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State Labels Hospital a Health Threat

Posted on: Friday, 2 June 2006, 00:00 CDT

By John Dorschner and Jacob Goldstein, The Miami Herald

Jun. 1--Condemning the hospital for putting binding restraints on elderly and mentally disabled patients, state regulators have ordered Aventura Hospital to stop admitting nonemergency patients.

One patient died after being placed in physical restraints on the hands and legs and given several medications that could serve as chemical restraints, although a state report didn't conclude those actions led to the patient's death.

Still, after finding problems with five patients placed in restraints, the Agency for Healthcare Administration declared the facility presented "an immediate threat to public health and safety" and took the highly unusual move of closing it to all admissions except those entering through the emergency room.

Hospital spokeswoman Luz Urbaez Weinberg said the Aventura facility is working with investigators to resolve the issues and hoped the ban would be lifted quickly.

Federal officials are getting involved after being notified by the state. Spokeswoman Sharon Fisher said the Center for Medicare & Medicaid Services is in the process of looking into the situation at Aventura.

Alan Levine, secretary of the Agency for Healthcare Administration, said, "It's very rare that the agency will take such an aggressive action. It's only when there is a potential danger to the safety, health or well being of patients."

Rick Wade, senior vice president of the American Hospital Association, called the state's move "atypical. . . . State health departments are very reluctant to take that kind of action unless there is some imminent danger to safety."

Many of the observations made by a state team, which visited the hospital last week, concerned restraints put on older patients who were simply lying in bed in an "unresponsive" state.

CAN BE HARMFUL

Restraints can cause harm, said Liz Capezuti, a professor of nursing at New York University who has studied the use of restraints in hospitals and nursing homes. She said they can increase the likelihood of bedsores and accelerate muscle deterioration. Confused patients can inadvertently hang themselves in an effort to get up.

Dr. Paul Schyve, senior vice president of the Joint Commission on Accreditation of Healthcare Organizations, the national hospital accreditation group, said, "Restraint is something that is to be used only when absolutely necessary and when the specific indications for restraint are there."

Hospitals accredited by the commission must reassess patients at least every two hours to determine whether it is possible to remove the restraints. Doctors may not order restraints "PRN," or as needed. One of the Aventura cases cited this sort of order.

In one case at Aventura, a physician ordered the use of restraints on a 78-year-old upon admission. The patient was placed in "soft wrist restraints" and taken to intensive care, put on a ventilator and listed as "unresponsive."

The patient remained flat in bed, but the doctor kept ordering restraints.

Schyve said patients sometimes must be restrained so they don't knock or pull tubes from their throats, but he added the restraints should be imposed only if the patient appears in imminent danger of knocking out the tube, and must be removed as soon as the agitation passes.

RECORDS LACKING

The healthcare agency's order for a moratorium noted that with several patients, the hospital records didn't indicate whether the patient showed behavior justifying the restraints, had been turned to reduce the possibility of bedsores or had been properly monitored.

Capezuti noted that the lack of documentation suggested not just lax record-keeping but also a failure by staff to coordinate care.

'The documentation is not as simple as 'Somebody didn't write this down,' " she said. "It's a way you communicate to other staff. This is a systems problem. . . . When they come in to stop admissions in a hospital, that's a pretty strong statement. "

The order was issued on Friday, but the state did not notify the public what had happened.

"I am shocked," Barbara Waks, an Aventura activist, said when she learned of the state's action. "I find this whole set of circumstances inconceivable, that this would happen to a local hospital that so many of us depend upon and they wouldn't tell us what they'd done. It's ludicrous."

Levine, who has portrayed himself as a champion of transparency of healthcare information, said such criticism was "a very legitimate point." The agency usually waits until a hospital responds to investigators' complaints before releasing information, but in the future the agency will consider announcing its hospital actions immediately, he said.

At the hospital, which is part of the HCA chain, spokeswoman Weinberg issued a statement: "We have completed and implemented an immediate plan of action to address their recommendations and feel confident this plan will allow us to make these corrections quickly."

She said a healthcare agency inspector was at the facility Tuesday evening, and the staff was hoping the state ban would be lifted quickly.

Meanwhile, Shayne Benkendorf, a diabetic, said she went to the hospital on Tuesday to have a toe amputated but wasn't admitted.

"I was stunned. They gave me no explanation."

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Copyright (c) 2006, The Miami Herald

Distributed by Knight Ridder/Tribune Business News.

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Source: The Miami Herald

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