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 observations on the Behavioral Health Unit (BHU), it was determined that no rights were posted or distributed which gave advocacy information; and patients were not informed of the method for lodging a complaint or grievance to advocacy services or the State Agency.

Observations on the BHU revealed that, unlike the hospital medical units, no information was posted or distributed to patients related to how to lodge an internal or external complaint or grievance. Interview with the unit RN manager revealed that patients could lodge complaints/grievances with staff who would handle complaints, and forward grievances to the appropriate hospital department. However, no patient information directing patients to staff in order to lodge grievances was found, nor was contact information for the complaint department given. Additionally, no provision was made for resolving conflicts of interest arising from complaints/grievances which might be against staff.
Based on a review of the Behavioral Health Unit (BHU) Patient Bill of Rights, and RN interview, it was determined that irrespective of clinical status, all BHU patients were required to wear location badges and, those who objected were coerced to remain in hospital gowns.

Review of the BHU Patient Bill of Rights revealed in part, "The patient has the right to know what hospital rules and regulations apply to his/her conduct as a patient."

Observations on the BHU on 1/9/2019 revealed a locked unit with a census of 14 patients. Staff physically conduct rounds every 15 minutes to confirm each patients' location and safety. Discussion with a staff RN revealed that all patients were asked to wear RFID badges which continuously showed their location on the unit. This unit requirement applied to all BHU patients, irrespective of clinical status. When queried about patients who refused to wear a badge, the RN stated that patients who refuse to wear location badges must remain in gowns. No policy related to this practice was found.

While cooperation with staff to wear location badges may be desirable, staff should not condition the patient right to wear their own clothing solely on compliance with location devices, especially on a unit where ingress and egress are controlled. Patient refusals to wear a location badge failed to demonstrate any correlate to a specific adverse clinical status. Therefore, the mandated wearing of hospital gowns by the objecting patient lacked clinical justification and was coercive.
Based on review of 6 open records 4 closed records, interviews, requests for contracts, orientation and training it was determined that the hospital failed to 1) define contracted police roles within the hospital; 2) define hospital oversight of police; 3), train police in healthcare restraints which would meet clinical oversight requirements; 4) orient police to hospital regulatory requirements related to patient access; and, 5) provide policy guidance related to the use of, and retention by contracted police officers of law enforcement weaponry including cuffs, tasers, batons, pepper spray, and guns.

Interview with Security staff at approximately 1000 on 1/9/19 revealed that the hospital had contracted town police for security duties between the hours of 7 pm and 3 am. A request for the contract and job description revealed that no job description and no contract had been developed.

Subsequent interview with the Director of Security on 1/9/19 at 1210 revealed that the hospital had a "Verbal contract" for an approximate year with town police, who the Director stated were a "Visible deterrent to unruly persons in the emergency department." However, the police were expected to intervene with unruly persons when asked and when observing such persons.

An orientation packet was provided by which contracted police were to be oriented. However, no evidence of actual orientation or contractor personnel files for each police officer were produced. Additionally, no police training was found related to each patient's right to access medical care, and there was no apparent expectation that contracted police would be required to have training in the therapeutic and safe use of healthcare restraints. Additionally, since it was not within the scope or skills of contracted police to determine who was and who was not a patient, contracted police could, with free agency, restrain a patient without clinical oversight, or deter a patient from seeking medical care.

A request for a "Use of Force" policy revealed no such policy or other similar policy existed by which the hospital governs the use of police weaponry carried by officers inclusive of cuffs, Tasers, batons, pepper spray and guns. In summary, while no adverse events were noted, the hospital could not assure patient safety where the hospital provided scant oversight for police actions, and the contracted officers lacked training and clinical oversight.
Based on a review of patient #1's record, it was determined that clinicians failed to document P1's history of kidney disease in the History and Physical (H&P). This failure to include important diagnostic information was carried through to the rest of the documentation in the medical record.

Patient #1 (P1) was an 80+ patient who presented to the emergency department in June 2018 with worsening shortness of breath and weakness. P1 was admitted . A H&P was completed the following day which cited sources of "the patient, the chart, and staff." The H&P documented in part, the "History of the Present Illness" and "Past Medical History." Review of the Past Medical History revealed no documentation of a history of kidney disease which could have informed discussions regarding the risks and benefits of computed tomography (CT) with contrast which P1 had following admission.