PeaceHealth St. Joseph Medical Center, Bellingham, Washington
Our Developmental Disability Services are failing us. As more and more people are being left at hospitals with no place else to go, one hospital has violated patient rights by using restraints and seclusion and not practicing up to the standard of care.
This needs to be corrected and other hospitals should take note that this harmful treatment can cause physical and emotional harm and deterioration to these individuals.
MEDICARE COMPLAINT INVESTIGATION
The Washington State Department of Health in accordance with Medicare Conditions of Participation set forth in 42 CFR 482 for Hospitals, found St. Joseph Hospital (PeaceHealth in Bellingham, Washington) NOT IN COMPLIANCE with the following conditions:
42 CFR 482.13 (e)(4)(i) – Patient Rights: Restraint or Seclusion–
The use of restraint or seclusion must be in accordance with a written modification to the patient’s plan of care.
- Failure to create or modify a plan of care for a patient placed in seclusion could lead to physical deterioration and delay in obtaining appropriate treatments
42 CFR 482.13 (e)(9) – Patient Rights: Restraint or Seclusion –
Restraint must be discontinued at the earliest possible time regardless of the length of time identified on the order
- Failure to remove a patient from seclusion after staff observed him to be re-directable or without significant disruptive behavior, can lead to physical and emotional harm to the patient
42 CFR 482.13 (e)(12) – Patient Rights – Restraint or Seclusion
When restraint or seclusion is used for the management of violent or self-destructive behavior that jeopardizes the immediate physical safety of the patient, a staff member, or others, the patient must be seen face-to-face within 1 hour after the initiation of the intervention – by a 1. Physician or other licensed independent practitioner, or 2, Registered nurse or physician assistant who has been trained in accordance with the requirement specified in paragraph (f) of this section.
- Failure to perform or document a one-hour post application evaluation on a patient during use of physical restraints or seclusion for violent behavior can lead to possible abuse, assault, and self-injury or poor patient outcome.
42 CFR 482.55(a)(3) – Emergency Services Policies
The policies and procedures governing medical care provided in the emergency service or department are established by and are a continuing responsibility of the medical staff.
- Failure to perform a complete initial assessment can lead to obtaining inaccurate patient information resulting in an ineffective plan of care, treatment or services.
STATE COMPLAINT INVESTIGATION
The Washington State Department of Health in accordance with Washington Administrative Code (WAC), Chapter 246-320 Hospital Licensing, conducted this complaint investigation and violations were found pertinent to this complaint.
WAC 246-320-226 (3)(f) Patient Care Services – Restraints/Seclusion
- The Washington Administrative Code was not met as evidenced by the fact the hospital failed to ensure staff performed and documented on-hour face-to-face evaluation after initiation of restraint or seclusion for patients exhibiting violent behavior, as observed in 3 out of 7 patient records reviewed.
- Seclusion was used preemptively and failed to remove patient from seclusion after staff observed him to be re-directable or without significant disruptive behavior. This can lead to physical and emotional harm to the patient.
- Failure to initiate or modify a plan of care for a patient placed in seclusion could lead to physical deterioration and delay in obtaining appropriate treatments.
WAC 246-320-281 (4) Emergency Services – Standard of Care.
If providing emergency services, hospitals must use hospital policies and procedures which define standards of care.
Failure to perform a complete initial assessment can lead to obtaining inaccurate patient information resulting in an ineffective plan of care, treatment or services.
#waleg #disabilities @DdOmbuds @SFrameK5
Because We Care - Beyond Inclusion 
I am very glad that the hospital was investigated for this issue since vulnerable adults have been harmed by these practices at this hospital.
I still am concerned about the fact that the hospital allowed one client to leave – barefoot and in scrubs – to run around Bellingham at rush hour, across busy streets, and did not notify the person’s mother/guardian or police about him eloping from the hospital.
It was only after the person showed up with bloody feet at the previous group home he had lived at that the police and mother were notified. The hospital told the mother that he had checked out of the hospital on his own.
These actions need to be investigated too and have a policy about what to do for vulnerable adult patients that may elope and how to manage the elopement. The hospital needs to recognize the legal duty of the guardian and that the vulnerable adult is not able to make decisions on their own – hence the reason for the legal guardianship.
Another issue that brought up concerns is that a person with a mental health diagnosis may not be admitted to behavior health unit (psychiatric unit) if they will not benefit from talk therapy? This really puts some vulnerable adults with mental health diagnoses at much greater risk too.
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