HospitalInspections.org

Based on record reviews and interviews, the hospital failed to ensure effective implementation of the grievance process for prompt resolution of patient grievances as evidenced by: 1) failing to include an allegation of verbal abuse in the grievance process for 1 of 1 abuse allegations reviewed (#RF1), 2) failing to determine whether patient concerns were complaints or grievances for 2 of 2 (#RF1 and #F12) complaint/grievances reviewed; 3) failing to acknowledge a grievance in writing to the patient for 2 of 2 grievances reviewed (#RF1 and #F12); and 4) failing to develop a policy and procedure that defined complaints and grievances, defined how patients were informed of the grievance process, specified time frames for the review and response of a grievance, and failed to include the process for written notice to the patient.

Findings:

1) Failing to include an allegation of verbal abuse in the grievance process:

Review of the "Complaint/Grievance Log" revealed an entry dated 04/14/13 & 04/15/13. The complainant was identified as Patient #RF1 and a family member of Patient #F12. The complaint/grievance was documented as Patient #RF1 verbally abused by employee. The Result/Outcome of Complaint/Grievance was documented as follows: SF1Administrator had charge RN and assisting RN complete incident reports. RNs met with Patient #RF1's family immediately-family satisfied. SF1Administrator met with families X 2 as well. Both satisfied with our handling of complaint. Resolved 04/15/13. There was no documented evidence the alleged abuse was identified as a grievance.

In an interview on 05/21/13 at 3:45 p.m., SF1Administrator stated SF7CNA verbally abused Patient #RF1 on 04/14/13. SF1Administrator stated a family member of Patient #F12 witnessed the incident and complained about the way SF7CNA treated Patient #RF1 and expressed concern that she did not want that CNA to provide care to her father (Patient #F12). SF1Administrator verified both were grievances, but neither were handled as grievances. SF1Administrator verified no written response was provided for either patient.


2) Failing to determine whether patient concerns were complaints or grievances:

Review of the "Complaint/Grievance Log" revealed an entry dated 04/14/13 & 04/15/13. The complainant was identified as Patient #RF1 and a family member of Patient #F12. The complaint/grievance was documented as Patient #RF1 verbally abused by employee. The Result/Outcome of Complaint/Grievance was documented as follows: SF1Administrator had charge RN and assisting RN complete incident reports. RNs met with Patient #RF1's family immediately-family satisfied. SF1Administrator met with families X 2 as well. Both satisfied with our handling of complaint. Resolved 04/15/13. There was no documented evidence the alleged abuse was identified as a grievance. Review of the Log revealed no prompt/space/column to identify whether the concern was a grievance or a complaint.

In an interview on 05/21/13 at 3:45 p.m., SF1Administrator verified the complaint/grievance log did not indicate whether the patient's concern was a complaint or a grievance. SF1Administrator verified both Patient #RF1 and the complaint received from the family of Patient #F12 were grievances but the hospital had not identified either one as a grievance. SF1Administrator verified the outcome column of the complaint log indicated both were handled as complaints.


3) Failing to acknowledge a grievance in writing to the patient:

Review of the "Complaint/Grievance Log" revealed an entry dated 04/14/13 & 04/15/13. The complainant was identified as Patient #RF1 and a family member of Patient #F12. The complaint/grievance was documented as Patient #RF1 verbally abused by employee. The Result/Outcome of Complaint/Grievance was documented as follows: SF1Administrator had charge RN and assisting RN complete incident reports. RNs met with Patient #RF1's family immediately-family satisfied. SF1Administrator met with families X 2 as well. Both satisfied with our handling of complaint. Resolved 04/15/13. There was no documented evidence the alleged abuse was identified as a grievance and there was no documented evidence a written response was provided for either complainant.

In an interview on 05/21/13 at 3:45 p.m., SF1Administrator stated SF7CNA verbally abused Patient #RF1 on 04/14/13. SF1Administrator stated a family member of Patient #F12 witnessed the incident and complained about the way SF7CNA treated Patient #RF1 and expressed concern that she did not want that CNA to provide care to her father (Patient #F12). SF1Administrator verified both were grievances, but neither were handled as grievances. SF1Administrator verified no written response was provided for either patient.


4) Failing to develop a policy and procedure that defined complaints and grievances, defined how patients were informed of the grievance process, specified time frames for the review and response of a grievance, and failed to include the process for written notice to the patient.

Review of the hospital's policy titled, "Patient/Family Grievance/Complaints", no policy number, and no date, provided as current by SF1Administrator, revealed in entirety the following: I. Policy: It is the policy of [hospital] to establish a formal means to voice complaint and resolve disputes. II. Purpose: To provide a mechanism by which patients, or persons on their behalf, can express complaints, resolve disputes, or bring attention to incidents, conditions, practices and/or polices may violate patient rights. III. Procedure: A. Upon receipt of a written or verbal complaint from a patient and/or family member, the staff member is to refer concern to the on-duty Charge Nurse, if applicable. B. The on-duty Charge Nurse is to complete a "Patient/Family Complaint Form". C. The on-duty Charge Nurse is to offer some immediate corrective action to resolve complaint. D. The on-duty Charge Nurse is to forward all complaint form to DON. E. The DON is to follow up on complaint within twenty-four hours to evaluate resolution.

There was no documented evidence in the policy of the definition of a complaint and a grievances and how each was to be addressed. There was no documented evidence in the policy of how the patient/representative was to be informed of the hospital's grievance procedures. There was no documented evidence of the time frame to review and respond to the complainant and there was no procedure for providing written notice to the patient of the hospital's determination regarding the grievance.

In an interview on 05/22/13 at 4:50 p.m. SF1Administrator verified the above policy and procedure was the only current policy for complaints/grievances. SF1Administrator verified the policy did not include a definition of complaints and grievances and did not include directives on how to address either one. She verified the policy did not include directives on how to inform patients/representatives on the grievance process. SF1Administrator verified the policy did not include a procedure for providing written notice to patients or time frames for review and response.

Based on record review and staff interview, the hospital failed to ensure the patient was free from all forms of abuse or harassment as evidenced by failing to ensure staff identified an allegation of verbal abuse, protected the patient during the investigation of an allegation of verbal abuse, and reported an incident of verbal abuse to the hospital administrator and the Department of Health & Hospitals, Health Standards Section within 24 hours of knowledge of the allegation for 1 of 1 random sampled patients reviewed for an allegation of abuse (Patient #RF1). Findings:

Review of the hospital policy titled, "Reporting Abuse", policy number (blank), provided as current by SF1Administrator, revealed in part the following: ....1. Employees who have witness or have knowledge of patient abuse shall immediately report it to their immediate supervisor, if for some reason the employee believes they cannot or should not inform their immediate supervisor, the employee may contact Hospital Administrator....4. The Hospital Administrator is to be informed immediately when information arises to indicate that patient abuse may have occurred....5. Documentation in the form of incident reports or written statements is to be completed and provided by employees reporting allegation of abuse or neglect....

Review of the hospital policy titled, "Prevention of Patient Psychological & Physical Abuse", policy number (blank), provided as current by SF1Administrator, revealed in part the following:....Patients will be protected from abuse during investigation of any allegation....

Review of LA R.S. 40.?2009.2 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...?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.


Review of the Governing Body minutes dated 04/17/13 revealed the following: "We terminated a CNA because of verbal abuse/inappropriate verbal communication with a patient...."

Review of the Incident/Occurrence Report dated 04/14/13, (no time documented, only p.m. circled) revealed Patient #RF1 was identified as having "Assaultive/Abusive behavior" to staff member SF7CNA. SF6RN (Charge Nurse) documented the following: Entered dining area to find Patient #RF1 stating to SF7CNA, "Step away from me." SF7CNA responded, "What is wrong with you?" Patient #RF1 then threw food tray, food hit CNA. I immediately began to diffuse situation by using calming technique and therapeutic communication with client. Client became tearful and called daughter, spoke to daughter along with patient's nurse, SF11RN.

Review of the "Complaint/Grievance Log" revealed an entry dated 04/14/13 & 04/15/13. The complainant was identified as Patient #RF1 and a family member of Patient #F12. The complaint/grievance was documented as Patient #RF1 verbally abused by employee. The Result/Outcome of Complaint/Grievance was documented as follows: SF1Administrator had charge RN and assisting RN complete incident reports. RNs met with Patient #RF1's family immediately-family satisfied. SF1Administrator met with families X 2 as well. Both satisfied with our handling of complaint. Resolved 04/15/13.

Review of the hospital's investigation of the alleged verbal abuse referenced in the Governing Body minutes and the Complaint/Grievance Log revealed the following:
"04/15/13 - On this date given, a patient's family member (Patient #F12) approached me in the hall with concerns of an incident that happened on 04/14/13 with SF7CNA and a patient (#RF1). The family member of Patient #F12 stated that SF7CNA was verbally abusive towards the patient (#RF1) and that she did not care for her actions (cursed and failed to remove herself from the room after the patient no longer wanted her around him). The family member of Patient #F12 said that SF7CNA continued to holler & state nasty verbal words to the patient (#RF1)...." The form was signed by SF3HR (Human Resources).

"04/15/13 (Report completed on Wednesday 04/16/13). Incident - employee SF7CNA and Patient #RF1 on 04/14/13 Sunday. On Sunday I (SF1Administrator) received a call (6:30 p.m.) from a third party nurse - SF8RN advising me of the incident between employee/patient. I inquired with SF8RN if she worked the shift on yesterday and she said no and that she heard about the incident from SF7CNA herself....At the time SF8RN called me approximately 6:30 p.m., I had not been notified nor made aware of the incident by the Director of Nurses (DON), nor the charge nurse (SF6RN). I asked SF8RN if she knew the outcome of the incident and she said that the patient was fine and that though CF7CNA claimed Patient #RF1 was the aggressor, SF8RN called me because she knew something was wrong since Patient #RF1 was a very pleasant patient. She also stated that SF7CNA does have an attitude frequently. I agreed that it has been mentioned that she does have an ugly disposition at times and poor mannered or poor bedside manners. SF8RN also being our Customer Service Trainer and I then discussed the importance of the Customer Service Training workshops that were scheduled to begin the next day. At the time of this call from SF8RN, neither SF8RN nor myself knew the extent of the incident. At least we were unaware that she was verbally abusive to the patient. SF8RN also mentioned that SF7CNA said that the RN-SF6RN (Charge) stated that she thought Patient #RF1 should have been PEC'd (Physician Emergency Certificate) for his behavior.....SF8RN stated that was ludicrous as the patient was absolutely not a candidate for a PEC.
On Monday, 04/15/13, I received a text from the DON only stating "Patient #RF1 was aggressive on yesterday" in an incident. The DON did not initiate an incident report, nor discuss the incident with me. SF7CNA was present at the hospital for the education workshops. About mid-morning SF3HR was approached by a family member of another patient (#F12). The daughter of Patient #F12 was present in the dining room during the incident between SF7CNA and Patient #RF1, and was very concerned about CNA's behavior and that she did not want CNA to take care of her father when she reports again. She proceeded to explain to SF3HR that though Patient #RF1 should not have pushed his tray towards CNA, CNA was verbally abusive and calling patient names such as "crazy" and cussed at or about him using these words, "F___ing Psycho." The daughter of Patient #F12 proceeded to calm Patient #RF1 down and told him that when he gets angry he should notify the nurse in charge. The daughter of Patient #F12 reported that patient was crying and trying to call his family to advise-she assumed....This is when I learned the extent of the incident. Still no report from the DON. I then contacted SF6RN, Charge Nurse during the incident. I inquired if an incident report had been completed and for her to provide me the details of what occurred on yesterday between CNA/Patient. SF6RN informed me that she did call the DON immediately following the incident and that the DON stated that an incident report was not necessary which is the reason SF6RN failed to complete one....SF6RN did say that because of her Psych back ground, that she thought perhaps Patient #RF1 should have been PEC'd. She reported that the DON agreed with her and asked SF6RN to contact SF14Physician to have Patient #RF1 PEC'd. SF14Physician did not agree with a PEC, however, he did mention that he would consider a psych consult since patient is calm (post incident) and is pleasant and calm historically. SF6RN mentioned that Patient #RF1's family reported to the hospital shortly thereafter because they had received a call from him very upset....I requested SF6RN to come in and complete an incident report and that the advice from the DON was absolutely inappropriate for both not having her complete an incident report and for recommending/concurring with such an extreme intervention-PEC. I called the other RN on duty at time of incident-SF11RN. She stated that not only did CNA use the "F____ing" word but actually said, "Mother-F____" to or about the patient where others were present in the dining room. SF11RN also stated that the patient did not throw tray, but pushed tray towards CNA. CNA had "no food" on her clothing per SF11RN's observation. SF11RN stated when she interviewed Patient #RF1, he stated that CNA has had a bad attitude with him since his admission and that he was fed up with her and just wanted her to stay away from him. SF11RN then reported that she observes SF7CNA to have a poor attitude. Met with DON on same day - Monday, 04/15/13 and shared my concerns about her handling of this incident and that I would be terminating SF7CNA effectively immediately. DON did not agree with my decision after everything that occurred stating she thought I should only suspend her.

On 05/21/13 at 10:00 a.m., in an interview with SF3HR, the allegations of abuse that were reported to DHH-Health Standards Section since the last DHH survey were requested for review. SF3HR stated the hospital has not reported any abuse allegations to DHH-Health Standards Section since the last survey.

In an interview on 05/21/13 at 3:00 p.m., SF1Administrator reviewed the Incident/Occurrence Report for Patient #RF1 and verified the CNA verbally abused Patient #RF1. When asked if the hospital had reported the verbal abuse to Health Standards Section within 24 hours of knowledge of the incident, SF1Administrator stated no, and stated she did not know she had to report abuse incidents to Health Standards Section. Documentation of the investigation was requested for review.

In an interview on 05/22/13 at 4:50 p.m., SF1Administrator verified the staff on duty when the incident between SF7CNA and Patient #RF1 occurred, did not identify the CNA's actions as verbal abuse and the Charge Nurse and the DON wanted to PEC the patient. SF1Administrator verified the staff did not take any actions to protect the patient from the CNA after the incident occurred. SF1Administrator verified the staff on duty did not report the incident to her as directed in hospital policy. SF1Administrator stated she terminated SF7CNA on Monday for her actions in the incident, and stated the DON resigned 2 days later. SF1Administrator also stated SF6RN no longer was employed at the hospital. When asked if any training of the staff on abuse prohibition and reporting had been done she stated the only training they had done was the Customer Service Training that were already scheduled the Monday after the incident. Review of the outline for the Customer Service training revealed no documented evidence that abuse prohibition was included.