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.

RHODE ISLAND HOSPITAL 593 EDDY STREET PROVIDENCE, RI 02903 April 9, 2018
VIOLATION: PATIENT RIGHTS: INFORMED CONSENT Tag No: A0131
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on record review and staff interview it has been determined that the facility failed to afford the patient or his or her representative the right to make informed decisions regarding his or her care for patient ID #1.

Findings are as follows:

Clinical record review for patient ID #1 revealed the patient was admitted on [DATE] for acute mania resulting in hyponatremia and subsequently developed catatonia. The patient's record revealed his/her catatonia, and decreased renal function required aggressive treatment with ECT (electroconvulsive therapy) and medications.

The patient's record revealed, the pateint was unable to make informed decisions due to his/her catatonia. The patient's spouse signed a consent form on 2/4/18 for the ECT treatments to be administered. The form also revealed the consent may be revoked at anytime during the ECT protocol. The family was unable to produce evidence of Power of Attorney for the patient, therefore the patient's spouse was the surrogate decision maker.

The record revealed attempts were made to decrease the frequency of ECT treatments, however, when the treatments were decreased, the patient demonstrated catatonia spectrum symptoms. The record revealed on 3/26/18 the pateint refused ECT treatment "as urged by family, without articulation for reason for refusal." The pateint continued to receive ECT treatments after this date. The note further revealed a family meeting was held the previous Friday in which the patient's spouse "..makes clear that he/she is the surrogate decision maker and would like to proceed with ECT."

The record revealed on 3/27/18 the patient's daughter did not want the patient going to ECT. The physician's note further revealed "..Daughter stated that her dad was "scared into saying yes" to ECT during last family meeting." When the patient's spouse was asked directly if he/she wanted ECT, he/she responded, "I want whatever the doctors think is best." A note dated 3/29/18 revealed a refusal for ECT treatments by the patient's spouse.

The hospital Ethics Committee was consulted on 3/30/18, and the case was discussed with the Chief of Psychiatry. Review of the Ethics Committee Consultation dated 3/30/18 revealed the team felt the patient "...would continue to decompensate unless he/she undergoes continuing ECT treatments, eventually tapered from 3 times per week to 2 times per week." The committe recommended to continue ECT treatments that are in the best interest of the patient. A physician progress note dated 3/31/18 revealed, "Must proceed to ECT on Monday morning even if family ojects.." An ECT treatment was administered on 4/3/18 and 4/5/18; the patient was discharged on 4/6/18.

When interviewed via phone on 4/9/18, the patient's spouse revealed he wanted them to stop treatments, but they continued. He was unsure of how many treatments were administered when he wanted them to stop.

The hospital did not afford the patient or his or her representative the right to make an informed decision regarding care, relative to the administration of ECT treatments for the patient.