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MEDICAL CITY PLANO 3901 W 15TH ST PLANO, TX 75075 Nov. 28, 2018

Based on record review and interview, the facility failed to ensure the patient right of a mechanism for timely referral of patient concerns regarding quality of care or premature discharge to the appropriate Utilization and Quality Control Quality Improvement Organization for 1 of 2 discharged patients (Patient #1), in that, Patient #1's family member requested an impartial review of alleged violations of patient rights pertaining to the discharge plan and the facility did not grant/fulfill the request.

Findings included

Patient #1's record reflected:
~ hospitalized [DATE] through 10/26/17 for a life altering traumatic brain injury due to a motorcycle accident.
~ Provided 24/7 - 1:1 sitter care in the hospital after 10/20/17 due to confusion and agitation.
~ "10/23/17 Psychology Consult...judgement, decision making, memory has been affected...denied AH/VH/SI/HI (auditory/visual hallucinations; Suicidal/homicidal ideation) titrate depakote...based on tolerability.
~ 10/25/17 Psychotic and easily agitated...confused speech...impulsive...delusional...injuries: Bilateral frontal/temporal/cerebellar...Active Problems: Deconditioning...psychosis...Unfunded...Plan to discharge home with family, continue family currently refusing to take patient home home...establishing charity bedside commode, wheelchair - family to purchase rolling walker...may need to make patient stable enough for discharge to shelter..."

The Case Manager documentation for Patient #1 reflected:
~ "10/25/17 Patient adamantly refused to go to rehab only wants to go home.
~ Rehab rehab...then denied as pt still had a sister.
~ PT (Physical Therapy) recommended inpatient rehab, day neuro rehab, or 24/7 supervision. ~ SW explained ready for discharge...per their inquiry about putting pt out the front door if they don't pick him up, SW explained that we might arrange pt to go to the Bridge Shelter.
~ 10/24/17 weight bearing left arm...ambulating with rolling walker...mother reported that pt can't afford adult day care... ~ 10/20/17 demonstrates flight of ideas with delusional thinking...mother, father, sis in law described that because of pt's delusional flight of ideas, that pt is not safe to be home alone and that (family) work and that there is not other family to care for pt while they are at work...
~ 10/18/17 SW talked with therapy and patient should be able to go home now.
~ 10/16/17 SW met with family...medically stable and is ready for discharge...Family concerned about his one home during the day to watch him..."

The hospital's 10/25/17 email from Patient #1's sister reflected, "file a brother...patient rights...has a right to an impartial review of alleged violations of patient rights...We request a review...they are putting my brother and family at risk by forcing a discharge, we were threatened...they would drop him off at a homeless shelter. I do not believe he can be cared for at home..."

During an interview on 11/28/18 at 9:18 AM, Personnel #1 was asked for the impartial review for the 10/25/17 emailed request. Personnel #1 stated, "It (request for review) was not identified at the time." Personnel #1 was asked the process to complete the impartial review. Personnel #1 stated, "We don't have a policy for that."

The facility's undated, "Patient Rights" handout required, "Protective Services...impartial review...of alleged violations of patient rights..."

The facility's 10/01/14 "Patient Rights" policy required, "treat all patients with respect and dignity...ensure that there is no harassment, discrimination...discharge of patients...payment source or ability...provide each patient with a written statement of patient rights at registration and AGAIN AT THE TIME any patient or patients representative has questions regarding their rights..."