HospitalInspections.org

Based on record review and interview the hospital failed to ensure staff were in compliance with State Laws, LA R.S. 40:2009.20, and hospital policy, Policy number 11-4.2.0, by failing to report all forms of abuse whether from staff, other patients or visitors, as evidenced by S11MD writing a Physician's Order to contact Elderly Protection Services. Under LA R.S. 40:2009.20 any person who is engaged in the practice of medicine 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 twenty-four hours, submit a report to the department or inform the unit or local law enforcement agency of such abuse or neglect. S11MD had a duty to make a complaint and delegated the responsibility to nursing staff. Findings:

Review of the medical record for patient #1 revealed an order dated 08/26/11 at 1315 (1:15 p.m.) to "consult S11MD, Psychiatrist, re: depression."

Review of the Consultation note by S11MD performed on 08/29/30 (in an interview on 12/09/11 at 10:29 a.m. S11MD stated he performed the consult/assessment on 08/29/11 but dictated it later that day and it was dated 08/30/11) revealed the following: "...Of particular note however, the staff at St. Landry Extended Care notified me that they did have some concerns about the patient's son who came in on Sunday, 8/28/11, and seemed to force her to sign her social security check or some other check over to him. I did also speak with the patient's daughter who appears to be a good contact, (name), at (phone number) and she reports to me that she has serious concerns about the patient's son that he was possibly over medicating her in an attempt to take her and her husband's money. (name) reports to me that the patient and her husband's bank account has been drained. I did explain to her that it sounds like it is appropriate as a referral for elderly protection and she is actually very much in favor of getting elderly protection involved..." Under "Recommendations" in the consultation report S11MD dictated: "...I have spoken with the patient's (family member) who is very supportive of an EPS referral and I have also spoken with the patient's primary team and the case manager on the floor about making such a referral."

Review of a Physician's Order dated 08/29/11 at 1450 (2:50 p.m.) written by S11MD reads in part: "SW (Social Worker)/Case Management please call Elderly Protection Services to investigate pt.'s (#1) home situation."

In a telephone interview with S11MD on 12/08/11 at 1:18 p.m. he was asked which staff had reported the incident described to him in his consultation note. S11MD replied "the entire team (on duty)." S11MD stated he was not aware of the "duty to report" per LA R.S. 40:2009.20 but that he (S11MD) did write an order to notify EPS.

Further review of the Physician's Order revealed S9US documented "notified (S8LPN)" on 08/29/11 at 1505 (3:05 p.m.). S8LPN documented "noted" on 08/29/11 at 1530 (3:30 p.m.). Review of the Physician's Order Sheet and Nursing notes for 08/29/11 revealed no documented evidence that EPS was notified per the Order written by S11MD.

In an interview with S9US on 12/08/11 she stated she notified S8LPN, assigned the care of patient #1 on 08/29/11, of the Physician's Order.

In an interview with S8LPN on 12/09/11 at 9:07 a.m. she stated that she asked S9US to make sure the Physician's Order to contact EPS dated 08/29/11 was passed on to Case Management. S8LPN further stated she "was not aware that the order was not carried out."

In an interview with S3Case Management on 12/08/11 at 9:25 a.m. she stated she "could not recall if she was notified of the order or if EPS was notified on 08/29/11."

In an interview with S13RN, Charge Nurse on 08/09/11, on 12/09/11 at 9:30 a.m. she stated she "did not know if the order was carried out."

In an interview on 12/08/11 at 9:15 a.m. with S2DON she stated she could not find any documentation in the medical record indicating that the Physician's Order to notify EPS was carried out.

The entire staff on duty on 08/29/11 (S13RN Charge Nurse, S15RN, S20LPN, S14LPN, S8LPN, S16CNA, S17CNA, and S18CNA) were interviewed either by telephone or face to face. All staff present on 08/29/11 denied knowledge of who reported the events of 08/28/11 to S11MD.

In an interview with S12RN, Charge Nurse on 08/28/11, on 12/08/11 at 12:45 a.m. (the date of the alleged incident of the son of patient #1 "seemed to force her to sign a check over to him") she stated she "had no recollection of the incident documented by S11MD or knowledge of how the information was passed on to S11MD the following day."

In a telephone interview on 12/08/11 at 9:40 a.m. with S10LPN, assigned the care of patient #1 on 08/28/11, he stated he did not witness the incident documented by S11MD but "overheard" that the patient's son and the family "did not get along."

The Office of Elderly Protective Services was contacted on 12/09/11. According to staff there if a call was placed to EPS the information would be entered into the computer regardless of whether or not the case was accepted. EPS stated that if the case involves a hospitalized patient's care at home that they may deny the case until the patient is in the home setting. They stated again that regardless of the outcome of the initial call the information is entered into the system. Two staff members at EPS searched the computer and stated that there was no documentation to indicate that a call was received on 08/29/11 in regards to patient #1.

Review of a hospital policy titled "Elderly Abuse", policy number 11-4.2.0, effective October 2007, no date of last revision, presented as current hospital policy reads in part: "Purpose: To provide staff with appropriate guidelines to follow in the event of incidents of patient abuse by others (i.e., family/friends ...). Policy: Any person who, in the scope of his employment at the hospital or in his professional capacity, has knowledge of or reasonable cause to believe that any patient has been the victim of abuse or exploitation has an obligation to report such abuse, first to his supervisor or department manager. LA RS 14.403.2 requires the reporting of abuse and exploitation of patients, established criminal penalties for abuse and for failure to report, and prohibits retaliation against individuals who report such incidents. The Social Worker/Case Manager and Administrator, along with the hospital attorney, will be responsible to ensure such reports are transmitted to the appropriate state and law enforcement authorities ...Procedure: Upon receipt of information relating to abuse or exploitation, Social Worker/Case Manager, in accordance with state statues, shall: Contact all parties with any interest in the alleged incident to inform them of the fact that the required report to the authorities is about to occur. Report orally or by telephone within twenty-four (24) hours of the discovery to the Department of Health and Human Service, Bureau of Protective Services. Report in writing within two (2) working days of discovery to DHH ...."

Review of LA R.S. 40:2009.20 revealed: Louisiana Revised Statutes Title 40. Public Health and Safety Chapter 11. State Department of Health and Hospitals.

?2009.2. Definitions (Excerpt)
(3) "Department" shall mean the Department of Health and Hospitals.
(4) "Unit" means the Medicaid fraud control unit created within the office of criminal law of the Department of Justice and which is certified by the secretary of the United States Department of Health, Education and Welfare.
?2009.20. Duty to make complaints; penalty; immunity.
A. As used in this Section, the following terms shall mean:
(1) "Abuse" is the infliction of physical or mental injury or the causing of the deterioration of a consumer by means including but not limited to sexual abuse, or exploitation of funds or other things of value to such an extent that his health or mental or emotional well-being is endangered.

(2) "Neglect" is the failure to provide the proper or necessary medical care, nutrition, or other care necessary for a consumer's well-being.

B. (1) Any person who is engaged in the practice of medicine, social services, facility administration, psychological or psychiatric services; or any registered nurse, licensed practical nurse, nurse's aide, home- and community-based service provider employee or worker, personal care attendant, respite worker, physician's assistant, physical therapist, or any other direct caregiver 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 twenty-four hours, submit a report to the department or inform the unit or local law enforcement agency of such abuse or neglect. When the department receives a report of sexual or physical abuse, whether directly or by referral, the department shall notify the chief law enforcement agency of the parish in which the incident occurred of such report. Such notification shall be made prior to the end of the business day subsequent to the day on which the department received the report. For the purposes of this Paragraph, the chief law enforcement agency of Orleans Parish shall be the New Orleans Police Department.

(2) Any person who knowingly or willfully violates the provisions of this Section shall be fined not more than five hundred dollars or imprisoned for not more than two months, or both.

C. Any person, other than the person alleged to be responsible for the abuse or neglect, reporting pursuant to this Section in good faith shall have immunity from any civil liability that otherwise might be incurred or imposed because of such report. Such immunity shall extend to participation in any judicial proceeding resulting from such report.

D. All hospitals shall permanently display in a prominent location in their emergency rooms a copy of R.S. 40:2009.20.

Based on record review and interview the hospital failed to ensure the Registered Nurse supervised and evaluated the care for each patient as evidenced by the failure of the nursing staff to carry out an order written by the physician to notify EPS (Elderly Protection Services) to investigate patients (#1) home situation for 1 of 7 sampled patients. Findings:

Review of the medical record for patient #1 revealed an order dated 08/26/11 at 1315 (1:15 p.m.) to "consult S11MD, Psychiatrist, re: depression."

Review of the Consultation note by S11MD performed on 08/29/30 (in an interview on 12/09/11 at 10:29 a.m. S11MD stated he performed the consult/assessment on 08/29/11 but dictated it later that day and it was dated 08/30/11) revealed the following: "...Of particular note however, the staff at St. Landry Extended Care notified me that they did have some concerns about the patient's son who came in on Sunday, 8/28/11, and seemed to force her to sign her social security check or some other check over to him. I did also speak with the patient's daughter who appears to be a good contact, (name), at (phone number) and she reports to me that she has serious concerns about the patient's son that he was possibly over medicating her in an attempt to take her and her husband's money. (name) reports to me that the patient and her husband's bank account has been drained. I did explain to her that it sounds like it is appropriate as a referral for elderly protection and she is actually very much in favor of getting elderly protection involved..." Under "Recommendations" in the consultation report S11MD dictated: "...I have spoken with the patient's (family member) who is very supportive of an EPS referral and I have also spoken with the patient's primary team and the case manager on the floor about making such a referral."

Review of a Physician's Order dated 08/29/11 at 1450 (2:50 p.m.) written by S11MD reads in part: "SW (Social Worker)/Case Management please call Elderly Protection Services to investigate pt.'s (#1) home situation."

In a telephone interview with S11MD on 12/08/11 at 1:18 p.m. he was asked which staff had reported the incident described to him in his consultation note. S11MD replied "the entire team (on duty)." S11MD stated he was not aware of the "duty to report" per LA R.S. 40:2009.20 but that he (S11MD) did write an order to notify EPS.

Further review of the Physician's Order revealed S9US documented "notified (S8LPN)" on 08/29/11 at 1505 (3:05 p.m.). S8LPN documented "noted" on 08/29/11 at 1530 (3:30 p.m.). Review of the Physician's Order Sheet and Nursing notes for 08/29/11 revealed no documented evidence that EPS was notified per the Order written by S11MD.

In an interview with S9US on 12/08/11 she stated she notified S8LPN, assigned the care of patient #1 on 08/29/11, of the Physician's Order.

In an interview with S8LPN on 12/09/11 at 9:07 a.m. she stated that she asked S9US to make sure the Physician's Order to contact EPS dated 08/29/11 was passed on to Case Management. S8LPN further stated she "was not aware that the order was not carried out."

In an interview with S3Case Management on 12/08/11 at 9:25 a.m. she stated she "could not recall if she was notified of the order or if EPS was notified on 08/29/11."

In an interview with S13RN, Charge Nurse on 08/09/11, on 12/09/11 at 9:30 a.m. she stated she "did not know if the order was carried out."

In an interview on 12/08/11 at 9:15 a.m. with S2DON she stated she could not find any documentation in the medical record indicating that the Physician's Order to notify EPS was carried out.

The entire staff on duty on 08/29/11 (S13RN Charge Nurse, S15RN, S20LPN, S14LPN, S8LPN, S16CNA, S17CNA, and S18CNA) were interviewed either by telephone or face to face. All staff present on 08/29/11 denied knowledge of who reported the events of 08/28/11 to S11MD.

In an interview with S12RN, Charge Nurse on 08/28/11, on 12/08/11 at 12:45 a.m. (the date of the alleged incident of the son of patient #1 "seemed to force her to sign a check over to him") she stated she "had no recollection of the incident documented by S11MD or knowledge of how the information was passed on to S11MD the following day."

In a telephone interview on 12/08/11 at 9:40 a.m. with S10LPN, assigned the care of patient #1 on 08/28/11, he stated he did not witness the incident documented by S11MD but "overheard" that the patient's son and the family "did not get along."

The Office of Elderly Protective Services was contacted on 12/09/11. According to staff there if a call was placed to EPS the information would be entered into the computer regardless of whether or not the case was accepted. EPS stated that if the case involves a hospitalized patient's care at home that they may deny the case until the patient is in the home setting. They stated again that regardless of the outcome of the initial call the information is entered into the system. Two staff members at EPS searched the computer and stated that there was no documentation to indicate that a call was received on 08/29/11 in regards to patient #1.

Review of a hospital policy titled "Elderly Abuse", policy number 11-4.2.0, effective October 2007, no date of last revision, presented as current hospital policy reads in part: "Purpose: To provide staff with appropriate guidelines to follow in the event of incidents of patient abuse by others (i.e., family/friends ...). Policy: Any person who, in the scope of his employment at the hospital or in his professional capacity, has knowledge of or reasonable cause to believe that any patient has been the victim of abuse or exploitation has an obligation to report such abuse, first to his supervisor or department manager. LA RS 14.403.2 requires the reporting of abuse and exploitation of patients, established criminal penalties for abuse and for failure to report, and prohibits retaliation against individuals who report such incidents. The Social Worker/Case Manager and Administrator, along with the hospital attorney, will be responsible to ensure such reports are transmitted to the appropriate state and law enforcement authorities ...Procedure: Upon receipt of information relating to abuse or exploitation, Social Worker/Case Manager, in accordance with state statues, shall: Contact all parties with any interest in the alleged incident to inform them of the fact that the required report to the authorities is about to occur. Report orally or by telephone within twenty-four (24) hours of the discovery to the Department of Health and Human Service, Bureau of Protective Services. Report in writing within two (2) working days of discovery to DHH ...."

Review of LA R.S. 40:2009.20 revealed: Louisiana Revised Statutes Title 40. Public Health and Safety Chapter 11. State Department of Health and Hospitals.

?2009.2. Definitions (Excerpt)
(3) "Department" shall mean the Department of Health and Hospitals.
(4) "Unit" means the Medicaid fraud control unit created within the office of criminal law of the Department of Justice and which is certified by the secretary of the United States Department of Health, Education and Welfare.
?2009.20. Duty to make complaints; penalty; immunity.
A. As used in this Section, the following terms shall mean:
(1) "Abuse" is the infliction of physical or mental injury or the causing of the deterioration of a consumer by means including but not limited to sexual abuse, or exploitation of funds or other things of value to such an extent that his health or mental or emotional well-being is endangered.

(2) "Neglect" is the failure to provide the proper or necessary medical care, nutrition, or other care necessary for a consumer's well-being.

B. (1) Any person who is engaged in the practice of medicine, social services, facility administration, psychological or psychiatric services; or any registered nurse, licensed practical nurse, nurse's aide, home- and community-based service provider employee or worker, personal care attendant, respite worker, physician's assistant, physical therapist, or any other direct caregiver 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 twenty-four hours, submit a report to the department or inform the unit or local law enforcement agency of such abuse or neglect. When the department receives a report of sexual or physical abuse, whether directly or by referral, the department shall notify the chief law enforcement agency of the parish in which the incident occurred of such report. Such notification shall be made prior to the end of the business day subsequent to the day on which the department received the report. For the purposes of this Paragraph, the chief law enforcement agency of Orleans Parish shall be the New Orleans Police Department.

(2) Any person who knowingly or willfully violates the provisions of this Section shall be fined not more than five hundred dollars or imprisoned for not more than two months, or both.

C. Any person, other than the person alleged to be responsible for the abuse or neglect, reporting pursuant to this Section in good faith shall have immunity from any civil liability that otherwise might be incurred or imposed because of such report. Such immunity shall extend to participation in any judicial proceeding resulting from such report.

D. All hospitals shall permanently display in a prominent location in their emergency rooms a copy of R.S. 40:2009.20.

Based on record review and interview the hospital failed to ensure the Center for Disease Control (CDC) guidelines for Tuberculosis (TB) screening were followed as evidenced by 4 of 4 records (S3LPN, S12RN, S8LPN, S11MD) reviewed having no documented evidence the TB screening was performed and/or read within the 48 - 72 hour guideline. Findings:

Review of the personnel records for S3LPN, S12RN, S8LPN revealed all 3 records contained documentation of a TB skin test. 0 of the 3 records contained documentation of the time the TB skin test was placed or read.

Review of the Credentialing File for S11MD revealed no documented evidence of a TB skin test. S2DON could provide no documented evidence S11MD had a current TB skin test on file at the hospital.

In an interview with S2DON on 12/09/11 at 12:34 p.m. she stated it could not be confirmed that the skin test for S3LPN, S12RN, or S8LPN were read within the 48 - 72 hour guideline without the time of administration and the time read documented.


Review of the CDC Guidelines revealed: "Tuberculin skin test: A diagnostic aid for finding M. tuberculosis infection. A small dose of tuberculin is injected just beneath the surface of the skin (in the United States by the Mantoux method), and the area is examined for induration by palpation 48--72 hours after the injection..."

Review of a CDC (Center for Disease Control) Recommendation and Report , 54(RR17); 1-141, document dated December 30, 2005 titled " Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, 2005 " revealed the following: " HCWs (Health Care Workers) Who Should Be Included in a TB Surveillance Program. " " HCWs refer to all paid and unpaid persons working in health-care settings who have the potential for exposure to M. tuberculosis through air space shared with persons with infectious TB disease. Part time, temporary, contract, and full-time HCWs should be included in TB screening programs. All HCWs who have duties that involve face to-face contact with patients with suspected or confirmed TB disease (including transport staff) should be included in a TB screening program. The following are HCWs who should be included in a TB screening program:..Physicians (assistant, attending, fellow, resident, or intern)..."