HospitalInspections.org

Based on document review and interview the facility failed to honor a patient's right (patient # 10) related to visitation and ensure patient safety (patient # 11) in two (2) of eleven (11) medical records (MRs) reviewed. (tag 142)

The cumulative effect of this systemic problem resulted in the facility's inability to ensure that Patient Rights were promoted.

Based on document review and interview the facility failed to honor a patient's right (patient # 10) related to visitation and ensure patient safety (patient # 11) in two (2) of eleven (11) medical records (MR's) reviewed.

Findings include:

1. The facility policy titled, Patient Rights Policy, no policy number, indicated patients' rights include, but are not limited to, the right to participate in the plan of care, reasonable responses to reasonable requests for service, and personal privacy and safety. Patients' rights also apply to persons who may have responsibility for healthcare decisions on behalf of the patient. This policy was last reviewed/revised on 03/07/2022.

2. The facility policy titled, Adoption of Newborn Policy, no policy number, indicated a patient had full rights until the termination papers were signed. If termination papers, Biological Parental Consent to Release Newborn to Adoptive Parents, Adoption Agency or Private Adoption Attorney Representative, while natural mother and infant are still hospitalized, then any issues relating to the infant must be approved by the adoption agency/attorney thereafter. This policy was last reviewed/revised on 03/08/2022.

3. Review of the Board of Trustee Bylaws, dated January 2024, indicated the local governing authority appointed by the Corporation to provide for the overall management of the hospital. The purpose shall be to provide services to best serve the needs of patients.

4. Review of Patient # 10's MR indicated the following:
a. Hospital Adoption Plan, dated 09/04/2024, indicated patient # 10 would be giving permission to G # 1 (Adoption Support Center) adoptive parents to provide care for the baby (patient # 11), make medical decisions, and receive medical information pertaining to the baby (patient # 11). Patient # 10 indicated would like the baby (patient # 11) moved to the adoptive parent's room immediately and would like the baby (patient # 11) identification band to be given to the adoptive mother.

b. Verification of Birth Facts, dated 10/12/2024, signed by patient # 10, indicated that she had been given the option to complete a voluntary paternity affidavit while hospitalized following the birth of her child, that the paternity affidavit had been fully explained to her, and she did not choose to complete a paternity affidavit.

c. Authorization for Treatment of Newborn, dated 10/12/2024, signed by patient # 10 and C # 2 (Licensed Social Worker) at approximately 10:57 am, indicated patient # 10 delegated authority to G # 1 to make all decisions and to obtain necessary health care on behalf of the child (Patient # 11).

d. Indiana Department of Child Services (DCS) Hospital Release Authorization, dated 10/12/2024, indicated DCS did not authorize release until TBD (to be determined) due to ongoing DCS investigation.

e. Statement of Child Placing Agency Placing Child in Care and Custody of Adopting Parents, dated 10/12/2024, indicated patient # 10 released and relinquished infant baby (patient # 11) to the care, custody and control of G # 1, a licensed child-placing agency in the State, for the purpose of adoption and consented to the adoption of the child by G # 1 adoptive parents. R # 1 (Notary Public/Representative) as a representative of G # 1, place the child in the care and custody of the adoptive parents in anticipation of the child's adoption and pending the finalization of the adoption. R # 1 authorized the adoptive parents to consent to any medical or other professional care and treatment for the child's health and welfare.

f. Relinquishment of Child, to Child Placing Agency, Consent to Adoption and Waiver of Notice Regarding Adoption Proceedings, dated 10/12/2024, indicated Patient # 10 deposed the following: She was the biological mother of infant baby (patient # 11), the child was conceived out of wedlock, the paternity of the child had not been established, she released and relinquished the child to the care, custody and control of G # 1 for the purpose of adoption and desire that the child be placed in the care and custody of the adopting parents pending the adoption. Patient # 10, C # 2, and R # 1 (Notary Public/Representative) signed.

5. Patient # 11's MR indicated the following:
a. Date of Birth 10/11/2024.

b. Case Management notes, dated 10/12/2024, no initial time, by C # 2, indicated patient # 10 appointed G # 1 to make decisions for patient # 11 while she was an inpatient at the hospital with R # 1 being G # 1's representative. All paperwork was completed in full. C # 2 was present and signed as witness for G # 1 paperwork of Relinquishment of child to the child placement agency (G # 1). Documents notarized. CPS (Child Protective Services) cannot state the birth father needs supervised visits because they are not taking custody. Due to the situation "C # 2 and Registered Nurse feel it would be appropriate to still have birth father remain supervised by his case manager". R # 1 indicated F # 1 (Father) had 15 days to file through the court for paternity and to his/her knowledge that had not happened. C # 2 spoke with patient # 10 who indicated she did not want to make any decisions for patient # 11 and appointed G # 1 to make all decisions for patient # 11 while he/she was in the hospital. At 4:26 pm C # 2 was notified F # 1 was here with one of the workers from the drug rehabilitation with him. At that time patient # 11 was taken to a different room for F # 1 to visit. At 5:03 pm, C # 2 was notified the adoptive parents were very upset, and C # 2 explained that the birth father had the right to see patient # 11 while he/she was here. The adoptive parent stated that G # 1 had decision making power and doesn't want F # 1 to see the patient, it was a safety risk, and their lawyers advised them that F # 1 was out of the time frame to establish paternity.

c. Consent for Circumcision, dated 10/12/2025 at 11:25 am, indicated R # 1 who was the representative for G # 1, signed the consent form.

d. Birth Parental Consent to Release Newborn to Adopting Parents, Adoption Agency or Private Adoption Attorney Representative (Newborn Chart), dated 10/12/2024 at 10:47 am, indicated to discharge the newborn (patient # 11) to the custody of G # 1. The form was signed by patient # 10 and C # 2. The form was notarized by R # 1.

e. Discharge of Newborn to Adopting Parents Child Protective Services (CPS), Adoption Agency, or Private Adoption Attorney Representative (Newborn Chart), dated 10/12/2024 at 10:50 am, indicated patient # 10 was aware the acknowledged male newborn would be discharged to the representative of G # 1. The form was signed by patient # 10 and notarized by R # 1.

6. In interview on 01/22/2025 at approximately 9:45 am with staff member C # 1, confirmed we only go by legal paperwork. Most of the time the adoption plan is sent from the attorney and if we do not have the paperwork, we contact the attorney and/or DCS. The birth mother can choose who she wants to let see the baby.

7. In interview on 01/22/2025 at approximately 10:00 am with staff member A # 7 (Director Women & Children's Department), confirmed the babies stay in the birth mothers' room or we have a room for the adoptive parents to be with the baby. On 01/23/2025 at approximately 1:50 pm with staff member A # 7, confirmed he/she had called DCS on 10/12/2024 and spoke with D # 1 who indicated they do not have that authority to make that decision related to visitation.

8. In interview on 01/22/2025 at approximately 4:20 pm with staff member N # 2, confirmed he/she was told that the night before CPS decided to allow F # 1 to visit the baby. Patient # 11 was taken out of the adoptive parents room and taken to another room to allow F # 1 to visit along with his Case Worker for almost an hour.

9. In interview on 01/23/2025 at approximately 10:40 am with D # 1 (Family Case Manager - Department of Child Services), confirmed he/she had nothing to do with the decision to allow F # 1 to visit patient # 11 in the hospital. According to DCS he failed to meet the deadline for paternity and F # 1 was only the alleged father.

10. In interview on 01/23/2025 at approximately 2:20 pm with staff member N # 1 (Clinical Manager Obstetrics/Pediatrics/Neonatal Intensive Care Unit), confirmed patient # 10 gave one of patient # 11's identification bands to the adoptive mother. R # 1 signed consent for patient # 11 to be circumcised.

11. In interview on 01/23/2025 at approximately 3:15 pm with staff member C # 2, confirmed he/she was directed by C # 1 to allow F # 1 to visit patient # 11. We did not get a copy of the Case Worker's identification who was with F # 1.