Hospital Cited In Patient Suicide

By Walter F. Roche Jr.

A state of immediate jeopardy was declared by state health officials early this year when they visited a Bradford County hospital to investigate a complaint about a patient's attempted suicide while in the facility's behavioral unit.
The patient, who was hospitalized following another attempted suicide, was found unconcious in his room hanging from a bathroom doorway.
State inspectors faulted the 267-bed Robert Packer Hospital for failing to remove hazardous materials from a room where a suicidal patient had been placed. The hospital is located in Sayre, which is about 50 miles northwest of Scranton near the New York border.
Hospital employees failed to remove a chair from the patient's room, which was subsequently used, along with a hospital flat sheet, in the suicide attempt.
Even after the incident the state surveyors found that while bathroom doors had been removed protrusions remained in behavioral unit rooms that could be used to attach a ligature and commit suicide.
The hospital also was faulted for failing to inform the patient's family of the suicide attempt. They also failed to comply with a state law requiring that such incidents be reported to the state Patient Safety Authority and the state Health Department within 24 hours.
Hospital officials did not respond to a request for comment but they did file a plan to remove the immediate jeopardy declaration and a plan of correction to prevent a recurrence.
In addition to removing the bathroom doors re-education sessions were held with behavioral staff about the need to remove items that could be used in a suicide attempt. Staff also were informed of the need to check on some behavioral patients every 15 minutes.
Flat sheets on behavioral unit beds were replaced with fitted sheets, according to the corrective action plan.
According to the state report the patient was admitted to the hospital following another suicide attempt in which the patient was stabbed in the abdomen and on the arms.
On Jan. 8 at 4 p.m. the patient requested a chair to take a shower. While the chair should have been removed as soon as the shower was completed it was still in the patient's room the next day when staffers found the patient hanging from the bathroom doorway.
The report also questioned why the hospital changed the category of the incident in hospital records from a "code blue" to a "rapid Response team."
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