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PROVIDENCE HOSPITAL 1150 VARNUM ST NE WASHINGTON, DC 20017 April 1, 2015
VIOLATION: COMPLIANCE WITH LAWS Tag No: A0021
**NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY**

Based on medical record review, policy review, equipment/services logs, and staff interviews, it was determined the hospital failed follow federal laws and hospital policy relative to the provision of auxiliary aids for communication by hearing impaired patients in one (1) of eleven records reviewed (Patient #1).


The findings include:


28 CFR Part 35 Subpart E Communications 35.160 stipulates 35.160 " General.
(a) (1) A public entity shall take appropriate steps to ensure that communications with applicants, participants, members of the public, and companions with disabilities are as effective as communications with others. (2) For purposes of this section, " companion " means a family member, friend, or associate of an individual seeking access to a service, program, or activity of a public entity, who, along with such individual, is an appropriate person with whom the public entity should communicate. (b) (1) A public entity shall furnish appropriate auxiliary aids and services where necessary to afford qualified individuals with disabilities, including applicants, participants, companions, and members of the public, an equal opportunity to participate in, and enjoy the benefits of, a service, program, or activity of a public entity. (2) The type of auxiliary aid or service necessary to ensure effective communication will vary in accordance with the method of communication used by the individual; the nature, length, and complexity of the communication involved; and the context in which the communication is taking place. In determining what types of auxiliary aids and services are necessary, a public entity shall give primary consideration to the requests of individuals with disabilities. In order to be effective, auxiliary aids and services must be provided in accessible formats, in a timely manner, and in such a way as to protect the privacy and independence of the individual with a disability. (c) (1) A public entity shall not require an individual with a disability to bring another individual to interpret for him or her. (2) A public entity shall not rely on an adult accompanying an individual with a disability to interpret or facilitate communication except- (i) In an emergency involving an imminent threat to the safety or welfare of an individual or the public where there is no interpreter available; or (ii) Where the individual with a disability specifically requests that the accompanying adult interpret or facilitate communication, the accompanying adult agrees to provide such assistance, and reliance on that adult for such assistance is appropriate under the circumstances. "


Providence Hospital Guideline for Patient Care Policy titled Procedure to Communicate with Deaf and Hard of Hearing last revised January, 2013 stipulates " PROCEDURE: 1. During the admission procedure, the " Point of Access " personnel will have the patient complete the Deaf and Hard of Hearing Needs Assessment form (Appendix A), which upon completion will be included in the patient ' s chart. 2. If the patient request a sign language interpreter, the Point of Access personnel (Primary RN, Patient Access or ER front desk technician) will complete and hand deliver/fax the completed Request for Interpreter Services form (Appendix D) to the Hospital Operator. A. Verify receipt of faxed requests by calling the operator, b. On evenings, nights, weekends and holidays, the operator will notify the Nursing Administrative Supervisor of the presence of a deaf and hard of hearing patient. Emergent Situation (Emergency Department): Immediate action will be taken to coordinate the desired service or equipment. 1. In the event that on-sight interpreter is needed/ requested on a STAT basis, the staff person in emergency room or on a unit with an Emergent situation will immediately contact the telephone operator and hand carry/ fax the Appendix D to the telephone operator ...4. Document any use of auxiliary aids in the patient ' s medical record. A. Documentation will include type of interpreter (VSI, in person interpreter, etc.) ...DOCUMENTATION: The provider must document in the patient ' s chart the use of the sign language interpreter. A waiver form or documentation must be in the Patient ' s chart when the patient refuses to use the Hospital ' s interpreter after being informed of their right. "

Providence Hospital Guidelines for Patient Care titled Abuse, Neglect & Exploitation Reportable Requirements and Conditions last revised May, 2013 stipulates " REPORTABLE REQUIREMENTS 1 ... Abuse, neglect or exploitation of elderly, or vulnerable adults (mentally and/or physically challenged) must be reported to the D.C. Department of Human Services ...Structure Standards: 1. In all suspected, witnessed, and reported cases of sexual and physical abuse and assault, step will be taken immediately to care for the patient, protect the patient ' s legal rights, and comply with police regulations. 2. The Emergency Department will directly report suspected abuse cases to the appropriate regulatory agency and/or police department. "


Patient #1 was seen in the Emergency Department on December 17, 2014 for complaints which included Abdominal Pains and Constipation for one (1) day; a medical history which includes Intellectual Disability and Hearing Impairment.


Medical record review was conducted on April 1, 2015 at approximately 10:30 AM revealed that Patient #1 was seen in the Emergency Department on December 17, 2014 at 7:02 PM for complaints of Constipation and Refusal to Eat. Patient #1 was seen in an urgent care center prior to arrival to the Emergency Department.

Triage assessment dated [DATE] at 8:08 PM revealed the nursing staff documented " Preferred Language: Sign Language " . During the Initial Nursing Assessment at 8:44 PM on December 17, 2014 the nursing staff documented " Pt [Patient] is deaf ...Video replay interpreter requested. "

Review of Systems on December 17, 2014 at 9:01 PM revealed the nursing staff documented Patient #1 ' s neurological status as follows: mental status- alert, cooperative and mentally challenged; and unable to speak. Patient #1 was noted ambulating back and forth to the bathroom from 9:48 PM until approximately 2:01 AM on December 18, 2014.

According to the Nursing Notes, on December 18, 2014 at 2:31 AM the medical staff made the decision to admit Patient #1 to the hospital and vital signs were stable. At approximately 3:24 AM, Patient #1 experienced a change of condition as evidenced by projectile vomiting, and then unresponsiveness. Cardiopulmonary Resuscitation was initiated; however, efforts to revive were unsuccessful. Patient #1 was pronounced dead at 3:48 AM.

The Medical Examiner was notified and body released to the Office of the Chief Medical Examiner on December 18, 2014.

The medical record lacked documented evidence of auxiliary aids being used, to include the video replay interpreter, to assist with communication during the Emergency Department stay.

On April 1, 2015 during onsite visit, the facility provided copies of the facility ' s Deaf Talk ASL Video Interpreting Station Sign-Out Log and other translation services logs. The facility ' s translation services include on-site interpreter, language access services, and sign language interpreters in person or through video remote service. Upon review of the logs from March 1, 2014 through March 15, 2015 revealed that on December 18, 2014 at 4:15 AM the hospital staff signed out the Deaf Talk Video Interpreting monitor for Patient #1 in the Emergency Department. This acquisition of the video interpreting monitor would occur approximately 30 minutes after the pronouncement of death for Patient #1.

The review of the various logs lacked documented evidence the hospital provided any translation services in accordance with the hospital ' s policy prior to December 18, 2014 at 4:15 AM.

In addition, the medical record lacked documented evidence of an incident of alleged abuse by the caregiver during the Emergency Department visit prior to Patient #1 ' s death, as reported by the hospital staff.

A telephonic interview was conducted on April 3, 2015 at approximately 1:00 PM with Staff Nurse. According to Staff Nurse, Patient #1 presented to the Emergency Department with two (2) caregivers; Group Home Supervisor and caregiver. The individuals were observed to be hearing impaired. The Group Home Supervisor wrote on her cellphone that a video interpreter was needed. The video interpreter was requested from the Nursing Supervisor. While awaiting the arrival of the video interpreter, s/he used gestures, non-verbal cues, and dry erase board to communicate with the care giver and perform assessment. The caregiver responded verbally to the written communication. The Group Home Supervisor left early part of the stay and the other caregiver remained at the bedside.

Throughout the evening Patient #1 was ambulating back and forth to the bathroom having small bowel movements. A decision to admit the patient to the hospital was made by the medical staff. While at the nurse ' s station, s/he was notified by the secretary that a medical resident stated the caregiver slapped Patient #1 in the face. S/he immediately went to the room to check on the patient. After determining Patient #1 had no obvious injury s/he left the room to find the medical resident that reported the incident; while other staff members remained in the room.

While searching for the medical resident, a commotion was overheard coming from the direction of Patient #1 ' s room. In response to commotion, s/he returned quickly and found Patient #1 projectile vomiting and then unresponsive. A Code Blue was initiated for Patient #1; which proved to be futile. Patient #1 was pronounced dead.

At the completion of the Code Blue, s/he stated s/he was going to complete an incident report concerning the alleged slap by caregiver; however, s/he was instructed not to complete one. S/he was unable to confirm the identity of the person giving the directive.


A face to face interview was conducted with the Risk Management staff during onsite visit on April 1, 2015. The findings related to provision of translation services were reviewed, discussed, and acknowledged.