PA. Veterans Home Cited on Narcotics

By Walter F. Roche Jr.

A Pennsylvania health facility for veterans has been cited for mishandling of narcotic drugs including the apparent theft of opiods by staff members.
The violations of drug handling and other regulations at the Gino J. Merli Veterans Center were included in a report recently made public by the state Health Department. Other violations uncovered in a Dec. 7 inspection include failure to implement a correction plan from a prior inspection and multiple violations of sanitary requirements in food preparation areas.
The facility "failed to demonstrate effective corrective action plans," the report states, noting that mishandling of drugs had been cited in a prior report.
Both inspections were to re-certify the licensed nursing home for participation in the federally funded Medicaid program.
As the report notes the facility has had a history of problems with the handling of narcotic drugs. A licensed practical nurse employed at the facility was investigated in April of 2017 for mishandling of drugs and was no longer employed at the center, according to the report.
Officials of the state Department of Military and Veterans Affairs, which run state veterans homes, did not reply to requests for comment.
In the new report, surveyors found that in the review of 33 residents' records, nine were found deficient.
The report cites the "potential misappropriation of residents' property by drug diversion."
The state inspectors reviewed drug dispensing records and individual patient records and found that in many cases there was no verification that the drugs dispensed were actually administered to the patients as prescribed.
In one specific case a nurse incorrectly transcribed a doctor's prescription resulting in the patient getting incorrect dosages.
A review of surveillance videos showed a licensed practical nurse pouring medication from two different containers on 13 occasions, the report states. And there was no documented evidence the drugs were actually administered to the appropriate patients.
A further review of drug dispensing records showed staffers routinely taking two pain killing pills when only one pill had been prescribed.
The report states that when questioned about the double doses , a staffer "stated that he would give Resident 51 more thn the physician prescribed." That staffer resigned Aug. 7
A second staffer who mishandled narcotic drugs was "no longer employed by the facility," the inspectors reported..
In yet another violation, the report states that inventories of narcotic drugs required at the end of each shify were not always conducted.
The report cites the home for sanitation violations in a food preparation areas including a "build-up of thick black grime on a hand-washing area.
The facility failed to maintain two food preparation areas in a manner to prevent the potential for microbiological growth.
Contact: wfrochejr999@gmail.com

RN Photographs Bared Patient

By Walter F. Roche Jr.

A nurse manager at a Western Pennsylvania hospital photographed and then displayed a photo of a patient's bared bottom and threatened employees with the loss of their jobs if they disclosed what she had done.
Three employees at the Highlands Hospital in Fayette County related the incident to a surveyor from the state Health Department, which recently made public a report on the matter.
The report cites the hospital for failing to treat a patient with "respectful care given by competent personnel."
According to interviews with hospital personnel the incident occurred when the nurse supervisor spotted the bared bottom patient on a monitor. The patient, whose scrotum was also visible, was in a seclusion room and was being monitored by camera.
"I was sitting with a behavioral health patient," one hospital staffer told the state inspector. "The manager was making the rounds. The manager stood to the side and looked at the monitor. The patient's buttocks were showing." the report states, recounting the description given by the hospital employee.
"The nurse manager laughed and said,"Picture is worth a thousand words," the report continued, adding that the manager then took out her cell phone and took a picture of the patient. "The nurse manager laughed and said 'You can't make this stuff up."
Other hospital employees described the nurse manager showing the picture to them along with threats.
One employee said the nurse manager showed the picture and then said, "If anyone finds out about this and I find out who did it, you will lose your job."
One of the employees interviewed said that she didn't say anything at the time because the supervisor was her boss.
"I just thought HIPPA, HIPPA, HIPPA," the employee said referring to the federal law (the Health Insurance Portability and Accountability Act)protecting patient privacy rights.
In a plan of correction filed by the hospital, facility administrators said they would initiate an employee retraining program and then monitor to ensure against any future violations. The plan did not indicate what if any action was taken against the nurse supervisor.
Contact: wfrochejr999@gmail.com

Crozer-Chester Cited for Ligatures

By Walter F. Roche Jr.
UPDATED

A state of "immediate jeopardy" was declared at a behavioral unit at the Crozer-Chester Medical Center when state health inspectors found loopable devices which could be used for suicide.
The report, just made public last week, cites a series of other violations of state and federal standards in the same unit including a non-working monitor and improper use of restraints.
The immediate jeopardy declaration forced hospital officials to prepare an immediate response to abate the risk to patients.
"Immediate jeopardy," the report states, is a situation in which a violation of standards "caused or is likely to cause serious injury, harm, impairment or death."
The violations were found in the hospital's Rejuvenation" program. A hospital spokesman said there were 20 beds in the unit for elderly behavioral patients.
The non-working monitor was one of several used to keep patients under constant surveillance. Though other monitors were working, staffers told state surveyors that they did not monitor the monitors.
"We are not required to monitor patient activity," one staffer told the surveyors.
Restraints, inspectors found, were kept in place for excessive periods and a physician failed to state the reason for the restraint in the record for one patient.
An examination of patient treatment plans showed some were not updated while others were not sign or initialized.
In the dietary area, the inspectors found that logs of temperatures on refrigerators were missing and unsanitary conditions, including human hair, were found in one refrigerator.
A hospital spokesman said the facility has been working with state health officials on development and implementation of a corrective action plan.
"We have made all of the upgrades required," said spokesman Rich Lenowitz.

Hospital Handcuffed Patients

By Walter F. Roche Jr.

A Pennsylvania hospital placed three patients in handcuffs without a physician's orders, a state health investigation has shown.
The Oct. 26 report issued by the state Health Department concluded that the Washington Hospital in Washington County had violated laws and regulations protecting patients' rights.
"Significant corrections evidencing compliance will be required," the report states.
A review of patients' records showed five patients were placed in restraints without first considering whether less restrictive interventions could have been applied.
In addition to the three placed in handcuffs, the records showed two others were placed in restraints without consideration of less restrictive measures.
"The facility failed to ensure restraints would only be imposed to ensure the immediate safety of the patients, a staff member or for others," the report states.
In a plan of correction, the hospital said that in the future handcuffs would not be used unless the patient is in the presence of a police officer.
One of the cases cited was a 66-year-old male patient suffering acute alcohol withdrawal who was handcuffed "as a result of threatening staff.
A 52-year-old male admitted for a mental health evaluation was handcuffed "as a result of assaulting staff."
The third case was a 41-year-old male who was brought in by a police officer who had placed him in handcuffs.
A staffer told the state surveyors that when police bring a handcuffed patient to the hospital "we switch handcuffs and they stay on until the doctor gives an order to release them."
In the plan of correction the hospital stated that in the future handcuffs will not be used until a physician assesses the patient.
Contact: wfrochejr999@gmail.com

Hospital Failed to Probe 4 Abuse Cases

By Walter F. Roche Jr.

A 590-bed Pennsylvania hospital failed to properly investigate four separate cases of suspected abuse, according to a report issued by the state Health Department.
The report on the Lancaster General Hospital, part of Penn Health, resulted in state surveyors declaring a state of immediate jeopardy, forcing hospital officials to come up with an immediate plan to eliminate the risks faced by patients.
The hospital "failed to ensure a comprehensive investigation of allegations of abuse. This failure placed patients who alleged the abuse and other patients that may have had contact with the staff member in question at risk," the report dated Nov. 14 states.
The inspectors also cited the hospital for failing to report the suspected abuse to police and other state agencies.
The hospital filed a plan of correction in which it promised to educate employees on abuse reporting requirements and to set up a dedicated phone line for reporting such allegations.
In one of the four incidents a patient reported awakening to discover a hospital employee "touching the patient's genitals while touching the employee's own genitals."
The hospital eventually concluded the report was unfounded and took no further action.
In a second incident a patient reported that an employee fondled "the genitals for five to 10 minutes while applying topical medication to a rash."
In the third incident a patient reported being grabbed by a nurse while waiting for an elevator. The patient, the report states, "was upset that a nurse put hands on the patient in a rough manner."
The fourth incident involved a patient who was struck by his wife, but the patient was able to free himself.
The surveyors faulted the hospital for failing to report the incidents to the proper authorities including the Adult Services Hotline. the Department of Human Services and local police.
The surveyors found that the employee who was involved in the first incident was allowed to return to work even though the allegation was not fully investigated.
John Lines, a hospital spokesman, said that the employee remains on administrative leave while the police investigation continues
The report also states that hospital records show no documentation that the there was any follow up with the patient making the allegation.
The report on Lancaster General was the second in recent months in which state surveyors faulted health administrators for failing to properly investigate allegations of sexual abuse. The other report was issued on the Lifecare Behavioral Hospital where two allegations of sexual abuse against the same employee were not fully investigated.
The employee had returned to work when he was arrested by police.
Contact: wfrochejr999@gmail.com

Geisinger Delayed Care for Insurance Check

By Walter F.Roche Jr.

The Geisinger Community Medical Center violated a federal law when it delayed care to a half dozen patients to get pre-authorization from their insurance carriers.
Surveyors from the state Health Department concluded that the delays in care at the 273 bed Scranton facility violated the Emergency Medical Treatment and Active Labor Act.
The inspection, the result of an unannounced on site November visit, found that in six of 20 cases reviewed, care was delayed by up to a full day awaiting pre-authorization from the individual insurance carriers. The six were seeking admittance to the hospital's behavioral health unit from referring hospitals.
"A participating hospital may not delay providing appropriate medical screening," the report states, "in order to inquire about the individual's method of payment or insurance status."
The report notes that the law does not bar health facilities from following reasonable registration procedures as long as those procedures do not "unduly discourage individuals from remaining for further evaluation."
Three of the six required specialized psychiatric care, according to the report.
In at least two of the cases reviewed, admission was delayed for a full day awaiting insurance carrier approval.
The hospital filed a plan of correction including a re-education program for emergency room staffers and an audit system to assure compliance. A hospital spokesman said the facility amended its procedures for handling transfers from other facilities thus avoiding any delays in care.
"We’ve taken steps to rectify that issue, which was related to patient transfers from outside facilities. We have amended our registration process for accepting transferring patients to reduce the risk of delaying treatment, and continue to work with the Department of Health to ensure our compliance with such requirements," the spokesman wrote in an email response to questions.


The hospital also revised its patient intake forms to eliminate the section requiring insurance coverage information.
Contact: wfrochejr999@gmail.com

Hospital Failed to Probe Abuse Complaint

By Walter F. Roche Jr.

A Pittsburgh behavioral hospital reinstated an employee who was still under investigation for sexual abuse of a patient, according to a report from the Pennsylvania Health Department.
The worker at the 49 bed Lifecare Behavioral Hospital was finally terminated after his arrest at the facility in October, according to a recently released report.
State inspectors, who were sent to the facility in response to a complaint, concluded that the hospital failed to properly investigate two separate complaints on the same unidentified staffer.
Records reviewed by the state surveyors showed one of the victims stated that the worker came into her room and said, "Let me rub your back."
She said she got nervous, got out of bed and started to walk out of the room. She said she told him she didn't need a back rub.
The first complaint against the employee was based on an incident that occurred between April and July.
A second complaint against the same employee for inappropriate touching was filed on Aug. 14, according to the report. He was suspended, but then reinstated on Sept. 10 when hospital officials concluded the complaint was unfounded.
The facility "reinstated the employee on Sept.10 absolving him of any wrongdoing regarding the Aug. 14 incident," the report states, "despite the employee remaining a suspect for the earlier incident."
The employee was at work at the facility on Oct.16 when police placed him under arrest.
The hospital filed a plan of correction in which it said workers would be retrained on the correct procedures to follow in response to a report of sexual abuse. The plan also calls for increased use of surveillance cameras and monitoring of employee activities.
Hospital officials also stated that they were asked by police not to immediately investigate the initial report.
Contact: wfrochejr999@gmail.com