Guardian Not Notified of Patient's Seclusion/Restraint

The Centers for Medicare and Medicaid Services (CMS) cited Laurel Ridge Treatment Center for failing to uphold a patient’s rights to make informed decisions regarding his or her care by not informing a patient’s guardian of a restraint and seclusion incident. The patient was restrained for less than one minute and placed in locked seclusion for 20 minutes, but there was no documented explanation as to why the patient’s guardian was not notified. An interview with the patient’s mother/legal guardian revealed that she did not want her daughter placed in locked seclusion due to traumatic events from her childhood, but was unaware of the incident until after her daughter was discharged. CMS also cited the facility for failing to perform a face-to-face physician evaluation of the patient who was placed in restraint (containment) and seclusion. The facility’s “Special Treatment Procedures on Seclusion/Restraints” states that such an evaluation must be completed within one hour of the initiation of containment or seclusion “‘to determine if the use of these measures is justified'” and to “‘ensure that [the] use of seclusion/restraint poses no undue risk to the patient’s medical or psychological well-being.'” CMS’ interview with the facility Nursing Director revealed that an evaluation was not performed because there was no physician physically present in the facility after 11:00 pm, since the facility utilized telemedicine for facility admissions past this hour. She added that “it was up to the attending physician whether they wanted to come in to do a face-to-face assessment.” In a related survey evaluating compliance with requirements for psychiatric hospitals, CMS cited the facility for failing to ensure that the number and qualifications of doctors of medicine and osteopathy was adequate to provide essential psychiatric services. The facility was cited for failing to ensure a physician was available to perform a one hour, face-to-face evaluation of the secluded patient mentioned above.