Federal regulators have cited the University of Maryland Medical Center Midtown for violating patient rights and several patient safety and hospital management regulations related to a January incident in which a woman was discharged from its emergency room in just a hospital gown.
The woman, who has been identified only as Rebecca, was found outside the hospital in frigid temperatures by a local psychotherapist who ran into her after leaving work. He called an ambulance and she was taken back to the emergency room and eventually put in a cab to a homeless shelter.
An investigation of the incident by the Centers for Medicare & Medicaid Services found numerous “deficiencies” related to the incident, which began when Rebecca arrived at the hospital for treatment for a head wound after falling off a motorbike.
She was treated, but the report found she resisted being discharged and nurses asked security to intervene. She was removed from the hospital in what many consider an act of “patient dumping.”
Among the deficiencies noted in a pair of federal reports, the hospital:
- Violated a federal law requiring that a hospital must protect and promote each patient's rights. “Specifically, the hospital enacted barriers to patients receiving care in the Emergency Department, failed to discharge a patient in a safe manner from the Emergency Department, and failed to protect one patient from harassment and potential harm.”
- Violated a patient’s right to receive care in a safe setting. “Security personnel indicated that they would turn patients away if they were ‘unruly’ or otherwise acting inappropriately. They would call police if the person did not leave. This practice meant that non-clinical personnel determined who could receive treatment in the” emergency department.
- Violated patient’s right to be free from all forms of abuse or harassment, citing the circumstances of her removal from the hospital.
- Violated patient’s right to confidentiality of records because “non-clinical staff had access to or were made aware of portions of [the patient’s] medical history and physical examination findings.”
- Failed to meet standards for data collection and analysis.
- Failed to perform quality improvement activities.
James E. Farmer, a personal injury attorney from Waldorf who represents Rebecca, said the report is evidence that his client’s rights were violated. Rebecca, whose family has said she has mental health issues, remains in inpatient treatment in Baltimore.
“There are certain things that have to be done for these patients,” he said. “They must be stabilized. They must be treated. There is absolutely no doubt that in the time she was there she was not treated with human decency and respect.”
Hospital executives said that the federal findings were similar to results of their own internal investigation as well as of a third-party analysis it commissioned. The hospital changed some procedures after its own investigation and also had to develop a “plan of correction” as part of the federal audit. Federal investigators will eventually revisit the hospital to make sure the plan is being followed.
“We are confident that we are doing the right thing to move forward,” said University of Maryland Medical Center CEO Dr. Mohan Suntha. “We look forward to when we will be able to demonstrate that to the community.”
The hospital also was cited for not recording when patients returned to the emergency room within a couple of hours. The hospital logs did not show that Rebecca had returned to the hospital after her initial discharge. There also was no indication that she was re-examined by a doctor or nurse, the report said.
Federal investigators also found the hospital did not display signs in the emergency room that outlined patients’ rights.
The report also found that emergency room doors were locked and security personnel decided what patients would enter, sometimes with no medical examination, based on their behavior. Investigators pointed out that some unruliness from patients might be caused by medical conditions.
The hospital’s leadership also was criticized for lack of oversight and awareness of problems at the hospital.
The emergency department reported a problem with patients’ access five months before the January incident, but there was no indication that hospital leadership was made aware of the issue, the investigators found. They also said leadership failed to identify possible unsafe discharge practices and possible harassment of patients by security staff.
As part of protocol changes brought about by the incident, the hospital has begun to record every time a patient visits the emergency room, even after only a short period of time. Each new encounter will “trigger” a fresh triage of the patient, the report said.
The hospital has also started to conduct audits of the patient log each month. In February, 41 patients returned to the emergency room within 24 hours and two were re-registered within a couple of hours.
All staff also were given additional training on federal requirements including patient rights required by law. Spot audits will be performed to make sure staff is following procedures
The hospital now keeps emergency room doors unlocked and the staff bylaws have been updated to show who can perform a medical screening. Security now must allow everyone seeking care into the lobby.
But Suntha emphasized that security measures remain in place. For instance, security officers will escort unruly patients into the lobby.
Suntha said hospital officials have no indication patients did not receive needed medical care because they were turned away.
“We didn’t solve the problem by removing security,” Suntha said. “We solved the problem so that patients are still protected and staff are still protected in our solution.”
Frankie Berger, director of advocacy for the Treatment Advocacy Center, agreed with Rebecca’s attorney that the report shows her rights as a patient were violated.
She said the report showed the hospital was “wildly” out of compliance in its lack of procedures for medical screening examinations, which she described as the most fundamental service a hospital emergency department can provide.
“As evidenced in this report, the hospital failed Rebecca in so many ways,” Berger said. “It is clear she was not properly cared for at any point throughout her interaction with the emergency department — from her initial insufficient screening and poor record keeping, to denying her screening and examination when she arrived by ambulance for the second time that day, to her cruel discharge to a cold winter street without clothing on. And all of this is underscored by the failure of hospital staff to recognize her symptomatic [mental health problems] as an emergency in need of treatment.”