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.

GOOD SAMARITAN HOSPITAL FOURTH AND WALNUT STREETS LEBANON, PA 17042 May 8, 2019
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
Based on review of medical records (MR), facility documentation and staff interview (EMP), revealed the facility failed to ensure that each patient received care in an environment that protected the patient's emotional and physical safety.

Findings include:

A review of the medical record (MR1), revealed the Patient was admitted to the Emergency Department on April 26, 2019. "ED Care Timeline......03:50 ED Note Patient was triaged when the Patient made threats to harm triage nurse. Charge nurse notified. Patient was brought back to SH 1 so staff could do EKG. Patient sat down on bed two minutes later Patient gets up. Patient stated 'I do not feel comfortable here. I need to be somewhere else and raises his voice.' Patient threw chair across hall and started kicking stretcher and cabinets and threatening staff. Security notified and police. Security on scene to restrain Patient deployed pepper spray in order to do so. Patient was restrained in handcuffs and brought to Room 25 where police came to interview the Patient and staff.

HPI: Patient presents to the emergency department stating that the Patient has a problem with substance abuse and is going to kill the girlfriend. Patient was taken back to a stretcher where the Patient began to become very violent and started breaking things in the emergency room and threatening staff. Security on scene to restrain Patient and deployed pepper spray in order to do so. Police were notified and Patient will be taken into police custody... ED Course & MDM: At this time Patient is a threat to staff and a danger to the emergency room environment. The Patient will be taken into custody by PD at this time. After reassessment in speaking with PD is deemed necessary for patient to be seen by crisis prior to any release. Crisis evaluated Patient and thinks the Patient needs to be brought in on a 302. Due to Patient being continuously aggressive and psychotic, is in restraints and given medication to help calm down. Case endorsed to Dr _____(name redacted) pending medical clearance and placement." Further review of MR1 did not reveal documentation of consideration to use of the least restrictive intervention prior to the use of the pepper spray and handcuffs.

A review of facility policy revealed "...Title: Handcuffs, review date: 8/18...Policy: It shall be the policy of the Security Department to have in place a procedure for the proper application and use of handcuffs...II. General Information: a. Wellspan Good Samaritan Hospital has authorized the use of handcuffs by its Security force. b. Security Officers shall be trained in the use of handcuffs as well as their applications...IV. Procedures: Note: Handcuffs are not to be used on any patient as a means of control or restraint unless said patient has committed a criminal act and continues violent, dangerous behavior. 1. Handcuffs can be used: a. To temporarily restrain a person (nonpatient) who demonstrates a clear and present danger or threat to themselves or others. b. Handcuffs are to be applied in response to felonious criminal behavior only. c. to restrain those who are known to have committed a felony. d. As a temporary restraining device until the person can otherwise be brought under control and or turned over to local police..." This policy is not in alignment with CMS standards that law enforcement devices can not be used for health care interventions.
VIOLATION: USE OF RESTRAINT OR SECLUSION Tag No: A0154
Based on a review of facility documentation and medical records and interview with staff, the facility failed to ensure that least restrictive measures were attempted prior to the use of pepper spray and handcuffs which were used to restrain MR 1.

Findings include:

A review of facility policy revealed "...Title: Handcuffs, review date: 8/18...Policy: It shall be the policy of the Security Department to have in place a procedure for the proper application and use of handcuffs...II. General Information: a. Wellspan Good Samaritan Hospital has authorized the use of handcuffs by its Security force. b. Security Officers shall be trained in the use of handcuffs as well as their applications...IV. Procedures: Note: Handcuffs are not to be used on any patient as a means of control or restraint unless said patient has committed a criminal act and continues violent, dangerous behavior. 1. Handcuffs can be used: a. To temporarily restrain a person (nonpatient) who demonstrates a clear and present danger or threat to themselves or others. b. Handcuffs are to be applied in response to felonious criminal behavior only. c. to restrain those who are known to have committed a felony. d. As a temporary restraining device until the person can otherwise be brought under control and or turned over to local police..." This policy is not in alignment with CMS standards that law enforcement devices can not be used for health care interventions.

A review of facility policy " Pepper Defense Spray, reviewed 8/18, revealed "...The hospital has issued, and approved the use of, chemical agents by hospital Security Officers. This will provide them with a way to defend themselves and will also be capable of controlling any individual or individuals when an Officer is facing active aggression...The proper use and carrying of Pepper Defense Spray are as follows; 1. Qualified Security Officers shall carry defense spray at all times while on duty. 2. Only Security Officers that are formally trained in Oleoresin Capsicum Spray will be allowed to carry defense spray...6. Officers using defense spray will notify Police and appropriate charges will be filed against the offending subject...". This policy is not in alignment with CMS standards that law enforcement devices can not be used for health care interventions.

A review of the medical record (MR1), revealed the Patient was admitted to the Emergency Department on April 26, 2019. "ED Care Timeline......03:50 ED Note Patient was triaged when the Patient made threats to harming triage nurse. Charge nurse notified. Patient was brought back to SH 1 so staff could do EKG. Patient sat down on bed two minutes later Patient gets up. Patient stated 'I do not feel comfortable here. I need to be somewhere else and raises his voice.' Patient threw chair across hall and started kicking stretcher and cabinets and threatening staff. Security notified and police. Security on scene to restrain Patient and deployed pepper spray in order to do so. Patient was restrained in handcuffs and brought to room 25.
HPI: Patient presents to the emergency department stating that the Patient has a problem with substance abuse and is going to kill the girlfriend. Patient was taken back to a stretcher where the Patient began to become very violent and started breaking things in the emergency room and threatening staff. Security on scene to restrain Patient and deployed pepper spray in order to do so. Police were notified after the patient was pepper sprayed. ED Course & MDM: At this time Patient is a threat to staff and a danger to the emergency room environment. The Patient will be taken into custody by PD at this time. After reassessment in speaking with PD is deemed necessary for patient to be seen by crisis prior to any release. Crisis evaluated Patient and thinks the Patient needs to be brought in on a 302. Due to Patient being continuously aggressive and psychotic, is in restraints and given medication to help calm down. Case endorsed to Dr _____(name redacted) pending medical clearance and placement.
An interview conducted on May 7, 2019 with EMP6 revealed, "we got a telephone call from the Emergency Department that a patient was threatening staff. One of the Emergency Department staff ran to the Security Office to get us. We went to the Emergency Department and the patient was threatening towards staff. The patient threatened to punch us and grabbed an IV pole and was swinging it around. At that point I upholstered my pepper spray. The patient then put the pole down, so I reholstered my pepper spray. The patient continued to grab at staff and objects in the room. Grabbed the blood pressure machine and did place my partner into a head lock. The pepper spray was deployed and the patient was handcuffed. The police then arrived and placed the patient into their handcuffs. The patient was taken to the Decon room. The patient continued to fight and spit on staff. After the patient was deconned the patient was walked to room 25 (the psychiatric area in the ED). The patient continued to fight and was placed into restraints.
An interview conducted on May 7, 2019 with EMP5 revealed that the police refused to take the patient because the police said if we take the patient to central booking we would have to bring the patient back in 10 minutes due to the behaviors. Security remained at the patient's bedside until the patient was transferred to another facility.
An interview conducted on May 6, 2019, with EMP1 revealed that patient was pepper sprayed and placed in handcuffs. Further interview revealed the patient was handcuffed by the local police but was released and remained at the facility until transferred to a psychiatric facility.

This incident revealed that pepper spray and handcuffs were used by facility security staff, in the application of a restraint, as a healthcare intervention and not as part of a law enforcement action.
VIOLATION: PATIENT RIGHTS Tag No: A0115
Based on review of facility documentation, medical records (MR), and staff interview (EMP), revealed the facility failed to ensure that each patient's rights were protected and methods used to restrain patients were only utilized after all other alternatives were attempted. (MR1)
Findings include:

Interview with EMP5 on May 7, 2019, revealed the facility trained security staff to carry and use handcuffs and pepper spray while on duty. The facility failed to develop a policy that addressed the use of these devices as a law enforcement action and not a healthcare intervention. When the handcuffs and pepper spray were used on April 26, 2019, due to MR1's physically aggressive behaviors, the facilty failed to ensure that law enforcement devices were not used as patient care interventions.

These failures placed this patient (MR1) and others in the facility at risk for serious injury and/harm.
VIOLATION: PATIENT RIGHTS: RESTRAINT OR SECLUSION Tag No: A0164
Based on review of medical records (MR), facility documentation and staff interview (EMP), it was determined the facility failed to ensure less restrictive interventions were determined to be ineffective, prior to the application of a restraint

Findings include:

A review of the medical record (MR1), revealed the Patient was admitted to the Emergency Department on April 26, 2019. "ED Care Timeline......03:50 ED Note Patient was triaged when the Patient made threats to harm triage nurse... Patient threw chair across hall and started kicking stretcher and cabinets and threatening staff. Security notified and police. Security on scene to restrain Patient and deployed pepper spray in order to do so. Further review of MR1 did not reveal documentation of any less restrictive interventions attempted prior to the use of the pepper spray and handcuffs.

A review of facility policy revealed "...Title: Handcuffs, review date: 8/18...Policy: It shall be the policy of the Security Department to have in place a procedure for the proper application and use of handcuffs...II. General Information: a. Wellspan Good Samaritan Hospital has authorized the use of handcuffs by its Security force. b. Security Officers shall be trained in the use of handcuffs as well as their applications...IV. Procedures: Note: Handcuffs are not to be used on any patient as a means of control or restraint unless said patient has committed a criminal act and continues violent, dangerous behavior.
A review of facility policy " Pepper Defense Spray, reviewed 8/18, revealed "...The hospital has issued, and approved the use of, chemical agents by hospital Security Officers. This will provide them with a way to defend themselves and will also be capable of controlling any individual or individuals when an Officer is facing active aggression...The proper use and carrying of Pepper Defense Spray are as follows; 1. Qualified Security Officers shall carry defense spray at all times while on duty. 2. Only Security Officers that are formally trained in Oleoresin Capsicum Spray will be allowed to carry defense spray...6. Officers using defense spray will notify Police and appropriate charges will be filed against the offending subject...". This policy is not in alignment with CMS standards that law enforcement devices can not be used for health care interventions.

An interview conducted on May 6, 2019, with EMP1 revealed that patient was pepper sprayed and placed in handcuffs. Further interview revealed the patient was handcuffed by the local police but was released and remained at the facility until transferred to a psychiatric facility.

This incident revealed that pepper spray and handcuffs were used by facility security staff, in the application of a restraint, as a healthcare intervention and not as part of a law enforcement action.

Cross reference:
482.13(e) Use of Restraints or Seclusion All patients have the right to be free from physical or mental abuse, and corporal punishment.