions were discussed with the patient nor was there documentation for a rational for restricting "all family visits."
2. A physician's order, dated 1/17/14, stating: "Phone restrictions from father disruptive to therapy in hospital." This restriction was dated 12/27/13 and documented that patient #9 was informed of the restriction on 12/27/13 but it was not signed as "approved" by the Unit Director/Physician until 1/17/14.
3. A physician's note (physician H) dated 12/11/13 states: "Speak with pt (patient #9) about if he wants his father to come in, also speak to treatment team."

On 2/11/14 at approximately 4 pm an e-mail from patient #9's social worker, staff N, was reviewed. The e-mail, dated 12/13/13 states: "On 12/9/13 this week I spoke with (patient #9's) guardian...They informed me that they gave a verbal authorization to restrict all contact over the phone to one of the nurse's but could not provide a date or name- I believe this may be why we had reports or restricted contact a couple weeks ago...after some discussion, they came to the conclusion that the best course of action would be to revoke the current authorization and to restrict all contact between (patient #9's father) and his son..."
There was documentation explaining why the patient's guardian was being asked to impose visit and phone restrictions since physician H's plan (on 12/11/13- above) was to discuss restrictions with the patient and team.

Interviews:
1. On 2/11/14 from 1:00-4:15 pm patient #9's record review (noted above) was confirmed by Nurse M.
2. On 2/11/14 at approximately 12 noon Nurse M and physician H stated that there had been confusion among staff regarding the status of patient #9's restrictions for visits and phone calls.
3. On 2/11/14 at 3:05 pm administrator A stated that the patient's restrictions on phone use and visits would not need to be reviewed by the hospital's Behavioral Treatment Committee. It was unclear why this was true for phone use based on the policy (above).