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.

JOHNSON CITY MEDICAL CENTER 400 N STATE OF FRANKLIN RD JOHNSON CITY, TN 37604 July 30, 2018
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on review of facility policy, medical record review, review of facility documentation, and interview, the facility failed to report an allegation of abuse timely for 1 patient (#7) of 3 patients reviewed for abuse.

The findings included:

Review of facility policy "Child Abuse and Neglect/Child Sexual Abuse, Protection and Reporting, Tennessee" last reviewed 12/5/17 revealed "...purpose: to define the process for assisting team members in recognizing, identifying, and caring for victims of suspected or known abuse neglect...any allegation, observation, or suspected case of abuse that occurs...should be reported immediately to a facility supervisor and to the attending physician or designee..."

Medical record review of revealed Patient #7 was admitted to the facility on [DATE] with diagnoses including Right Lower Quadrant (RLQ) Pain and was discharged home on 2/2/18.

Medical record review of a Physicians Order dated 2/2/18 revealed "...Fleets Enema [mineral enema] one time..."

Review of a facility investigation dated 2/2/18 revealed Registered Nurse (RN) #1 (male) asked Patient #7 if she would like a female RN to administer the fleets enema and the patient said yes. Further review revealed "...[RN #1] made a bad joke about sticking something up an ass and squirting water in it..."

Interview with the Pediatric Unit Nurse Manager, on 7/23/18 at 10:15 AM, in the conference room, revealed "...[RN #1] jokingly went into the patient's room and was joking around with the patient and the family...he [RN #1] told the patient the physician had ordered a fleet's enema and asked [Patient #7] if she wanted him to give the enema or have a female nurse administer it...the patient told him she wanted a female to give the enema...[RN #1] said to the patient 'oh shucks, I was looking forward to putting it in your ass'...he got the female nurse to administer the enema..." Further interview revealed "...[RN #2] said [RN #1] told her what he had said to the patient and said ' I should have not said that to her'...when [RN #3] was in the room the next morning, the patient's mother told [RN #3] what [RN #1] said...She [mother] stated the nurse's comment was very inappropriate for a male nurse to say that to her daughter..." Continued interview confirmed RN #2 failed to report the incident to the facility.

Interview with the Nurse Manger of the Family Birthing Center, on 7/23/18 at 11:30 AM, in the conference room, revealed "...[RN #2] said that [RN #1] asked her to give the enema at the patient's request...he told her he said something inappropriate to the patient...[RN #2] said he told her what he had said to the patient...something about putting a hose up her ass...she [RN #2] did not report it to anyone..."

Telephone interview with RN #3 on 7/23/18 at 12:00 PM revealed "...the patient's mother told me about the conversation with [RN #1] which occurred earlier in the morning...[RN #1] said to the patient 'I was looking forward to shoving that up your ass'...she said the comment was very inappropriate..."

Interview with the Director of Quality Management on 7/23/18 at 2:30 PM, in the conference room, confirmed RN #2 failed to report the incident to the facility.

Telephone interview with RN #2 on 7/25/18 at 10:05 AM revealed "...just as I was going into the patient's room [RN #1] met me in the hallway and said he may have said something inappropriate to [Patient #7]...he said 'darn, I wanted to stick a hose up your ass'..." Further interview confirmed the nurse did not report the incident timely to a supervisor.