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.

NORTHLAKE BEHAVIORAL HEALTH SYSTEM 23515 HIGHWAY 190 MANDEVILLE, LA 70448 June 26, 2019
VIOLATION: PATIENT RIGHTS Tag No: A0115
Based on record reviews and interviews, the hospital failed to meet the requirements of the Condition of Participation for Patient's Rights as evidenced by failing to remove patients and staff from a building of the hospital after multiple sightings of bats in the building and in patient's rooms. This deficient practice resulted in 1 (#2) of 5 sampled patients and a mental health technician being bitten by a bat (see findings tag A-0144).
VIOLATION: RN SUPERVISION OF NURSING CARE Tag No: A0395
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record reviews and interviews, the hospital failed to ensure the RN supervised and evaluated the nursing care of each patient. This deficient practice is evidenced by failing to report a patient that had a suspected bat bite to the physician immediately for 1 (#2) of 5 patients sampled.

Findings:

Review of the hospital's policy titled Early Response revealed in part:
It is the policy of Northlake Behavioral Health System to promptly address concerns regarding care or changes in a patient's condition as reported by any patient, family member or employee.

B. Guidelines for initiating a call: 6. Any injury to the body.
The following are expectations of the responder:
1. Response within 1 hour
2. The responder will assess, stabilize, facilitate transfer to a high level of care if necessary, and educate and support.

Review of Patient #2's medical record revealed she was in the Rampart Unit of the hospital.

Review of Patient #2's nurse's notes dated 6/14/19 at 8:00 a.m. revealed the following entry: Notified S8RN, S9LPN infection control and S2COO of bats (3) reported on unit last night. 1 bat went into patient's room for two hours prior to it being found on the patient's bed by her feet. Examination of patient's skin revealed fresh blood exposed tiny area to left foot great toe. Area beside exposed skin appears to have a mark without breaking the skin.
Review of Patient #2's medical record revealed a physician's order dated 6/14/19 at 1:00 p.m. The order was to send Patient #2 to the emergency room for evaluation of a possible bat bite to left foot great toe because Patient #2 was exposed to bat in room for 2 hours with the bat found on the patient's bed by her feet.

Review of Patient #2's physician's orders revealed an order dated 6/14/19 at 2:45 p.m.to transfer Patient #2 to Willow unit for lodging.

In an interview on 6/26/19 at 9:05 a.m. with S4MHT, she said on 6/14/19 she was in a room pumping milk for her baby when a bat landed on her arm and bit her. S4MHT said she had to get [DIAGNOSES REDACTED] shots. She said administration was taking it lightly like it was just a bird. She said she was not sure why it took so long to get staff and patients off the unit. S4MHT said the patient was bitten sometime during the night and she was bitten around 3:00 p.m.

In an interview on 6/26/19 at 10:40 a.m. with S3RN, she said she was working on 6/14/19. She said the supervisor came and looked at Patient #2's foot. She said they waited on the doctor to round and he came around 12:00 p.m. She said they did not notify the physician before he rounded.

In an interview on 6/26/19 at 12:00 p.m. with S7DON, she said the physician should have been notified immediately when Patient #2 was bitten by the bat. She said they get an order from a physician to transfer to another unit. She said the move went too slowly.

In an interview on 6/26/19 at 12:05 p.m. with S1Adm, she verified the RN should not have waited for the physician to make his rounds at 12:35 p.m. to notify him of Patient #2 being bitten by a bat (4 hours 35 minutes after discovery). She also noted that if the physician had been notified that morning, the patient's may have been moved out of the unit sooner and S4MHT may not have also been bitten by a bat.
VIOLATION: PATIENT RIGHTS: CARE IN SAFE SETTING Tag No: A0144
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**


Based on record reviews and interviews, the hospital failed to ensure patients received care in a safe setting as evidenced by failing to remove patients and staff from a building of the hospital after multiple sightings of bats in the building and in patient's rooms. This deficient practice resulted in 1 (#2) of 5 sampled patients and a mental health technician being bitten by a bat.

Findings:

Review of Patient #2's medical record revealed she was in the Rampart Unit of the hospital.

Review of Patient #2's nurse's notes dated 6/14/19 at 8:00 a.m. revealed the following entry: Notified S8RN, S9LPN infection control and S2COO of bats (3) reported on unit last night. 1 bat went into patient's room for two hours prior to it being found on the patient's bed by her feet. Examination of patient's skin revealed fresh blood exposed tiny area to left foot great toe. Area beside exposed skin appears to have a mark without breaking the skin.

Review of Patient #2's medical record revealed a physician's order dated 6/14/19 at 1:00 p.m. The order was to send Patient #2 to the emergency room for evaluation of a possible bat bite to left foot great toe because Patient #2 was exposed to bat in room for 2 hours with the bat found on the patient's bed by her feet.

Review of Patient #2's medical record revealed a physician's order dated 6/14/19 at 5:45 p.m. for [DIAGNOSES REDACTED] vaccine.

Review of Patient #2's medical record revealed discharge instructions from a local hospital dated 6/14/19. The instructions were for Bat exposure, [DIAGNOSES REDACTED]-prone. The instructions included the following: Bat exposures are dangerous because there is a risk you can get [DIAGNOSES REDACTED]. [DIAGNOSES REDACTED] is a deadly viral infection. It causes fever, confusion and death. There is no effective treatment once [DIAGNOSES REDACTED] develops.

In an interview on 6/24/19 at 10:08 a.m. with S1Adm, she said the Rampart Unit was currently closed because of an incident with bats. She said on 6/14/19 around noon she got a call because Patient #2 was possibly bitten by a bat. She said the night before, the staff from Rampart had called maintenance because they found a baby bat on the unit. S1Adm said the staff had also found a bat on Patient #2's bed on the morning of 6/14/19. She said the RN examined Patient #2 and found a mark with a dried spot of blood on Patient #2's toe. Patient #2 was sent to the ED at Hospital "A" to be examined for a bat bite that afternoon. She said the ED doctor said the wound on her toe looked like a bat bite and gave her an Imovax ([DIAGNOSES REDACTED]) shot. She said Patient #2 will get other shots on the 3rd, 7th and 14th days. S1Adm said she did not know about the bats until Patient #2 was being sent to the ED the afternoon of 6/14/19. S1Adm said nobody reported anything to her about bats being on the unit. S1Adm said the staff should have notified her of a bat on the unit on 6/13/19 when the staff discovered them.

In an interview on 6/24/19 at 10:22 p.m. with S2COO, she said maintenance told her the staff had seen bats on Rampart unit about 11:30 p.m. on a Thursday (6/13/19). S2COO said she went to the unit with 2 maintenance men and one of them picked up a bat that was in the hall. S2COO said two MHTs said they saw a bat go into a patient's room that had 3 patients in it (Patient #1, #2, #3). She said the maintenance men checked the room but could not find the bat. She said they did not wake the patients up or evacuate them from the room. She said she left around midnight and heard the next day staff had found several more bats during the night. S2COO said an employee got bitten on 6/14/19 in a break room. S2COO said she did not have them evacuate the unit because she had been told the maintenance men were experts on bats so she felt like they could handle it.

In an interview on 6/26/19 at 8:50 a.m. with S5RN, she said she was working on Rampart on 6/13/19. She said they saw a bat on the unit around 11:00 p.m. S5RN said the bat came out of the bathroom and was walking on the floor so they called maintenance to come get it. She said it went into a Patient #2's room. She said maintenance came and got two of them and searched for the bat in the patients room but could not find it. She said she guessed she wrongly assumed the bat came out of Patient #2's room and went somewhere else. She said later in the night they found another bat on the unit. S5RN said nothing was discussed about moving the patients.

In an interview on 6/26/19 at 9:05 a.m. with S4MHT, she said some staff had seen a bat on Rampart on Sunday 6/8/19 and another on Tuesday 6/10/19. She said on Thursday night 6/13/19, the night shift said they had seen 5 bats. She said on 6/14/19 she was in a room pumping milk for her baby when a bat landed on her arm and bit her. S4MHT said she had to get [DIAGNOSES REDACTED] shots. She said administration was taking it lightly like it was just a bird. She said she was not sure why it took so long to get staff and patients off the unit. S4MHT said the patient was bitten sometime during the night and she was bitten around 3:00 p.m.

In an interview on 6/26/19 at 9:15 a.m. with S6MHT, she said she was working the night of 6/13/19 on Rampart unit. She said 2 bats came out of the bathroom when a patient was going into the bathroom. One went to the hall and the other bat went into Patient #2's room. She said maintenance could not find the one that went into Patient #2's room. She said S2COO did not take it seriously. She said there were 3 patients in the room and nobody took them out of the room. S6MHT said she was scared of the bats. S6MHT said the nurse never came out of the nurse's station even when they saw another bat later. She said a third bat came out and the MHTs told the nurse again and she did not care. She said that bat went into another patient's room by the bed. She said the patient was scared and was standing on the bed. S6MHT could not recall the patient's name. She said nobody suggested they leave the unit with the patients. S6MHT said somebody on the day shift showed her a video from that day where a bat fell from the air vent into the nurse's station.

In an interview on 6/26/19 at 12:00 p.m. with S7DON, she said the patients should have been moved immediately when bats were discovered on the unit, especially when the MHTs said the bat went into Patient #2's room but they could not find it. She said she was on vacation during the incident.

In an interview on 6/24/19 at 12:50 p.m. with S3RN, she said she had first reported a bat on the unit the Sunday before the patient was bitten. She said it was on the floor and it was reported to the house supervisor, DON and COO. She said on the Wednesday or Thursday, they heard what they thought were bats in the ceiling and reported it to maintenance. She also said she was on Rampart the day it was discovered the patient and the employee had been bitten. She said she was not sure why they were not moved off of the unit sooner.
VIOLATION: PATIENT RIGHTS: FREE FROM ABUSE/HARASSMENT Tag No: A0145
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**



Based on record review and interview, the hospital failed to ensure patients were free from neglect as evidenced by failure to ensure neglect of care was reported to LDH-HSS within 24 hours of the incident where multiple bats were discoved in a unit with patients and a bat was observed going into a patient's room. The hospital neglected removing patient's from the unit and a patient was bitten by a bat for 1 (#2) of 5 sampled patients.

Findings:

Review of the State law R.S. 40:2009.20 revealed "Any person who is engaged in the practice of medicine, social service, facility administration, psychological services or any RN, LPN, nurses' aide, personal care attendant, respite worker, physician's assistant, physical therapist, or any other healthcare giver having knowledge that a consumer's physical or mental health or welfare has been or may be further adversely affected by abuse, neglect, or exploitation shall, within 24 hours, submit a report to the department or inform the unit or local law enforcement agency of such abuse or neglect."

Review of the policy titled Patient Rights revealed in part:
B. Neglect means a negligent act or omission by an individual responsible for providing services in a facility rendering care or treatment which caused or may have caused injury or death to an individual with mental illness or which placed an individual with mental illness at risk for injury or death, and includes but is not limited to failure to provide a safe environment.
8. Notify DHH Health Standards Section of all allegations, no matter how irrational the allegation may be, within 24 hours.

Review of Patient #2's medical record revealed she was in the Rampart Unit of the hospital.

Review of Patient #2's nurse's notes dated 6/14/19 at 8:00 a.m. revealed the following entry: Notified S8RN, S9LPN infection control and S2COO of bats (3) reported on unit last night. 1 bat went into patient's room for two hours prior to it being found on the patient's bed by her feet. Examination of patient's skin revealed fresh blood exposed tiny area to left foot great toe. Area beside exposed skin appears to have a mark without breaking the skin.

Review of Patient #2's medical record revealed a physician's order dated 6/14/19 at 1:00 p.m. The order was to send Patient #2 to the emergency room for evaluation of a possible bat bite to left foot great toe because Patient #2 was exposed to bat in room for 2 hours with the bat found on the patient's bed by her feet.

Review of Patient #2's medical record revealed a physician's order dated 6/14/19 at 5:45 p.m. for [DIAGNOSES REDACTED] vaccine.

Review of Patient #2's medical record revealed discharge instructions from a local hospital dated 6/14/19. The instructions were for Bat exposure, [DIAGNOSES REDACTED]-prone. The instructions included the following: Bat exposures are dangerous because there is a risk you can get [DIAGNOSES REDACTED]. [DIAGNOSES REDACTED] is a deadly viral infection. It causes fever, confusion and death. There is no effective treatment once [DIAGNOSES REDACTED] develops.

In an interview on 6/26/19 at 8:50 a.m. with S5RN, she said she was working on Rampart on 6/13/19. She said they saw a bat on the unit around 11:00 p.m. S5RN said the bat came out of the bathroom and was walking on the floor so they called maintenance to come get it. She said it went into a Patient #2's room. She said maintenance came and got two of them and searched for the bat in the patients room but could not find it. She said she guessed she wrongly assumed the bat came out of Patient #2's room and went somewhere else. She said later in the night they found another bat on the unit. S5RN said nothing was discussed about moving the patients.

In an interview on 6/24/19 at 12:50 p.m. with S3RN, she said she had first reported a bat on the unit the Sunday before the patient was bitten. She said it was on the floor and it was reported by email to the house supervisor, DON and COO. She said on the Wednesday or Thursday, they heard what they thought were bats in the ceiling and reported it to maintenance. She also said she was on Rampart the day it was discovered the patient and the employee had been bitten. She said she was not sure why they were not moved off of the unit sooner.

In an interview on 6/24/19 at 3:00 p.m. with S1Adm, she verified she did not self-report Patient #2's neglect to the Louisiana Department of Health. S1Adm said in retrospect, it was neglect and should have been reported.