Patient suffered dehydration and kidney failure in psychiatric hospital found to be understaffed

The Centers for Medicare and Medicaid Services (CMS) cited the governing body of Texoma Medical Center when it found “the hospital failed to ensure the medical staff monitored and evaluated inpatient medical care and appropriately intervened when a significant change in a patient’s condition occurred.” CMS also found the facility’s nursing services to be deficient, in part because “[t]he hospital failed to provide adequate number of nursing personnel.”

Staffing

CMS found that the psychiatric Acute Care Unit and Progressive Care Unit did not have enough staff to help patients with activities of daily living. One patient was observed

… sitting in a wheelchair with an attached lap tray. The unit was malodorous. (Patient #9) wore a stained sweat shirt and complained she did not have a bath ‘in three days.’ Staff #8 verified (Patient #9’s) bath was three days ago.

Another patient was observed “curled up on the sofa next to the entrance way. The patient was disheveled, dressed in a plaid jacket with badly stained sleeves and front… Observations … reflected a strong urine smell in the hallway across from the patient laundry room.” A male patient “was observed sitting at a table in front of a lunch tray in the otherwise empty day room. No staff assisted the patient.”

In interviews, staff “stated patients did not get bathed or shaved due to the lack of staff… nor did patients get to go outside due to staffing issues.” Another said that, “providing showers for patients was ‘extremely difficult’ due to staffing issues. Before visitation, staff would ‘wipe them [the patients] down and spray some scents on them to make them smell good.” Staff explained that Mental Health Technicians would “get pulled” from the units “daily” for other tasks, so that “nurses were left with up to 32 patients.”

Medical Care

Additionally, CMS found the hospital failed to provide adequate medical care to psychiatric patients. One patient did not eat or drink for several days after admission, losing 9 lbs in 3 days and requiring transfer to an acute care hospital’s ICU for dehydration and renal (kidney) failure. Nursing notes documented her condition and refusal of food, but no interventions were documented until staff found:

[C]lient was cool to touch, unresponsive and unable to obtain pulse… respirations 40 and erratic… unresponsive to verbal/physical stimuli… client is cold, color is white and pasty.. orders received to transfer to ER (emergency room) for evaluation… client’s family called regarding transfer and change in condition.

At the acute care hospital, the patient was diagnosed with acute renal failure and began dialysis treatment.

When CMS toured Texoma Medical Center’s psychiatric units, a current patient “reported she had not eaten in 10 days.” This second patient’s medical records showed she had entered the facility eight days earlier with blood pressure of 100/75, and additional readings were as low as 81/51. However, her medical records reflected no additional blood pressure readings in the five days leading up to the inspection. In total, CMS found that 4 out of 4 patients with high or low blood pressure results were not provided with appropriate follow-up care. Additionally, a patient with sleep apnea was not given CPAP equipment to aid in breathing at night. The patient slept just 4.9 hours per night, felt sleepy during the day and missed four days of therapy.