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.

Based on record reviews and interviews, the facility failed to ensure that Registered Nursing staff evaluated and documented the appropriate nursing care for 1 of 1 patients (Patient #1) who made allegations of a sexual nature against other patients and staff.

Findings Include:

Record review of the Nursing Notes revealed in part the following information:
8/11/18 @ 1926: SAPD police officer A. Elias, Badge # 159 here to take pt statement, reference case number 335. Info card placed on front of chart.

8/11/18 @2059: Pt has been up and down the hallway cursing, slamming doors, hitting the wall, threatening to "Fuck Up" various staff. Making multiple phone calls going on disorganized rants about someone stealing her insurance, practicing strange religions, and calling her a prostitute. Pt threw a couple of heavy bags into another pt room, frightening the occupants of that room. Haldol 5 mg Im administered at 2043. Monitoring effectiveness of medication at present.

8/17/18 @1945: Sitter at bedside for safety. Upon conversation with pt, pt noted to be alert and orieinted x2. Flight of ideas noted and was noted to also be paranoid with staff. Conversation did not make sense. Pt verbalizes "This man is trying to get me pregnant." Spoke to charge nurse and sitter was changed to a female.

8/17/18 @2020: Pt becoming very anxious and paranoid with staff. Saying we are trying to "Give her cancer and AIDS" in her medication. Also verbalizing staff wants to sexually abuse her. Then rants off about how her mother would abuse her. Noted to be combative. Called security alert. Behavioral Tech, 2 security guards, charge nurse, nursing house supervisor at bedside. Tried to reorient pt to reality but patient continued to be paranoid and inappropriate. Charge nurse gave IM Ativan, and upon doing so, pt tried to get needle and stab nurse with it. Also spitting on staff.

Further review of the nursing record revealed no documentation as to why the police were called out to take a statement from Patient #1 or if the Sexual Assault Nurse Examinier (SANE) was notified of the patient's allegations of sexual assult. Furthermore, there is no evidence that the nursing supervisor was notified or a report of the above allegations made to the Texas Department of Health and Human Services.

Record review of the facility policy entitled: Abuse: Identifying, Documentation, and Reporting of Suspected Abuse, Neglect, and Exploitation, dated 3/2015 revealed in part the following information:

Allegations that occur on hospital premises:
-Allegations include abuse, neglect, mistreatment, or exploitation.

A) Call San Antonio Police to investigate and collect evidence as needed.

B) Report allegation immediately to all of the following:
- Nurse director/ Manager notifies administration and legal as appropriate.
- Treating Physician
-Hospital Administrator in house or on- call
- Quality/ Risk Management

D) If there is an allegation regarding sexual assult or rape contact the appropriate SANE nurse immediately.

E) Submit a prelimenary report to the Texas Department of State Health Services.

In an interview conducted on 8/31/18 at 2:45 pm, the Behavioral Health Administrator confirmed the above findings, and revealed that staff failed to follow the facility policy regarding reporting potential abuse/ neglect.