HospitalInspections.org

Based on record review, staff, and patient interviews, it has been determined that the hospital failed to ensure patients are free from verbal abuse and treated with respect. Additionally, hospital employees failed to report allegations of abuse right away according to the hospital's abuse reporting practices, for 1 of 4 sample patients reviewed (Patient ID #1).

Findings are as follows:

On 5/14/2024, the Rhode Island Department of Health received a report from the hospital which alleged that on 5/13/2024 at 7:00 PM, Employee A was speaking "aggressively/disrespectfully" to Patient ID #1. The report indicates that according to the witness' statement, Employee A was yelling and swearing at the patient and is quoted as stating the following: "I don't give a f*** what you want to do, and you can do everything for your damn self, you don't need my help as much as you say you do."

According to Title 23 Health and Safety Chapter 17.8 Abuse in Healthcare Facilities R.I. Gen. Laws § 23-17.8-1, "Abuse" is defined as:

"...(v) Intentionally engaging in a pattern of harassing conduct which causes or is likely to cause emotional or psychological harm to the patient or resident, including but not limited to, ridiculing or demeaning a patient or resident, making derogatory remarks to a patient or resident or cursing directed towards a patient or resident, or threatening to inflict physical or emotional harm on a patient or resident."

During a surveyor interview on 6/5/2024 at 11:15 AM with Patient ID #1 in the presence of the Nurse Manager, she/he stated that Employee A was yelling "derogatory things" at him/her the evening of 5/13/2024. When asked to describe what she/he meant by this, she/he indicated that Employee A often yells at him/her to "stay still" or "don't keep scooting down" and when Employee A is placing a urine collection device on him/her, Employee A says she has to "push your fat over." The patient stated that Employee A often tells him/her that if she/he does not stay still, "they're going to take it away," referring to the purewick urine collection device. The patient indicated that on the evening of 5/13/2024, she had asked Employee A to hold his/her left arm but Employee A "let it drop." The patient stated that Employee A did use the "f-word" when speaking to him/her the evening of 5/13/2024 and stated she/he felt "terrible" when Employee A used the "f-word" in front of him/her. The patient stated, "It hurts my feelings" when Employee A tells him/her that she will push his/her fat over. The patient revealed that Employee A has been treating him/her this way "for years."

During an interview conducted by the hospital with Patient ID #1 on 5/14/2024 at 10:38 AM, the patient indicated that on 5/13/2024, she/he asked Employee A for help as she/he was trying to undress but Employee A told him/her "you can do it yourself, I can only assist you." The interview states that the patient reported she/he is sometimes wet from the purewick urine collection device and will ask for help, but Employee A complains that the patient plays with the device and the patient "will lose it if she has to keep changing it." The patient stated during this interview that Employee A will tell him/her "I have to push your fat over" and that Employee A sometimes "swears at [him/her] and can be loud which makes [him/her] uncomfortable." Further review revealed the patient stated Employee A, " ...talks down to [him/her] ..."

During a surveyor interview on 6/5/2024 at 10:29 AM with Employee B, Nursing Assistant, she indicated that on 5/13/2024 during the evening shift, she heard yelling from Patient ID #1's room and she ran fast to see what was going on. Employee B stated she walked into the patient's room and observed Employee A yelling at the patient, "I don't give a [f***] about you wanting to go to bed, it's up to me." Employee B indicated that she then asked, "what's going on?" and Employee A said that the patient, "wants to go to bed." Employee B indicated she left the room and encountered Employee C, Nursing Assistant, in the hallway who asked her, "is she always like this?" referring to Employee A. Employee B indicated that she then spoke to the nurse on duty, Employee D, about the situation and reported it on the following day, 5/14/2024, to Employee E, who was the nurse on duty.

During an interview conducted by the hospital with Employee B on 5/15/2024 at 10:45 AM, Employee B revealed that Employee A yelled, "You can do all this [f******] [s***] yourself." Additionally, according to the interview, when Employee B asked Employee A and Patient ID #1 what was going on, Employee A replied, "Nothing. [She/He] can do all this on [his/her] own. [She/He]'s being lazy." Further review of this interview states in part that Employee B reported the incident to Employee D who told her, "this happens all the time."

During an interview conducted by the hospital with Employee C, Nursing Assistant, Employee C revealed she was in the room next to Patient ID #1's room and heard the patient yell, "I'm not finished" to which Employee A replied, "that sounds like a personal problem." Employee C stated she heard Employee A say, "I don't give a [f***] if you want to go to bed." Employee C stated during this interview that she also saw Employee A enter another patient's room and say, "who the [f***] left you like this."

During an interview conducted by the hospital with Employee D on 5/16/2024 at 10:30 AM, Employee D revealed that when Employee A answers call lights she "will say 'what' or 'What now'." Further review revealed that Employee D stated nothing had been reported to her on the evening of 5/13/2024.

During an interview conducted by the hospital with Employee E on 5/16/2024 at 3:25 PM, he described Employee A as " ...abrupt, rough around the edges ..." and stated, " ...there is room for coaching [Employee A] on how she speaks to patients."

During an interview conducted by the hospital with Employee F, Nursing Assistant, on 5/16/2024 at 3:15 PM, she revealed she heard "a commotion" in Patient ID #1's room but thought the patient and Employee A were joking and heard Employee A say, "you can do it faster."

Record review of Patient ID #1's "Medical Nursing Flowsheet" dated 5/13/2024 revealed a section titled, "Signs of Abuse and Neglect" for which employees are to document "Observed/Reported or None."

Review of the 3:00 PM to 11:00 PM shift documentation on this flowsheet revealed this section was not updated to reflect the allegation of abuse as witnessed and heard by the employees on duty the evening of 5/13/2024.

Review of the hospital's Investigative Summary stated that it was determined Employee A engaged in "inappropriate/unprofessional conduct" while interacting with the patient which violated the hospital's "Standards of Conduct" since she used "vulgar language." The summary further states, "all staff are always expected to perform the duties of their positions in an appropriate, professional, and respectful manner."

During a surveyor interview on 6/5/2023 at 9:30 AM with the Nurse Manager in the presence of the Interim Chief Nursing Officer and the Risk Manager, the Nurse Manager indicated she was made aware of the allegation the next day, 5/14/2024, at 9:25 AM following an incident report submitted that morning by Employee E. She indicated that concerns related to abuse are to be reported right away but was unable to explain whether Employee B reported the incident right away after she witnessed it, since Employee D indicated, nothing was reported to her. Additionally, the Nurse Manager stated she would be re-educating Employee B about the hospital's reporting practices.