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.

BRYNN MARR HOSP 192 VILLAGE DRIVE JACKSONVILLE, NC 28540 May 23, 2013
VIOLATION: PATIENT RIGHTS: NOTICE OF RIGHTS Tag No: A0117
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on hospital policy and procedure review, medical record review, job description and personnel record review, document review, and physician and staff interviews, the facility staff failed to obtain consent for notification of patient's rights and consent for treatment for 2 of 11 patients (Patient #1 and Patient #9)

The findings include:

Review of the hospital's policy and procedure "Patient's Bill of Rights" revision date 10/2012 revealed "the written "Patient's Bill of Rights" will be given to the patient and discussed with him/her in a manner consistent with the patient's or legal guardian's level of comprehension upon admission but no later than 72-hours after admission, with a copy obtained by patient and legal guardian. The patient and/or legal guardian will sign in black ink an acknowledgement of receiving and understanding the Bill of Rights...the signed acknowledgement will be retained within the medical record. 2. In the instance of a minor and an adult patient having a legal guardian, the guardian has the authority to exercise rights on behalf of the patient ...II. L. the right to full information in laymen's terms, concerning diagnosis, treatment, and prognosis, including information about alternative treatments and possible complications. When it is not possible or medically advisable to give such information to the patient, the information shall be given on his behalf to the patient's designee ...P. Except in emergencies, the physician must obtain the necessary informed consent prior to the start of any procedure and/or treatment..."

1. Open medical record review on 05/22/2013 of Patient #1 revealed a [AGE] year old female by IVC (involuntarily commitment) admitted on [DATE] with the diagnosis of psychosis. Review of the medical record revealed a Patient's Right and a Consent for Treatment forms. Continued review revealed the documents were not signed by the patient or the legal guardian and no documentation that attempts were made to call the legal guardian for consent.

Interview with the Administrative staff on 05/22/2013 at 1015 revealed "per our policy we do obtain consent even for the patient's who are IVC'd. Either the patient or guardian should sign the Patient's Right form and the general consent form. If the guardian is with the patient when they are admitted ...then they sign the Patient's Rights and Consent for treatment at that time. If the guardian is not with them then the admissions clerk is suppose to call and get phone consent ...If the admissions office is unable to reach the guardian at the time of admission they will document it on the form and the nursing staff is suppose to get consent the first time they call for medication consent ...I do not see a signature on the Patient's Right form or treatment consent nor do I see where they attempted to get a phone consent." Interview confirmed the hospital staff failed to obtain consent for patient's rights and treatment.

2. Closed medical record review on 05/22/2013 of Patient #9 revealed an [AGE] year old male admitted on [DATE] by IVC with diagnosis of mood disorder and suicidal ideations. Review of the medical record revealed a Patient's Right and a Consent for Treatment forms. Continued review revealed the documents were not signed by the legal guardian and no documentation that attempts had been made to call the legal guardian for consent for treatment.

Interview with the Administrative staff on 05/22/2013 at 1015 revealed "per our policy we do obtain consent even for the patient's who are IVC'd. Either the patient or guardian should sign the Patient's Right form and the Consent for Treatment form. If the guardian is with the patient when they are admitted ...then they sign the Patient's Rights and Consent for treatment at that time. If the guardian is not with them then the admissions clerk is suppose to call and get phone consent...If the admissions office is unable to reach the guardian at the time of admission they will document it on the form and the nursing staff is suppose to get consent the first time they call for medication consent ...I do not see a signature on the Patient's Right form or treatment consent nor do I see where they attempted to get a phone consent." Interview confirmed the hospital staff failed to obtain consent for patient's rights and consent for treatment.

NC 584, NC 108