Tucson Medical Center has overhauled patient restraint procedures at its psychiatric ward, but not before a state authority investigated dozens of complaints and sent a special enforcement team to work with the hospital.
In three separate inspections in the past year, inspectors with the Arizona Department of Health Services told Tucson Medical Center administrators that some staff members were not meeting all the requirements for secluding or restraining patients in the Palo Verde Mental Health Services unit.
In some instances, staff members were going beyond acceptable practices to involve the hospital's security guards, or were shirking mandatory documentation, according to inspection reports.
In response, Palo Verde unit staff members and security staff members are attending an intensive three-day crisis prevention and intervention training, said Linda Wojtowicz, chief nursing officer. The new method teaches staff to de-escalate dangerous situations to prevent patient problems and staff injuries.
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Additionally, the hospital has closed programs for juvenile and geriatric psychiatric patients, opening more beds for adults. One root cause of the problems was an overflow of psychiatric patients at Tucson Medical Center's emergency room, and the patients would sometimes wait hours to be admitted to Palo Verde, said Judy Rich, hospital administrator.
Now patients can be transferred more quickly after ruling out prevailing medical problems to receive specialty care faster, said spokeswoman Julia Strange. The staff also can focus on the adult population instead of a variety of age groups.
The hospital was inspected again this month, and inspectors validated Tucson Medical Center's changes as being successful, she said. That report has not yet been made public.
TMC was fined $4,050 in November for problems at Palo Verde. Then inspectors surveyed the hospital on Feb. 28 to investigate 32 complaints that had piled up with the Health Services Department.
One violent patient was confined to a designated "time out room" for 20 days, locked inside for several hours at a time, before being transferred to an acute-care psychiatric facility out of town, according to an inspection report.
In another case an 18-year-old patient was handcuffed, pinned against a wall and strip-searched after she stole a staff member's wallet, according to the report.
"Handcuffs are considered law-enforcement restraint devices and are not safe appropriate health care restraint interventions," a state inspector wrote.
In other cases, security guards held a patient to the floor so a nurse could give him an injection and guards restrained a deaf man's arms, making it impossible for him to communicate through sign language, according to the report.
While investigating two more complaints on May 30, state inspectors again found staff members not following restraint procedures and again linked restraint problems to the practice of assigning security officers to supervise psychiatric patients in the emergency room.
In one case, a security guard used a pressure point technique to calm an out-of-control 18-year-old patient who was a frequent patient at the hospital and well known to the staff. The technique requires directing pressure to nerves near the jaw, but a staff member observing the incident reported that the guard slapped the patient's stomach and choked him, according to the report.
The hospital allowed the security guard to continue working in the emergency room while it investigated the abuse complaint, according to the report.
"When asked if an employee accused of abusing a patient would be removed from patient care during the investigation, (the emergency room director) responded, 'no.' She explained that it would not be fair to the employee if the allegation was not true," an inspector wrote.
In many of the cases, the emergency room staff was making do in difficult situations by recruiting guards to help bring situations under control, Strange said, but now the hospital has a system to better handle those situations.
Overall, the hospital had no policies that addressed the investigation of allegations of patient abuse or that addressed the role of security officers interacting with patients with psychiatric diagnoses, inspectors noted.
Hospital spokeswoman Strange said those policies and procedures are in place now and the whole staff has been re-trained in recognizing patient abuse and knowing patient-restraint policies.