HospitalInspections.org

Based on interview and review of 1 of 4 clinical records there was a failure to ensure the patients right to make informed decisions as follows:

Citing patient #4, a 17 year old male brought to the facility by his father on 2/21/2011. Review of the pre-admission assessment by MD #24 reflected the "patient presented secondary to suicide ideation with plan to jump off a bridge. diagnosis: Mood disorder NOS."

On 2?21/2011 at 1500 the following was noted:
"Came in accompanied by his father tearful and very upset that son is admitted."

Complainant and his father stated at 1:30pm on 7/14/2001 that, at time of admission they told MD #24 the patient was not suicidal and that he only said he was at school to get out of a test. the father stated that MD#24 did not inform him of a right to refuse treatment if the father signed signed a form to release the hospital of liability.

Further record review had no evidence the father was offered the choice of taking his son home if the father signed release of liability. Nor was there documented evidence of why this option was not offered to the father.

Based on interview and review of 1 of 4 clinical records, a problem prone event occurred that was not reviewed by the QAPI program.
Findings:

Citing patient #1, a 31 year old male admitted to this psychiatric hospital on 4/16/2011. He resided at a personal care home where he got into a physical fight due to psychosis. He has had past hospitalizations at Rusk State Hospital and Vernon State Hospital. Diagnosis: Bipolar disorder with psychosis.

From 4/18/2011 through 4/23/2011 it was noted the patient received IM emergency psychoactive medications four times due to violent and aggressive behavior.

On 4/24/2011 at 0200 the following was noted:
" At midnight the patient was shouting in his room. He came out hitting his hand on the wall. He became violent and hit a psych tech on the head and approached staff with clenched fist. Code called. Patient restrained and IM emergency med administered. at 12:15am.
At 0150 patient remained aggressive and personally restrained for over one hour and a repeat of IM emergency med administered Orders received from doctor #29 to transfer the patient via 911 police to ER where mechanical restraints can be applied. At 0215 police arrived, handcuffed the patient and left the hospital with the patient."

" 4/24/11 late entry by RN supervisor #27"
" Administrator on-call contacted to discuss doctor #29 orders for patient to be placed in restrains and need for assistance from law enforcement to transport patient 911.
Doctor #30, (medical director), phoned X3 with no answer for consultation."

On 7/14/2011 at 0950 personnel #27 stated she did not like what happened in the transfer of patient 911 police and felt it would happen again because " we have no mechanical restraints."

Personnel #20, compliance officer and #21, risk manager stated at 11:20am on 7/14/2011 that the case of 911 Police handcuffing patients for transport had not been reviewed as a problem prone area by the QAPI program.
Therefore, a similar incident of this nature could occur. This was verified by personnel # 28, chief nursing officer who stated at 4:00pm 7/14/2011 that very aggressive patients enter the hospital intake area and no other hospital will accept a transfer.